Medical Futures Lab

During our final critique last night, many of the comments of our proposed app addressed concerns about the reliability of patients’ self-tracking information. In other words, will a patient honestly report that they have taken their medications and followed their exercise and diet plan for that day?  Most comments acknowledged that we could link our app to different programs such as a Fitbit, a Nike fuel band, and prescription refills to monitor whether a patient was actually fulfilling their treatment plan. These modifications would provide objective data that the patient is following through with their treatment plan.

source: medgadget.com

While these modifications would definitely streamline the process of providing correct information, I think they miss one of the most valuable aspects of self-tracking. Since I our app, the patient has to check off which aspects of their treatment plan they followed during the day, it automatically forces them to reflect on their day and their progress in achieving their goals. If the information automatically syncs to the app, it eliminates a crucial step in the goal setting process, which is reflecting on your current progress in achieving your goals.

source: newyearresolutions.org

The problem can be viewed from two different perspectives: the patient perspective and the physician perspective. From a physician’s perspective, it is extremely useful that the automatically recorded data would provide objective findings on a patient’s progress. A physician could see that a patient is only running once every two weeks from the information provided in a fit bit or other device. It reduces the need for the physician to rely on accurate self-reporting by their patients. From a patient’s perspective automatically reported data reduces time spent self-tracking, but it ultimately doesn’t make the patient more engaged in their treatment plan and illness.

If we move towards an app that relies less and less on patient self-tracking it also moves away from a collaborative physician-patient relationship. The goal of our app is to create a shared-decision making tool that can be used at the clinical encounter. We wanted to move away from the historical physician-patient relationship which is very unidirectional. In this model, the physician tells the patient their treatment plan, and the patient follows that treatment plan. The purpose of self-tracking is to have the patient track their health to make them more engaged and better able to manage their condition. If we remove the physical process of entering in information, we risk losing patient’s engagement and thus decrease a patient’s responsibility of their own health.

I recently had a conversation with my friend who is a first year medical student and I made a comment about his new iPad. He began to tell me that his medical school requires that every new student purchase an iPad, a policy that is becoming a norm at medical schools around the nation. While most hospitals don’t allow electronic medical records to be viewed on an iPad, there are many useful mobile applications for medical students or doctors to use when they are making rounds or studying. Here are three that are especially popular or newly created:

source: techvibes.com

• Epocrates- Probably the most popular and well-known app used by medical professionals. It allows medical professionals to look up most drugs, and view the correct dosage amounts for children and adults. It also allows shows side effects and harmful interactions with other drugs. It has been used to replace the physician’s desk reference book.
• Touch Surgery- This is a relatively new app designed to help surgeons in training to learn the steps of an operation. It was created to help make up for the hours of surgical residents being cut, which means less time in the operating room practicing needed skills. The app is also designed to improve patient safety and to give medical students and surgical residents a boost of confidence before trying the procedure on a patient. 
• Up To Date- This app has an abundance of reference information that physicians can look up when trying to make a treatment decision. It is often used to look up innovative treatment approaches that physicians report have been successful in the past, when normal treatment options aren’t working.

These new apps, especially Epocrates and Up To Date, have the potential to make medical training less about memorizing thousands of pieces information and instead place a larger emphasis on understanding. Instead of essentially having medical training turn physician’s into walking computers, physicians now have the ability to carry around unlimited information with them on a tablet.

The increasing use of mobile apps is inevitable in the future of medical care, so the question becomes to what extent should physicians rely on these applications. A trusting patient-physician relationship often stems from the belief that our doctor has much more knowledge about our condition then us, but perhaps this view is becoming outdated. As information is readily available online, it is reasonable to assume that a patient could be more informed about their condition then their doctor. Medical training needs to change to accommodate this shifting relationship, with a greater emphasis on understanding a patient’s needs and trying to incorporate them into a treatment plan. It needs to not only teach physicians information, but also how to find needed information. However, we must stay wary of becoming too dependent on these applications, and not focus our time looking at a screen instead of the patient.