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10/17/2017

Dr. Smartphone

My brother tells me my doctoring days are done. We keep up a lively, ongoing email discussion of current technologies as they relate to topics such as big data analysis, Internet of Things (IoT), and smartphone technology. He recently challenged me that due to the rapid increase in computational power and sophistication of data analysis, smartphones will soon replace doctors as the main source of medical diagnosis. He is probably correct. But will my doctoring days be over?

Consider the linked article by Madhunita Murgia in The Financial Times (you may get one view of this unless you have a subscription or Google “Murgia smartphone”). Murgia lists a fairly exhaustive list of both current and looming smartphone apps and smartphone attachments that are – frankly – amazing. A fair number of these are backed by technical and clinical staffs, as well as massive computational clouds, that provide analysis of what you and your smartphone observe – about you. By keeping track of the number of calls you initiate, your movements (or change in that number), the quality of your voice, the results of heart EKG sensors on the phone cover and voluntary responses to personalized texts, your smartphone can instantly analyze your current physiology and often correctly identify any pathophysiology better than some (most?) physicians. Given the IoT technology trajectory, the smartphone will only get better and do so at a far faster and broader pace than the average MD during his or her limited 30 years of solo or group practice experience. It is the medical “Wisdom of the Crowd”, to borrow from a current TV show. Read the above linked article (if you can) just to get a glimpse of what is already here and what is quickly going to be available.

Security and privacy issues may be the one limiting factor in this technological progress. Consider one example of current technology in the area of smartphone post-partum depression diagnosis and management. A company called Ginger.io has developed a smartphone-based tool for patients to use to identify depression by a series of interactive text questions with a company coach as well as raw data from your phone checking the number and length of phone calls to friends, as well as an analysis of quality of your voice (no actual content – yet). Joseph Walker at the Wall Street Journal (subscription needed) offered one patient’s experience:

Tara Dye, who participated in Novant’s postpartum program, said she wasn’t aware of the extent to which her smartphone data was tracked. Ms. Dye says she was told the app would record her location and how far she traveled, but she didn’t realize that her behavior was being probed for a link to depression. She says she doesn’t mind the extent of the tracking, because it was in service of her health care, but she wishes there had been greater disclosure.

Finally, Andy Kessler, also at the Wall Street Journal, argues we are too worried about all this smartphone monitoring. He believes that eventually courts will rule that use of our personal data (heart beats, facial recognition, voice quality, etc…) will be determined to be a property rights issue and eventually companies such as Ginger.io and Apple will have to pay you for the use of your personal data. That may well be. But it does not currently put the “data horse” back in the privacy barn.

I am not sure where that leaves me or the other average doctors as smartphones eclipse us in diagnostic acumen. Like most technological advances during my practice lifetime, I have worked to embrace the ones that work and sifted through and discarded the ones that did not. Will there still be a place in the practice of medicine for one-on-one, patient-doctor relationships? An 87 year-old patient of mine recently commented to me that although I had not significantly improved her chronic back pain, she appreciated the time I took, the education I provided, and the reassurance that her problem was not more severe. Perhaps she was just being nice.

My brother would argue the smartphone would have been faster, cheaper and avoided the risk of her traveling to my office. I’m not sure. Let me ask Dr. Siri…

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