Hi, my name is Nahum, and it has been 5 seconds since I last checked my pulse

recent article questioned the value of the standard annual physical examination with a person’s primary care doctor. By following patients who had regular checkups, and observing them relative to others who did not have this yearly ritual, the researchers behind this work concluded that the benefit is not significant enough to justify the time and cost.

There was significant reaction to this research, on the part of primary care physicians across multiple countries. Especially in this day and age, the annual visit is seen as the one time in the year when a physician can take some extra time to focus on the complete patient, rather than just deal with an immediate complaint.

The reason why the effect of yearly checkups may be less significant than expected, is  because many patients do regularly interact with a medical professional. In other words, when a patient gets a flu shot or has some form of screening test against various diseases, or consults a doctor for contraception or needs some type of medical documentation for insurance purposes, this is still an opportunity for the physician to look over the medical record and check to see if any problems exist.

To summarize, the sense is now that a nonspecific general assessment done [only] once a year does not seem to add much to the health of the general population. Considering the total amount of money spent on annual checkups, eliminating this from the standard practice could potentially save a tremendous amount of money, that could then be repurposed for other needed areas in medicine.

What strikes me as strange is that in the last year, the world seems to have become “sensor junkies”. The whole concept behind physiological sensing is to constantly monitor  our status. Sensors are going to become far more widespread than they are now, and soon, technology will allow us to constantly check on thousands of physiological parameters. People will also expect to have their terabytes of sensory data saved online and then constantly analyzed by advanced computer algorithms, in order to identify any possible abnormality. I suspect that it will not be too long before packages of sensing information are sold in the same way that cable companies push new TV channels.

Why the discrepancy? How can it be that there is no value, financial and/or medical, in a yearly checkup, at the same time that people are clearly desperate for as much physiological information as possible? While the yearly checkup is only one set of health status data points, it seems that people today are keen on every piece of information that they can acquire. So can we expect that patients will fight to keep the annual visit?

In order to understand the place of each type of medical data in the management of a person’s healthcare, one must understand the connection between sensor information and the primary care physician.. As it stands now, when a person goes to see their doctor, the doctor has access to the information from the digital electronic medical record as well as from the present history and physical exam. Although there is definitely talk of linking sensor information into electronic medical records (Apple HeatlthKit is pushing this very hard), at the moment, that link does not universally exist.

It seems therefore, that there are presently two islands of medical data. One island includes the EMR and the immediate findings on an exam and physician-generated testing. The second island encompasses all of the health status information collected from sensors and other sources. And these two islands are presently still not overlapping. The question is why not? Is it JUST the technical aspect of getting sensor information into the EMR?

There are still many physicians who are not comfortable with potentially important medical information being collected 24/7. Physicians ask whether they should be held responsible for abnormalities in collected sensor information, even when the patient never presents for an actual visit. Legitimately, the physicians argue that no human can possibly track all of the data on potentially thousands of patients. Therefore, for physicians to acquiesce and accept responsibility for tracking a patient’s health status year-round, very powerful analytic and presentation tools, including automated warning systems, have to be made available to primary care doctors. Only in such a scenario, can a family physician hope to stay on top of the welfare of every patient under his or her supervision.

Actually, this is an opportunity for a whole suite of startups to create patient–sensor–doctor linkages. Those companies that can better summarize the sensor information and more accurately alert the physician when a problem arises, will quickly rise to the top of the pile and be the most financially successful. This will happen very quickly because physicians will absolutely need to find a way of handling all of the incoming data in the most efficient way possible. Ideally, such data collection/analysis/warning systems will even have options to automatically and directly notify the patients that they must come in for an evaluation. By using the physician’s appointment schedule, the computer will be able to book the patient based on the severity of the alert. The physician will of course be able to see all of this activity, and will be able to check a box to document awareness of the situation.

As I have discussed in the past, the role of the physician will fundamentally change within the next few decades. Physicians will become responsible for tracking the health status of their patients 24/7. Out of necessity, physicians will need to use the most advanced tools possible in order to stay on top of all of the data they are responsible for. Physicians will become overseers, managing other healthcare professionals who greet the patients and do the evaluations necessary. All along the way, automated protocols generated by computerized learning systems will guide the care. Metrics, which are so desperately needed in order to evaluate the efficiency of the health care being provided, will be generated by the computer. Everything that the doctor needs to know to be sure that patients are being well treated, will be delivered to the doctor on a virtual silver platter.

Some people are frightened that this will create a distance between themselves and healthcare providers. The exact opposite is true. People will begin to feel that there is someone who is helping them on a constant basis to achieve their best possible health. Problems will be identified before they grow beyond modern medicine’s control. People will have the opportunity to make decisions based on all of the same data that the healthcare provider has. Using advanced computer consulting tools, patients will be able to literally discuss their healthcare with an advanced computer system, even before the patient meets with their physician.

This entire process will hopefully soon become second nature to everyone. The idea of waiting an entire year to see a doctor for a 15 minute evaluation, will seem totally outdated and clearly ineffective. Ultimately, it is not that the annual visit is ineffective. It simply is not enough. And we are living in a new reality where the annual visit will be replaced by second to second physiological monitoring. I personally welcome this as the important next stage in providing the best possible health care to everyone.

Thanks for listening

My website is at http://mtc.expert

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.
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