Recently, one of my patients, who I'll call Nima, told me about the app for the iPhone and iPad called Proloquo2go. It's a fascinating little bit of software designed for people who have trouble with verbal communication — such as stroke patients, or, in the case of Nima's daughter, those who have autism. It works like this: The user points at little pictographs that represent various words — a pictograph represents "I," another for "want" and then a glass filled with white liquid might stand for "milk." Then the program speaks the words out loud. In this way, Proloquo2go allows Nima's daughter to communicate a drink preference in a restaurant — or any number of other desires. Nima says it's been a godsend for her family, and a recent 60 Minutes feature on the software indicates other families feel the same way.
"This is the first thing that's helped," Nima says. "Before, my daughter had trouble communicating with her family. Now, we're getting to the point that she's able to communicate with anyone. Her world is wide open."
We're accustomed to thinking of apps as novelty items — small bits of convenience that, overall, affect our lives only incrementally. But Proloquo2go is just one health app among many that are transforming the way people live with medical conditions — and how doctors treat them.
The Canadian-made "Bant" is an example that falls firmly into the first category — an app that empowers patients.
Created by the Centre for Global eHealth Innovation at Toronto's University Health Network, the program is intended to be used by Type-1 diabetics, who should check and log their blood glucose levels four times throughout the day. Bant users prick themselves with small electronic devices called glucometers, which then communicate wirelessly with the Bant software so it can flag troubling blood sugar trends that may indicate users need to adjust an upcoming insulin dose. Intended for teens who can be apt to forget their testing, Bant was credited with users conducting about 50% more monitoring in a clinical trial — possibly because participating teens who logged their tests were rewarded with credits at the iTunes store.
Bant's name, of course, refers to Sir Frederick Banting, one of the great researchers in medicine and one of the Canadian doctors who helped to discover insulin. And the success of the University Health Network software suggests health apps may be just as transformative for their users as insulin was for diabetics. Perhaps one day soon, we'll all carry around software that monitors many different facets of our health. What if a smartphone could sense an abnormal heart rate and changes in blood pressure? Maybe an app could then recognize the signs of a heart attack, and contact 911.
Then there are the apps designed to make things easier for physicians. Early in my career, it was common for my medical peers to keep stacks of index cards in the pockets of their white lab coats. Not sure of the exact dose of medication for a 130-pound, 31-year-old woman with kidney disease? Just consult the index card for the formula, and perform the calculation. These days, though, such smartphone apps as Epocrates, Medscape or Micromedex provide a whole host of reference tools, each of them accessible via a smartphone in a pocket. These types of apps allow clinicians to access breaking medical news, clinical guidelines, drug dosing and medical calculators.
As a manager of doctors, as well as a practising physician myself, I'm intrigued by the possibility that these apps could usher in a new age of more efficient medicine. Take the new voice-recognition software that comes with some of the leading smartphones on the market. You can ask Siri on the iPhone 4S, "Will it snow this weekend?" and it'll show you the weather forecast. It's conceivable we'll soon be able to recite our symptoms to a doctor app, which then provides a diagnosis, as well as a prescription.
Could smartphones take the place of general practitioners? I recently read an article on the New England Journal of Medicine's website that mentioned the various errors to which human doctors are susceptible: everything from confirmation bias to "anchoring," a term that means placing too much importance on one element of a medical narrative. Would new and more sophisticated diagnostic apps eliminate these sorts of human errors?
Maybe for the easy stuff. But as I consider our science-fiction present, I can't escape a quote I came across in medical school from the legendary Canadian doctor William Osler: "As no two faces are the same, so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions which we know as disease."
In other words, every malady presents itself differently. For that reason I can't help but believe that plain old physician intuition will always be an important component of the process that leads from a messy set of symptoms to an accurate diagnosis and treatment. Great physicians treat individual patients, not numbers.
I'm excited about the potential of new health apps like Bant and Proloquo2go. Tools that improve doctor patient communication and empower patients are fantastic. But I'm a little wary of the robo-doc reference programs that are bringing us to a Star Trek-like present. Machines help, but humans think. The most valuable tools for any doctor are education, clinical experience and good old rational human judgment.
