Can’t decide what to eat?

They've got you jumping around on their Wii Fit and you can keep your faculties in trim with Brain T

Now regularly invading the Sunday supplements and lifestyle technology sections of the dailies, the middle-brow appears satisfied that gaming is ‘mainstream’, something ‘older’ people and on occasion ‘females’ are now enjoying as a pastime of choice.

Upon closer examination though, it rapidly becomes apparent that such editorial is usually talking about the work of a one company in particular - Nintendo, and the rest of the industry is benefitting from their innovation hugely.

Since the launch of their handheld DS and latterly Wii systems, this old Japanese company has become an accepted synonym for mainstream gaming. Their most recent success, Wii Fit, sent non-gamers rushing to the shops to buy a brilliant (and expensive) ‘balance board’ with software which could apparently measure and improve their fitness.

Despite also emitting the same whiff of pseudo-science which some found objectionable about their Brain Training games, the masses were mostly able to make the leap that their ‘Wii Fit Age’ score was simply a motivational device which encouraged them to play, and not a clinically accurate diagnosis of their cardio-vascular health.

There was of course, the unfortunate subjective analysis (you’re fat) that the software doled out to one ten year old girl, but most people emerged relatively unscathed.

So, having convinced aging gamers that they can delay the onset of Alzeimers with Brain Training, and selling an elaborate set of bathroom scales into living rooms with lucrative success with Wii Fit - they now make a move into a previously untapped room of your house - the kitchen. Their latest DS release, Cooking Guide, prizes open the gap between them and their ‘competitors’ even farther. Subtitled ‘Can’t decide what to eat?’, this is a snappy, convenient little tool designed to help you answer that recurring question and then guide you through the culinary process.

It’s a perfectly effective recipe software and most useful in the manner in which it allows you to interrogate its database, selecting recipe options based on your available ingredients, spare time or country of origin.

Having chosen your meal, the software takes you step by step through preparation and cooking in a surprisingly un-patronising manner. Fears of your DS’s circuitry becoming jammed up with raw pork are unfounded, as there’s really no need to touch the device once you start cooking.

The entire process can be driven through effective voice-recognition, requiring you to clearly shout ‘continue’ to move on to the next step. A chef avatar thankfully devoid of any particular character traits guides you through the cooking, and suggests a real opportunity for celebrity chefs in the future.

Surely Ramsay will see this as an opportunity to stretch his franchise even further and license, ‘Can’t decide what to fucking eat?’

The whole exercise is more a very effective proof of concept than an essential purchase, and it’s unlikely that the software will make the same headlines that Brain Training did. That said, as another demonstration of the durability of the DS as a device, it’s very persuasive.

Quite how effective Brain Training and Cooking Guide are as a gateway drug into other gaming experiences isn’t wholly clear as yet. The DS remains one of the richest platforms for innovation in game design around, and it would be great to think that having had their brains trained, players move on to try other experiences. Cooking Guide is also suggestive of a yet un-tapped market for decision making software. Politics Guide : Can’t decide what to think? Anyone?

Iain Simons writes, talks and tweets about videogames and technology. His new book, Play Britannia, is to be published in 2009. He is the director of the GameCity festival at Nottingham Trent University.
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Want to know how you really behave as a doctor? Watch yourself on video

There is nothing quite like watching oneself at work to spur development – and videos can help us understand patients, too.

One of the most useful tools I have as a GP trainer is my video camera. Periodically, and always with patients’ permission, I place it in the corner of my registrar’s room. We then look through their consultations together during a tutorial.

There is nothing quite like watching oneself at work to spur development. One of my trainees – a lovely guy called Nick – was appalled to find that he wheeled his chair closer and closer to the patient as he narrowed down the diagnosis with a series of questions. It was entirely unconscious, but somewhat intimidating, and he never repeated it once he’d seen the recording. Whether it’s spending half the consultation staring at the computer screen, or slipping into baffling technospeak, or parroting “OK” after every comment a patient makes, we all have unhelpful mannerisms of which we are blithely unaware.

Videos are a great way of understanding how patients communicate, too. Another registrar, Anthony, had spent several years as a rheumatologist before switching to general practice, so when consulted by Yvette he felt on familiar ground. She began by saying she thought she had carpal tunnel syndrome. Anthony confirmed the diagnosis with some clinical tests, then went on to establish the impact it was having on Yvette’s life. Her sleep was disturbed every night, and she was no longer able to pick up and carry her young children. Her desperation for a swift cure came across loud and clear.

The consultation then ran into difficulty. There are three things that can help CTS: wrist splints, steroid injections and surgery to release the nerve. Splints are usually the preferred first option because they carry no risk of complications, and are inexpensive to the NHS. We watched as Anthony tried to explain this. Yvette kept raising objections, and even though Anthony did his best to address her concerns, it was clear she remained unconvinced.

The problem for Anthony, as for many doctors, is that much medical training still reflects an era when patients relied heavily on professionals for health information. Today, most will have consulted with Dr Google before presenting to their GP. Sometimes this will have stoked unfounded fears – pretty much any symptom just might be an indication of cancer – and our task then is to put things in proper context. But frequently, as with Yvette, patients have not only worked out what is wrong, they also have firm ideas what to do about it.

We played the video through again, and I highlighted the numerous subtle cues that Yvette had offered. Like many patients, she was reticent about stating outright what she wanted, but the information was there in what she did and didn’t say, and in how she responded to Anthony’s suggestions. By the time we’d finished analysing their exchanges, Anthony could see that Yvette had already decided against splints as being too cumbersome and taking too long to work. For her, a steroid injection was the quickest and surest way to obtain relief.

Competing considerations must be weighed in any “shared” decision between a doctor and patient. Autonomy – the ability for a patient to determine their own care – is of prime importance, but it isn’t unrestricted. The balance between doing good and doing harm, of which doctors sometimes have a far clearer appreciation, has to be factored in. Then there are questions of equity and fairness: within a finite NHS budget, doctors have a duty to prioritise the most cost-effective treatments. For the NHS and for Yvette, going straight for surgery wouldn’t have been right – nor did she want it – but a steroid injection is both low-cost and low-risk, and Anthony could see he’d missed the chance to maximise her autonomy.

The lessons he learned from the video had a powerful impact on him, and from that day on he became much more adept at achieving truly shared decisions with his patients.

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide