Author Archives: alexlam

Apr 18 2014
Culture, Design, e-patient, Health, Humanities, Humanity, Story, Technology

Guided Medicine or Big Brother: A Thought Experiment

Self-tracking devices have been lauded as the potential solution to filling in the gaps in traditional clinical data collection.  Oftentimes, measurements in the doctor’s office are not truly indicative of the patient’s everyday behavior and lifestyle; patients may experience white coat syndrome, or increased anxiety in the presence of the doctor.  Automatic self-tracking in everyday living may provide more accurate data because the data is collected in more natural settings.

One of the goals of self-tracking is to model and predict human behavior.  This sounds quite promising; however, how does this automated self-tracking actually come about?  Would we want our personal handheld devices to predict our next moves?  And what a fascinating thought experiment it would be to have our phones, these inanimate devices, give us life suggestions.  But oh wait, they do.

Google Now carefully watches its users’ every interaction to improve its efficacy.  It can predict where you will go judging by your past behavior.  It can detect that on Wednesdays, you like to get a Grande green tea frappe at Starbucks before your Russian literature class, and sometimes, when you’re having a particularly packed week, you treat yourself and venture into the bold Venti end of the spectrum.  While Google Now has the potential to notify you if there is a promotion on green tea frappes, it may suggest another drink perhaps, and as a subtle suggestion, a drink with fewer calories and a lower fat content.

Photo Credit: clipandfollow.com

Popular Science awarded Google Now as the 2012 “Innovation of the Year” for its potential to serve as an “intelligent personal assistant.”  It can infer your age bracket from your recent searches and tailor advertisements to your curated predilections.  For your mother, it can suggest her favorite hair dyes or jewelry boutiques, but what if one day following her sixtieth birthday, it begins suggesting cholesterol medicine and life insurance?  While this teeters on the edge of being mildly insensitive, it may regrettably be a sensible recommendation.

But it doesn’t stop there.  Google Now has a minute-by-minute map of your life.  Not only can it suggest nearby attractions and events, but it can also summarize your daily physical activity.  Given your latest late-night food adventures, it could now suggest restaurants with healthier vegetarian options.  It could also suggest a route that requires more physical exertion (to make up for that discreet donut run that you thought went undetected), and in your hurry, you wouldn’t notice that it was slightly more strenuous, with a steeper incline of about two degrees.

Photo Credit: geofffox.com

Physicians have the potential to produce mobile health applications that use the same tracking devices as Google Now.  While they have the promise of displaying customized content and advertisements, they can also subtly suggest healthier eats and longer walking routes.  With smartphones constantly linking accounts and contacts, mobile health applications will soon be connected to the information collected by Google Now.  And suddenly, without your conscious awareness, you will be forced to be utterly and irrevocably healthy.

Apr 17 2014
Culture, e-patient, Education, Health, Humanities, Humanity, Medicine

Instant Access to Yourself

With our constant obsession with technological advancements and the fashionable desire to be the first owner of the newest products, we must remember what we already have.  And this isn’t just a banal platitude about being grateful for what we have.  Even though the answers to the world’s problems seem to lie in the continued miniaturization of sensors and further embedded systems, have we forgotten what is already available to us?  Perhaps we should shift the focus from finding the most sophisticated devices to becoming more proficient with what already exists.

In the summer of 2013, I took a psychiatry course at the Geffen School of Medicine at UCLA.  The course had the rather grandiose title: “Personal Brain Management,” yet that was exactly what the physician taught.  It turns out that by having a greater control of what we think and how we think can protect us from a wealth of illnesses.  The only technological advancement I needed to supplement my project was a thermometer, yet that was enough.

Photo Credit: stress-relief-tools.com

My independent project focused on utilizing biofeedback for Mindfulness-Based Stress Reduction (MBSR).  MBSR advocates that practicing mindfulness meditation can help reduce stress and promote greater mental and physical health.  By using a simple stress thermometer, I was able to increase my awareness of my body temperature.  While such a physiological marker may seem to be beyond our control, managing our internal thermostat is surprisingly possible. Roughly speaking, more relaxed states are correlated with increased body temperature, and the thermometer served as a means to quantify these changes.

With just a crude thermometer in hand, I was able to cultivate my relaxation response (in contrast to the familiar stress response).  At the end of a six-week trial, I found that I was better able to control my body temperature, and I scored significantly lower on a battery of stress measures.  For my project, I did not need a smartphone or the newest Nike product or the most sensitive sensors.  I needed myself and 30 minutes of my day.  And am I really so important that I cannot sacrifice the entirety of 30 minutes to myself?

Photo Credit: clintonpower.com.au

In our constant and desperate search for what is new, let’s not forget that we have instant access to ourselves.  While innovative electronic devices can help us organize data and take measurements, let’s not get carried away with their seemingly whimsical promises.  It is as much our duty to discover and invent as it is to make more effective use of what already exists.  By remembering that the first generation of iPhones was released in 2007, we become aware of the humbling reality that perhaps society can function without a supercomputer in hand.

While simple and sophisticated mobile health applications can encourage patients to become more empowered, decreased reliance on digital technology is in its own right just as empowering.  My project at UCLA showed me that I could become more self-sufficient and cultivate my body’s natural capacity to heal with a minimalist approach to technology use.

Mar 17 2014
1 Comment
Communication, e-patient, Health, Humanity, Medicine, Technology

Can Telehealth and Integrative Medicine Coexist?

Telehealth advocates the use of electronic services to support patient care, education, and monitoring.  Proponents of telehealth acclaim its potential to reduce healthcare costs and to increase patient satisfaction.  Implementing telehealth, however, would require deconstructing the traditional healthcare encounter.  Patients and physicians would have to redefine their expectations for one another, and some argue that telehealth belittles the patient-physician relationship.

Photo Credit: firsthealth.org

Nevertheless, there are clear advantages for telehealth.  Telehealth can serve as a means of supporting traditional healthcare.  When distance separates participants, patients can use electronics to directly contact their physicians.  They can receive direct clinical service miles away from the doctor’s office via virtual visits.  If the patient’s health records, medical images, and medication lists are already compiled online, such virtual visits can serve as a timely and efficient way to improve patient care.

Additionally, telehealth allows the early detection of irregular or unfavorable body rhythms.  For instance, early detection of irregular heart and brain rhythms could prevent potential heart attacks and seizures.  In this respect, telehealth plays a role in preventive medicine and contributes to better health outcomes.

Schwamm (2014) gave an example that cellphone cameras could be used to photograph rashes and skin lesions.  This would allow dermatologists to diagnose and treat their patients without having to physically meet.  While this form of treatment is fast and efficient, it seems to be in stark contrast with integrative medicine.

Photo Credit: mc.vanderbilt.edu

Growing in favor since the 1990s, integrative medicine emphasizes a holistic approach to medicine with a focus on health and the physician-patient relationship.  With this method of telehealth, the physician-patient relationship is almost nonexistent, and patients are reduced to their skin problems.  Furthermore, diagnosis via photograph is hardly holistic; rashes and skin lesions may be signs of a multitude of health problems.  It is unlikely that only the dermis is affected, and it would be erroneous to assume that the organ systems of the body work independently.

In Engel (1977)’s seminal article, he claimed the need for a new medical model—namely, the biopsychosocial model.  This model posits that biological, psychological, and social factors all play a significant role in the context of disease and illness.  Integrative medicine relies on this model because it focuses on the whole body.  Therefore, it seems to be opponent to this localized method of diagnosis.

Photo Credit: theemotionmachine.com

While telehealth has its greatest benefits in early detection, it still has some outstanding limitations.  In accordance with the biopsychosocial model, the physician also plays a role in helping the patient cope with stress and vulnerability.  On a standardized stress scale, finding out that you are HIV+ scores a 99/100.  Given current technological advances, it is possible to get tested for HIV without ever having to actually see a doctor; however, this is a questionable idea.  Beyond biomedical treatment, the physician also provides intimate psychological and social support.

Currently, telehealth and integrative medicine can coexist; however, telehealth has its limitations.  While it should complement and add value to existing medical care, it should not substitute healthcare completely.

Feb 28 2014
Communication, Culture, e-patient, Humanities, Humanity, Medicine

A Technocultural Medical Revolution

ePatients are often lauded for their effective use of technology.  They use technology as a means to take measurements, research information, and create communities.  While their use of technology is often the focus of attention, their culture is often neglected.  Ferguson and Frydman (2004) address both of these points in their seminal article about ePatients and argue, “We are witnessing the most important technocultural medical revolution of the past century.”

The culture of the ePatient movement definitely needs attention.  By changing the dynamics of the physician-patient relationship, ePatients are effectively changing the culture of how laypersons interact with physicians.  Carman (2013) proposes that there is a continuum of engagement for patients in direct care.  Currently, most patients fall under the category of consultation; that is, they receive information about a diagnosis.  ePatients argue that they should have greater engagement.

