Nathan Ratner, a third-year medical student at the University of Minnesota and third-place finisher in last year’s Elsevier Hackathon in Finland, talks to Eric Wicklund at mHealth Intelligence, about the promise of mobile health technology.
The ability to look up information in an efficient and targeted way is critical to getting the right information, right when I need it. For instance, UpToDate, which is an online resource designed by clinicians for clinicians, is a type of Wikipedia for healthcare professionals, and it has an incredibly wide database of peer-reviewed articles, written by MDs and PhDs. In addition, Johns Hopkins University produces an antibiotic guide. I use it through an app on my phone. Those are just a couple of examples of digital resources that I have utilized extensively throughout my medical education so far, and I plan to continue utilizing them throughout my career. It shows the potential for how much impact these kinds of services can have to really improve both the efficiency and efficacy of education”
I think despite survey results suggesting that ‘Half of US Medical Students believe that using a Mobile in front of Colleagues & Patients would make them appear less competent’ I think it’s clear that even medical students who are studying in medical schools that are failing them because they haven’t gone paperless with made for iPad course materials they still don’t think twice about using their mobile as a tool. How long before we update the dinosaurs and start examining medics on their ability to use a content loaded smartphone and requiring them to have/use it when with Patients?
“The mobile phone or tablet is like the modern-day doctor’s bag. Suddenly we as physicians have vast resources at our fingertips that enable us to better educate patients about their disease process, our recommendations for a treatment plan and possible side effects or complications. This is a huge benefit to the therapeutic relationship”
The amazing thing is I think the Smartphone Medical from 2013 URL showed that it’s already so much more than that eg. your smartphone has a faster processor than a surgical robot from just a few years ago (and no one ever had a surgical robot or an ECG machine in their Doctors bag did they?).
“I would like to use mHealth to facilitate greater interaction with patients. This is not mentioned that often, but I think it is one of the greatest benefits of mHealth. When you have a situation where you have an expert who has all of this knowledge in their head, and they’re just dispensing edicts, such as, “This is what I think you have (and) this is what I think the appropriate treatment is,” whether intentionally or not, it can create an asymmetric power dynamic. However, if you are able to look up information with the patient, that facilitates a more collaborative relationship. Building that therapeutic alliance is more important than ever, because there are so many conditions that require a tremendous amount of active patient management and self-care in order to ensure successful outcomes”
I really hope when Doctors get to properly experience looking up information with Patients (this was the most transformational thing that I experienced 20 years ago at Medical School back in he early days of the internet) because when they do that its only a very small step before they realise Patients have more often than not got more time, interest and ability to look things up so we need to start teaching medics to work with Patients who have already looked things up.
“An easy criticism to make is we’re devaluing the doctor. People may say, “Well, anyone can just look this information up.” But I don’t think it’s the access to the information that’s actually going to change medicine, because doctors still need to know all of this. Medical school is not going to get easier. What’s going to change is how we share information, how we communicate, and my hope is that, as the system of global health becomes more robust for physicians, the same thing will happen for patients. I want to see the health literacy patients possess increase”
I see this as a common misconception amongst Doctors who don’t share online content with their Patients. It’s surprising that young medical students still think it’s possible (or desirable) for us to try and produce Doctors who know everything.
“I think the greatest risk is how information is shared with the general public. If it’s done right, then the good information gets through, and it’s accessible. When it goes wrong, patients can end up doing themselves a disservice. Patients do their own research and develop ideas about what may be wrong with them and what it will take to cure them based on that information. When physicians inform patients the interpretation of the patient’s research is not correct or does not fit the situation, physicians risk losing physician/patient trust. That’s happening now. Information that’s made accessible to patients needs to be done in such a way that there’s a clear bright line between the information that’s valid and information that is not. The mHealth ecosystem is being formed right now; if there isn’t a lot of care taken to really educate patients and form these systems so that there’s a clear delineation between what’s information you can trust and what’s information that may have an agenda behind it, you could see issues at a much bigger scale than we have now. But this is also one of the issues that mHealth can have a tremendous role in solving”
With government healthcare systems giving the health records of millions of their citizens to foreign advertising companies without even thinking about consent, the pharmaceutical giant Roche now owning FlatIron – the leading US provider of EHR’s for Oncologists and Teladoc and IBM Watson partnering to give 2nd opinions to Patients who are already under the care of an oncologist I think this is without doubt a major challenge but it’s not going to be solved by mHealth per se but by smart clinicians who are prepared to make themselves accessible and work transparently in order to help Patients and Carers trust them.
“I’m most looking forward to services that can interact with patients in a way that help to give them critical information when they need it. I imagine a SIRI-like device that could access your medical record, know your history and, with the algorithm, be able to synthesize that information and give you a quick and reliable answer to the question, “Do I need to go to the emergency room for this?” “No, you called a bunch of times before about this, and you don’t need to worry,” or “Yeah, you should go to the emergency room.””
I think we’ll arrive at that situation by recording millions of fully documented Consultations with Doctors and incorporating the feedback from the Patient journey. A great reason in and of itself to evolve on from the 2000+ year old office visit only model of care.
“Medicine, especially at the primary care level, and even at the specialist level, will become more automated. It’s inevitable. One thing I hope to pursue through my career is to maintain the human element, to really emphasize communication and relationship-building within these technologies, like the economist Richard Thaler, who was awarded the 2017 Nobel Prize for Economics. All of his work was building humans back into these very analytical economic models, and I think there’s a lot of benefit and cost savings that comes with automation, but I do think that we run the risk of losing the human relationship, that research shows, is in fact critical to positive therapeutic outcomes”
I think it’s abundantly clear that in the drive for efficiency and profiteering the sick care system has disrupted the very thing that Patients want: a human relationship with someone who cares about them. It’s optimistic to hear a medical student expressing such an observation but hopefully it’s not another one of those common sense things that US medics are being taught to ‘grow out of’.
“Honestly, the thing I’ve been most interested in recently is the success of telehealth in sharing medical knowledge, especially for places where there are physician shortages. The two most prominent examples right now are stroke codes in rural hospitals, where there’s no on-staff neurologist. There’s a service that allows emergency physicians to immediately have access to a neurologist. For example, I’m in Minnesota, and in northern Minnesota there are some rural areas where there’s just no on-staff neurologist at these critical access hospitals, but with the push of a button they can have a neurologist – literally, a world-class neurologist at an academic health center here in the Twin Cities, on the video screen, and they can look up a patient’s records and talk through the entire management of the stroke with the emergency doctors. What that does is saves critical minutes and seconds from having to transport that patient to a different hospital, to being able to manage it right there and try to save as much brain tissue as possible”
Such a simple innovation that’s been obivous for years. It stuns me that we still have major Professional bodies representing tens of thousands of Doctors whining about the Physician shortage while just paying lip service to the opportunity to use the tools of our time.