By Meera Dalal, M.D.
During our medical training, we're taught to gather and use information from three sources: a patient history, a physical exam and lab tests. By far the most difficult to master is the physical exam. A good exam requires knowledge of anatomy and physiology, and awareness of normal variations that allow a doctor to recognize abnormalities.
Technology can help, and at TedMed 2013, the SmartPhone Physical exhibit by MedGadget/Nurture showcased some of the latest advances. The goal was to bring complex tests that are pricey to perform with traditional equipment into primary care clinics.
The result: accessible, affordable $200 phone accessories, most of them approved by the U.S. Food and Drug Administration as "equivalency standards," meaning they're equal to the industry standard. This technology could improve access to these tests, cut down on referrals, and provide overall better care.
"It's great for primary care physicians, new doctors with less experience, teaching and even some patients," said Shiv Gaglani, a medical student at Johns Hopkins and curator of the exhibit. "Some physicians can go through their entire training without really learning to look into an eye."
But I was skeptical. In medicine, we learn to question everything. If my own mother came to me saying hugs were good for a cold, I would take the hug, then ask to see the evidence. So I decided to try it out. Gaglani would be my "doctor" for this 10-minute exam using the following gadgets:
Blood Pressure Monitor by Withings and Blood Oxygen Monitor by iSp02
We started off, like in all physical exams, by taking the vital signs: blood pressure, heart rate, and oxygenation. The screen buzzed with colorful readings and real-time measurements, and then uploaded my information into an iPad, where I could get it through an app. It was a start, but I wasn't that impressed. The technology for "automated vital signs" had been around for a while, and a few years ago I taught my 7-year-old cousin how to use the machine on my grandmother.
ECG Cellphone Case by AliveCor
By squeezing my thumbs onto the metal plates of this iPhone cover, I was able to get a partial ECG that was uploaded and emailed to me. Interesting! One of the problems physicians have is that patients with heart symptoms often improve and the ECG normalizes by the time they see the doctor. This device was simple enough that patients with symptoms could get this cell phone case and be taught how to use it. So the next time symptoms occurred, we could get an ECG from during the cardiac event. One of the women who tried it earlier had palpitations during her exam and was diagnosed with a rhythm abnormality.
iExaminer by Welch Allyn
The eye exam, or "fundoscopy," is the only way we can look directly at blood vessels inside the body without having to cut anything open. It can tell us a lot about diseases such as high blood pressure and diabetes. Unfortunately, it takes a lot of practice, so many of us end up referred to an ophthalmologist. The iExaminer was able to take an impressive visual photo of the inside of my eye and turn it into a .pdf.
This smartphone looked at lung function, which usually is tested at a special lab during an uncomfortable exam. Guidelines for chronic lung diseases such as asthma, cystic fibrosis and chronic obstructive pulmonary disease suggest these tests should be done regularly, but because it is often inconvenient to make a separate trip, they're underused. It would be great if these tests were more accessible.
"Unlike the lab machine, which uses pressure, this device uses sound and has been shown to be almost as accurate," said SpiroSmart co-creator Mayank Goel. "This opens up so many doors; imagine even being able to do this test over the phone!"
Other devices included ThinkLabs' ds32A digital stethoscope that records body sounds (like heart murmurs), the MobiUS SP1 handheld ultrasound machine that looked at the carotid arteries in the neck and was surprisingly accurate compared to the full ultrasound machines, and an otoscope that looked at my eardrum and took a picture.
Overall, I was grudgingly impressed. The devices seemed to combine the best parts of human experience and technology, using technology to gather reliable information, especially for those with less experience, and the physician to interpret the results.
Studies looking at "inter-rater reliability," the concept of how likely is it that different people interpreting the same physical exam sign will get the same diagnosis, show that technology is often better for gathering consistently objective information.
The long lineup at the SmartPhone Physical Booth at TedMed included the surgeon general and Dr. Daniel Kraft, faculty chair of medicine at Singularity University in San Diego, who was impressed by the potential for improving access to care, whether in remote areas or overseas.
"It can enable primary care anywhere. And even though we need to do more testing to ensure accuracy, the potential is great," Kraft said.
One of the problems, however, is that each device has to be attached to the phone in a separate way, and data is uploaded to different apps, creating a huge amount of information to sift through.
"Our ability to gather data is overtaking our ability to pare it down and use it to improve our health," said TedMed editor-in-chief John Benditt.
And it's true. The creation of complex devices and technology is surpassing our ability to learn it and use it to its full potential before the "next big thing" comes out. What I'd really like to see is an ECG machine and BP machine that combines data with the lung machine and uploads it to the same profile. Arguably, the next big challenge in medicine may not be the creation of new technology but finding a way to integrate existing ones.