July 26, 2013

Could a smartphone physical be in your future?

As my attending physician walked in with the next patient, I quickly stuffed my iPhone into my pocket. There was a strict "no cellphone" policy in the pediatric clinic where I was working as a third-year medical student. If my attending had caught me, I would have received a stern lecture about how cellphones were not to be used while patients were in the room.

We proceeded to examine the patient, a young boy named Tim, who had an earache. As part of the routine physical exam, I used my otoscope - a device first described in 1363 - to examine Tim's eardrum. Unfortunately, it was difficult to see the characteristic cone-shaped membrane. The more I maneuvered the otoscope, the more Tim yelped in pain. I finally gave up and admitted that I couldn't find the eardrum. Tim had been subjected to enough agony, and we sent him home with a course of antibiotics for a presumed ear infection. My attending later confessed that after 10 years of practicing, she still sometimes had trouble seeing the eardrum.

I remembered Tim's eardrum when reading the 2013 program of TEDMED, an annual conference in Washington showcasing the most promising medical advances in the country. A medical technology blog that I write for had organized an exhibit called "The Smartphone Physical" to showcase smartphone apps - many of them already commercially available - that doctors could use in a physical. As part of the exhibit, the team used CellScope, a mobile phone attachment to show attendees a picture-perfect magnification of their inner ear canal - much clearer than I'd seen with my otoscope.

I recently mentioned the device to a pediatrician. "That'll be the day," she replied.

Many doctors share her skepticism of smartphones in medicine. Less than half of attending physicians in a recent survey reported using smartphones for patient care. Many doctors worry that these technologies will hurt their relationships with patients. In a 2012 essay in the Journal of the American Medical Association, Georgetown University physician Caroline Wellbery warned that "these devices deprive us of the very essence of presence. . . . We may be surrendering our capacity to be in the moment."

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