Eight births. Through all of them, not one doctor told Narcisa about the need to strengthen her abdominal muscles. They’re the main support system for the spine, but they tend to get stretched out during childbirth.

Years of carrying around babies and cleaning homes took their toll. The 47-year-old mother, whose name is not being used to protect her privacy, finally went to physical therapist Michelle Reeves at Volunteers in Medicine Clinic of the Cascades in Bend for what had become daily pain in her spine.

To help the woman, who doesn’t speak English, Reeves relied on a new device at their visit last week that’s now in all of the clinic’s exam rooms. It’s a large electronic screen — picture a big-screen TV positioned vertically — that features detailed anatomical renderings of organs, systems within the body and medical conditions. It has a touch screen so doctors can rotate the organs up, down, right or left and add or remove layers of tissue, muscle and bone to reveal what’s underneath. Doctors can also use a highlighting tool to draw on the screen.

Reeves called up an image of a spine, then touched the screen to show why strengthening the nearby abdominal and gluteal muscles that support it would relieve her pain.

Was the device helpful? “Mucho,” Narcisa answered, smiling. It was her last visit with Reeves, and, thanks to the exercises Reeves had prescribed, she was already feeling much better.

These so-called Wallboards, made by a company called Outcome Health, are just one of the ways the clinic is working to improve its providers’ communication with Spanish-speaking patients. About 80 percent of the clinic’s patients are Latino. Volunteers in Medicine provides services for free and most of its providers are volunteers.

For visits that feature a language barrier, such as Narcisa’s, the clinic has medical interpreters who translate between patients and providers. But there’s a shortage of interpreters, and not all of them describe things the same.

The Wallboards explain medical conditions visually using anatomical renderings instead of words, which some patients find easier to comprehend, said Beth Larsen, who oversees grants and community partnerships for the clinic. Many of Volunteers in Medicine’s patients struggle not only with language barriers, but with health literacy as well, she said.

“Medicine is really hard to understand,” Larsen said. “The body is really complex.”

Drug ads in exam rooms

Chicago-based Outcome Health gave the clinic not only the Wallboards, but a large screen for its waiting room and small tablet devices perched on stands in each exam room. All of it was free.

As with most things, however, there’s a trade-off. Outcome, whose products are in about 55,000 medical clinics nationwide, is funded largely by pharmaceutical companies. Part of the deal with receiving the free devices is allowing them to display ads for various medications.

Direct-to-consumer pharmaceutical advertising, such as drug commercials or billboards, has long been controversial. The American Medical Association called for a ban on the practice in 2015, arguing it’s fueling escalating drug prices by encouraging people to ask for more expensive drugs, even if they’re not the best choice for that individual.

It’s one thing to see a drug commercial at home, but seeing it at the doctor’s office gives the subliminal message that the clinic endorses that product, said Dr. Susan Tolle, director of Oregon Health & Science University’s Center for Ethics in Health Care.

“You have to literally consider them patient education if you put them in your clinic waiting room, I think,” she said. “Because patients will ask about those things, too. You’ve actually encouraged them to do so.”

The Volunteers in Medicine staff discussed the issue before getting the devices and ultimately decided the pros outweighed the cons, Larsen said. Not only is there a lack of interpreters, patients get overwhelmed with all of the information that’s thrown at them. The screens present information in a “more gentle way,” she said.

“We got these because we were trying to find a way to do patient education and this was the only thing we could do that was affordable,” Larsen said, “and so we thought, ‘Let’s just get creative and use it to our best advantage.’”

It’s a complicated subject, and there is no right or wrong answer, Tolle said. A potential problem in the future could be that providers have to spend lots of time explaining to patients why the drugs they saw advertised aren’t the best options for them.

A physician herself, Tolle said she spends a good deal of time talking to patients about the ads they saw on TV. Most of the time the drug is not the best choice for the patient asking about it, she said.

“But, at the same time, these devices are awesome,” she said. “Is there a way to manage all of that in our ever-changing world?”

Volunteers in Medicine’s patients don’t come in asking for specific medications, Larsen said. It’s a different culture. Also, the ads aren’t in Spanish.

“They’re not big drug users,” she said. “They’re there for care. If we can facilitate their care by having them understand what’s happening or what their issue is, it amps the fear down a lot.”

Useful information

The goal behind the Wallboards was to create the doctor’s office of the future, said Anil Harjani, Outcome’s vice president of strategic partnerships. These days, people do their banking on their phones. Some people even order off touch screens at restaurants.

“But when you go to your doctor, it still hasn’t changed in decades,” Harjani said.

Volunteers in Medicine’s ophthalmologists, dermatologists, cardiologists and other specialists are already using the screens to help their patients understand their conditions. Not everyone is comfortable with them yet, but Larsen said the clinic plans to host training sessions.

The screens operate on a loop that cycles between ads and educational messaging about things like breast cancer awareness and eating fruits and vegetables. A larger proportion of time is spent on the latter, Larsen said.

PatientPoint, a Cincinnati-based company that makes devices similar to Outcome’s, has a team that creates the educational content on its devices. They work “in a vacuum,” completely separate from the pharmaceutical manufacturers that sponsor the ads that also appear on th devices, said Julie Cain, PatientPoint’s vice president of product strategy. The information is about conditions like arthritis and diabetes and comes from reputable sources like the Centers for Disease Control and Prevention and Mayo Clinic, she said.

“Most recently, we had a patient call in and say that the segment on a waiting room screen helped her spot the signs of a stroke in her husband,” Cain said.

Making it their own

The staff at Volunteers in Medicine plans to personalize the tablets by creating short, simple videos — think YouTube — and upload them to the devices for patients to watch while they’re waiting in the exam rooms.

Larsen has a list of about 12 video ideas. One example would be how to use an inhaler. Many patients have two inhalers: one for emergencies and another they’re supposed to use routinely, even when they feel fine. Unfortunately, many people don’t use the latter one, Larsen said. Another video might be for Type 1 diabetics: how to check blood sugar and inject insulin.

Pharmacists would then tell patients to explain to them how they use their medications before picking them up, Larsen said.

“It’s one thing to say, ‘This is how you use this,’” Larsen said. “It’s another thing for someone to watch it and come back and tell you how to use it.”

— Reporter: 541-383-0304,

tbannow@bendbulletin.com

“Most recently, we had a patient call in and say that the segment on a waiting room screen helped her spot the signs of a stroke in her husband.”— Julie Cain, PatientPoint’s vice president of product strategy