Patients may get more involved by sharing their preferences in a treatment plan, thereby taking into account their individual culture, background, and spirituality.  On the most engaged end of the spectrum, patients have partnership and shared leadership with the physician.  Carman (2013) imagines that with this level of engagement, “treatment decisions are made based on patients’ preferences, medical evidence, and clinical judgment.”

Clearly, this is a step away from current physician-patient interactions.  With higher levels of engagement, patients are expected to be health literate.  They are considered equals with the physicians and can elect their own treatment plans.

But is this change in culture possible?  People around the globe unanimously regard physicians to be the most respected professions, and there are multiple reasons for this.  Medical professionals have a direct impact on the lives of everyday people.  They are present when people feel the most vulnerable, and they serve as their confidants.  Physicians tend to have higher levels of education and higher income, and they have great responsibilities and expectations.

Photo Credit: illustrationsource.com

In cultures that have a predominant social hierarchy, the idea of being an ePatient seems almost frightening.  For many East Asian countries, some patients would not dare correct their physicians.  It would be disrespectful, impolite, and indicative of lesser social status.  It would disregard power dynamics, and the patients would be overstepping long entrenched boundaries.  It is, therefore, unsurprising that the ePatient movement has its roots in the Western world.

Additionally, in the ePatient-physician relationship, it is critical to distinguish the difference between health literacy and medical education.  While patients may understand the biological processes behind their illness, physicians have had at least seven more years of education in medicine whether in medical school or in residency.

Photo Credit: healthydebate.ca

In this technocultural medical revolution, there must be balance.  Mutual respect is key.  There must be an acknowledgement that the physician has greater expertise, but physicians cannot regard themselves as superior.  It is true that the physician cannot fully understand what the patient is experiencing, but the physician can at least practice empathy.

In any case, we must be aware of these cultural phenomena if the ePatient movement is to be globally ubiquitous.

Photo Credit: growingolder.org

Feb 28 2014
Communication, Design, e-patient, Electronic Medical Record, Health, Prototyping, Technology

Ping. Have It Your Way.

Ping.  That must be my daily reminder.  How am I feeling now in terms of arousal and valence?  Well, I just had my weekly meeting with my research advisor.  He was really getting into the nitty-gritty and suggested that I should have been farther along with my project.  I don’t even like this project.  I wish I could just get it over with… Anyway, probably low valence.  It was a pretty negative experience.  Also high arousal… He really stresses me out, and I could feel my blood pressure rising.

Photo Credit: mzstatic.com

One of the greatest benefits of mood tracking is increased self-awareness.  Mood tracking apps like Moodscope and Mobile Therapy remind users to take a step back and to reevaluate their life choices.  They can reflect on what is bringing them happiness and what is bringing them down.  By connecting their moods with other factors happening in their lives, users can develop a greater understanding of themselves with respect to their environment.

The beauty of mood trackers is that they also provide spatial and temporal information.  Users can link their moods to their immediate spatial surroundings and to the time of recording.  By randomly sending pings throughout the week, these apps can help users determine where and when they tend to feel upset or happy.

Additionally, mood trackers do not only take in information, they can also offer advice.  Mobile Therapy offers therapeutic exercises, including breathing visualization and muscle relaxation.  It also offers strategies to quit smoking, treat anxiety, and detect relapses in psychotic disorders.  Ideally, these mood tracking apps could personalize therapeutic exercises to a user’s specific input.  You could “have it your way” by inputting end goals, such as cultivating happiness or controlling the relaxation response.

Photo Credit: play.google.com

With most mood trackers, it is also possible to add information through texting—users can share paragraphs of information if they feel inclined to do so.  Therapists and physicians could use these self-reflections to see how their patients are doing over time.  Appointments with health professionals are short, and they are not necessarily indicative of how the patient normally acts.  Some patients may experience white coat syndrome, so there is an additional benefit of having records of patients outside of the doctor’s office.

In the future, perhaps these apps could notify the patient’s physician directly.  Jon Cousins describes the benefits of connecting his data to those close to him: “We leave traces of ourselves with our numbers, like insects putting down a trail of pheromones, and in times of crisis, these signals can lead us to others who share our concerns and care enough to help.”

If physicians have access to their patients’ personal information, they can individualize their treatments.  While there would be a lot of information to handle, this issue could be alleviated with efficient organization and clean programming.  It is possible to automatically assemble the relevant information in a visually aesthetic way, and these apps track not only the physical health of users, but also their mental and psychosocial health.

← Older posts
Follow

Get every new post delivered to your Inbox

Join other followers: