Apple announced the company is working on a new app, called Health, that allows a user to store in one place all aspects of their health data, from heart rate to blood sugar levels, cholesterol measures and calories burned. The Health app, Apple says, will enable an exercise app to determine the number of calories you consume a day — and, in turn, how hard you have to exercise to burn off all that food.
Coupled with Apple’s rumored-to-be-released-this-fall iWatch wearable computer, the software represents another incursion of technology into our lives, raising the question: Are we relying too much on gadgetry to improve ourselves?
In considering the answer it’s useful to examine a profession at the forefront of incorporating technology into everyday work — doctors. Key figures in medicine today believe physicians are paying too much attention to their iPads and not enough to their actual patients — so much so that it’s hurting docs’ ability to do their jobs.
Take the remarkable essay in the New York Review of Books by Dr. Arnold Relman, the 90-year-old former editor of the New England Journal of Medicine, who was hospitalized last year after breaking his neck in a fall. The experience provided him with new insights into the way today’s doctors do their jobs.
“Attention to the masses of data generated by laboratory and imaging studies has shifted [doctors’] focus away from the patient,” Relman notes. “Doctors now spend more time with their computers than at the bedside.”
Consequently, Relman and many other physicians believe that some physicians are losing all the old skills that used to be critical to making a quick and accurate diagnosis. These skills tend to be part of the physical exam, the part of an appointment that sees a doctor using touch, sight and all the other senses to learn about what’s ailing the patient — flashing lights into the pupils, watching the way a patient walks, pushing and tapping on the abdomen and listening to the chest with a stethoscope. Skills the legendary physician William Osler called “inspection, palpation, percussion and auscultation.”
A physical exam can be fast and accurate, and the tests are cheap, since they tend to use only the most basic elements of technology. And, as I discovered when I practiced medicine earlier this year in remote parts of Kenya, these analogue diagnostic techniques are particularly valuable when electricity supply is unreliable.
But these methods require intimate contact with patients, which can be uncomfortable for doctors who are more accustomed to interacting with computer screens. They also require physicians to use their own senses, to trust their judgments, and to engage in messy probabilities rather than the relative certainty provided by computer algorithms.
“If you come to our hospital missing a finger,” said Abraham Verghese, a faculty member at Stanford Medical School, in a recent feature about this phenomenon in the Washington Post, “no one will believe you until we get a CT scan, an MRI and an orthopedic consult.”
Medical educators such as Verghese and others are pushing back against the trend. At Baltimore’s Johns Hopkins Children’s Center, pediatric cardiologist W. Reid Thompson has set up Murmurlab, a website that hosts more than a thousand recordings of heart beats, to better train physicians on the ability to use stethoscopes rather than echocardiograms to tell the difference between an innocent and life-threatening heart murmur.
For his part, Stanford’s Verghese has compiled a list of low-tech physical examinations that every med school student should learn. Verghese’s list is called the Stanford 25, and it includes things such as testing a patient’s pupil for its response to light, which can reveal neurological damage, and observing the way a patient walks, which can assist in the diagnosis of Parkinson’s and many other maladies.
I wonder whether the non-medical world should adopt the concept of the Stanford 25. What are the skills that everyday people should know how to do without smartphones or tablet computers? My own, non-medical version of the Stanford 25 would include being able to add, subtract and multiply without a calculator app. So would retaining the ability to navigate a city with a paper map, rather than just Google Maps.
During the summer, at a time when all of us will be trying to spend as much time as possible outdoors with friends and family, disconnected from the Web, it strikes me that all of us, not just doctors, have a duty to exercise the most important computer we have at our disposal — our own brains — so that we don’t lose the ability to function on our own.