Mobile health: Just because we can do it doesn’t mean we should

I just deposited a check into my bank account by photographing the check with my iPhone and zapping it through cyberspace.  I realize this is ho hum to the under 35 crowd.  Soon, there won’t be any paper checks as the entire transaction will occur electronically.  As a member of the over 35 crowd (plus 20 years), I am wowed by this process.  I remember being astonished when my kids told me how they performed this same process months ago.   It’s the same amazement I experience when I first read about a new piece of technology called a “fax machine.”

You mean you slide a document into a machine and an exact copy emerges elsewhere?

In my younger days, depositing a check into a bank account meant waiting in line with my bank book in hand waiting for a living, breathing human to count and record my allowance and snow shoveling earnings. The bank that my kids use has no physical offices.  It is entirely in the Twilight Zone.

Medicine will not be left behind here.  The manner in which medical care will be administered will be beyond what we can imagine.  We see glimpses of it already, but our vision of its trajectory is limited.  There will be huge advances, but as with all technology, there will be a cost.  The traditional doctor-patient relationship will fade out as this will not be the bedrock of medical care.  There will be nostalgia for it from those who experienced it, much as I have warm memories of bank books, rotary phones, ice cream sodas and playing basketball after school in the school yard.

I’m sure there is technomedicine going on today that I’m not aware of and would be amazed by.  Smartphones will become medical diagnostic tools.

Easy stuff

  • Tell Siri your history and send a photo of your rash to a derm app and a prescription will arrive at your door in 1 hour.
  • Place phone on your chest and cardiopulmonary data will be forwarded to your cardiologist who will transmit medication adjustments to you electronically.
  • Shine a beam of light through a urine specimen that will confirm if urinary tract infection present.

Hard stuff

  • A coronary bypass surgery performed robotically by a surgeon in New York City on a patient in Abu Dhabi.
  • Artificial organs created in 3-D printers.
  • Miniature cameras journeying through the digestive tract, circulatory system and major organs delivering customized treatment for various diseases.
  • Smartphone analysis of saliva sample that will screen for risk factors for 20 common chronic diseases that will have effective preventive strategies.
  • Satellite delivery of yet to be discovered form of radiation to the developing world which will decimate foodborne illness.
  • Patient will place his palm on a glass, and an electronic signal will be transmitted to internal organs whose function needs adjustment to treat disease or preserve health.

I worry about the collision of technology against the doctor-patient relationship, which is an ongoing conflict. For example, most patients and physicians do not feel that electronic medical records have nurtured the doctor-patient relationship.  I think it’s been a wedge separating physicians from patients. The tidal wave of technology forges ahead with no true regard or attention to the ethical costs incurred.

Doing stuff just because we can doesn’t make it right.  Smartphones won’t be smart enough. Will there be an app for empathy, compassion, facial expression and listening?  Perhaps, AppMD will be tomorrow’s health care provider, and physicians will join the ranks of typewriter repairmen and encyclopedia salesmen.

Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower

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