Dear Apple, Google, Samsung, Intel, etc.: build the the medicalized smartphone

medical phone

The medicalized smartphone is coming along
=done; the rest is in progress

The image you see above comes from a book written by a true visionary in the medical field. Dr. Eric Topol is a world renowned expert in the field of technology and medicine. Needless to say, he is an individual that I closely follow for his insights and inspiration.

The image is effectively the kind of drawing a visionary would sketch out on a napkin. The technical details are clearly not of import at this stage (such as the location of the battery or the type of CPU or what type of Wi-Fi and telephone support there would be). The purpose of such a sketch is to indicate the components of what would be a dramatic advance in the ability to practice medicine.

The future of medicine is distinct from the past in that now, patient involvement is critical to the success of treatment. Even when I was a resident, we were taught that it was our job to act, and it was the patient’s job to accept whatever we said. A patient who would leave a copy of a literature article in front of a professor during grand rounds, would be considered problematic and hysterical. The likelihood that the professor would even look at the journal article would be extremely small. And the more the patient would insist that the journal article could literally save his life, the greater the likelihood that the professor would totally dismiss anything the patient had to say. The very basic principle was that if the professor did not already know about this article, then it was not worth being known.

In today’s world, the obvious has finally become part of the standard of care. What is obvious is that the patient plays a critical role in his or her own well-being. Doctors on one hand, insist that they are expert in the fields that they take responsibility for. On the other hand, there is so much information being generated on a daily basis, it is impossible for a physician within a reasonable period of time, to become well versed in all of the research being generated.

I personally spend three to four hours if not more, a day reading medical and technology updates. I do this 7 days a week. I could not run a full time practice, do all this reading, and spend any significant time with my family. So clearly we have a problem. And one solution to that problem is to empower patients with the ability to study their own medical problems, to literally become experts in their own medical cases and to discuss with, not just receive orders from, their doctors about the best approach to curing themselves.

There are a number of therapies in medicine that are not cut and dry. It is reasonable to try one type of therapy and then assess the outcome. If the outcome is substandard, an analysis needs to be done to make sure that the treatment was optimally provided. If so, a decision has to be made to move on to the next level. And today, it is finally being realized that patients are key to this assessment process. Patients can speed the turnaround time between attempted, but failed treatments. And the time saved by including patients could be the time needed to find the actual cure.

N.B. The simple fact is that compliance with medication orders, amongst outpatients, is very poor. The appropriate response to a less than optimal outcome is to first assess whether the patient even took the medication in the first place. This is just one of a set of classic examples of the lack of a one-to-one correlation between the wishes of the physician and the actions of the patient. The device that is sketched out above includes multiple modules that would provide information to the doctor, to the patient and would monitor the patients’ activities to make sure that therapeutic instructions are being carried out. The intent of such a system is not to make the patients feel as if they are in a glass cage monitored like a laboratory rat. The purpose of such a monitoring system is to assist the patient in achieving the goals that he has jointly set together with the physician.

The patient doctor relationship is transforming from one of coach and player to one of colleagues, working towards a common end. And the purpose of this device is to make sure that there is no breakdown in communication between the two parties. More so, devices like this will dramatically reduce the amount of travel and cost associated with communicating with one’s physician. When a patient can truly be fully assessed at home, and then have an adult (i.e. not paternalizing) professional conversation about their health, we are already on the way to a revolution in health care.

Of course, there will still be the need for fancy machines like CTs and MRIs. And surgeons  will still be busy enough with whatever they are still doing in the future. But just the implementation of artificial intelligence will already drastically reduce the amount of testing and unnecessary treatment that patients receive. And via AI, patients will be able to ask questions and make suggestions that their doctors may not think of or have time for. In the near future, personalized medicine, not just in the form of genomics, will create totally personalized medications that are 3D printed and have little to no side effects, but with near 100% success. And the data necessary to create such personalized medications will greatly come from the patient, not the doctor.

The power of a drawing on a napkin is astounding. Perhaps restaurants should start providing pens along with napkins for all of the future visionaries.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.