The benefits – and some drawbacks – of new technology was the subject of the BGS Special Interest Group for Telecare and Telehealth where Dr Frank Miskelly, consultant physician at Imperial College London, had this key message for his audience. “The secret is to look at the problem and then ask how you can use technology to solve it. Too often you get companies who want to sell you some kit saying ‘we’ve got the solution, can you now find the problem?’”
For the geriatrician, telemedicine could be useful in managing chronic diseases such as COPD, heart failure, diabetes, Aids and Alzheimers. In many cases patients could monitor themselves at home, avoiding long trips to clinics and avoiding hospitalisation by flagging up problems early. It could mean equity of health care by overcoming geographical boundaries. Doctors in Texas, for instance, had been helping patients in Columbia. It could also be used in psychiatry, radiology – many radiologists now kept equipment at home so that they could examine X rays at all hours – and dermatology.
“For example, a dermatologist may have a six month waiting list. Most skin conditions don’t kill you and you can wait six months but a few, like melanoma, need to be seen quickly. So someone takes a picture of the lesion and sends it to the consultant who can then prioritise.
Telemedicine could also be used for video conferencing between professionals and for clinical consultations. In some cases laypeople could carry out a procedure and forward the results to the experts. In the wider field it was proving useful in battle zones, on oil rigs, in educating doctors in the developing world and in prisons where it might take a doctor an hour to get in and out. On the downside equipment was expensive, needed maintenance at both ends and could be complicated. Consultations needed very high quality streaming, especially if the patient was moving and sound quality could be poor. “And, of course, there is no eyeball to eyeball personal contact and in acute medicine you need that.”
Another use was in the development of ‘smart homes’ with multiple sensors linked to a central computer to showing whether the occupant had fallen or fainted or left gas on or water running. Such projects, however, were not always foolproof. One residential home had been wired up at considerable expense to include a feature which indicated when a resident was still in bed at lunchtime, the premise being that this would indicate a problem.
“This happened with one old man but when they knocked down his door they found him in bed with his neighbour. People don’t always act predictably and you’re not always unwell if you’re still in bed at lunchtime. In another old people’s home the system was wired up to sound an alarm if an outside door was opened but then the residents started opening it just to get attention.”
The arrival of the smart phone has given rise to all kinds of new issues including ethical ones as Dr Kate Scott, foundation programme director for the Northern Trust, pointed out. “In a world population of seven billion, around six billion have mobile phones. Its power is phenomenal but our behaviour is still evolving. Guidance has lagged behind: we are still learning ‘netiquette’. “
Today’s doctors said their phones could house anything which the pockets of white coats used to do. They were useful for teaching, for sending images including radiography, for taking notes, for accessing the latest information. Apps could provide all kinds of information and guidance. “But there are concerns over reliability and validity and possible conflicts of interests,” she added. “Some are produced by drug companies and there is not much regulation”.
Social media could also be a minefield with doctors inadvertently making friends with patients online or people seeking information about doctors from their online contacts. Past behaviour could remerge or reposting might mean messages reached people for whom they were not intended. The temptation to voice complaints or criticisms instantly could lead to poor relations between departments or to their being found years later. There was also the possibility of smart phones distracting doctors with subsequent risks to patients as well as patients themselves misusing their phones by, for example, taking pictures of other patients.
“The BMA and the GMC are updating their guidelines on the use of social media but I don’t think trusts generally are prepared for the sheer power of these devices. I’m afraid if we don’t plan properly there’ll be an incident which will then provoke a knee jerk reaction such as a total ban.”
- Keynote speech from Robert Francis QC
- Appraisal and doctors in court
- When I was a young ‘un – The changing professional life of the geriatrician
- The contribution of our elders
- Old and still driving
- Chronic disease begins in childhood