Thursday March 14, 2013
Modern medicine goes mobile
By MICHELLE TAM
Doctors discuss using tablet devices such as the iPad and other Android models at work.
THAT blasted love affair with ais kacang. That must be it. Never again, you groan, as your sore teeth throb in pain.
Inside the consulting room, however, any sense of certainty disappears. Medical jargon – maxillary teeth, third molars, supragingi-what? – only make your head spin.
You reach for your smartphone to Google ‘full mouth debridement’, but hold on: the dentist is already tapping away at a tablet device to explain the treatment you need!
Soon, you’re fully informed on the procedure to remove plaque and tartar deposits, and feel much better for it.
If this situation sounds unusual now, rest assured: the times, they are a’changin.
Made for medicine
Many patients – unequipped with prior medical knowledge – find it difficult to fully understand or visualise a doctor’s description of their health problems.
And when it comes to your health, ignorance is far from bliss.
But a certain type of device – which most instinctively understand how to use, seniors and the very young included – is gaining popularity in medical settings.
With apps that allow physicians to access patient data, lab results, and a great number of other functions, it is no wonder that many have adopted tablet devices as an integral part of their practice.
The benefits are mutual: a study published in the AMIA Annu Symp Proc. 2011 stated that patients who used tablets to participate in their own hospital care reported mostly positive results, as they felt it would ‘improve their satisfaction with their care and help them feel more engaged in the process’.
Thus, several healthcare professionals and junior doctors shared their thoughts on tablet use in medical settings via e-mail interviews.
Paediatric cardiologist Dr Lim Miin Kang has used an iPad for work for over five years.
Apart from using it to help explain his patients’ ailments, the 56-year-old’s trusty mobile apparatus also stores cardiology apps such as Cardio Z.
Its uses include calculating Z-scores, which are used to express how much a measurement deviates from the average in a patient’s size and age class.
“As I need to source information on the go, I also use UptoDate, a medical update instrument that provides the latest information on clinical medicine,” he said of the popular, physician-authored app used in 158 countries.
Dr Lim also uses his tablet to take notes and capture important images during conferences.
To him, there are no shortcomings to tablet use by healthcare professionals.
However, others profess to a case of nomophobia: the fear of running out of battery!
That aside, Dr Nadzariah Cheng binti Abdullah has enjoyed using her Samsung Galaxy Tab 7.7 over the past year.
Despite professing to an “old-fashioned” preference to work on her laptop or read from print, the veterinary surgeon’s tablet is an all too convenient tool in her work.
As she works at various clinics on a referral basis, keeping all her information on the tablet – be it snapshots of digital X-rays or lab results – saves her the trouble of dragging books or piles of records around.
“When owners call me to confirm medication details, I refer to the records as soon as I’m free. They only have to wait a little if they call during consultation or surgery,” said Dr Nadzariah.
Apart from using Dropbox to store her data and WhatsApp to communicate, she appreciates the tablet’s handy photo and video-taking capabilities.
“The lovely colours are really important for my work, and I can easily show owners the large, sharp and clear pictures,” said the 59-year-old.
“I could snap a picture of my patient’s problem, such as an eye with a defect. The screen then lets me zoom into the area to be managed, so I can easily point out the detail to the owner without having to upset the pet by poking or prodding at the painful part,” she added.
She also looks for relevant supporting information online to show to owners, as they appreciate the immediacy of the tablet.
However, Dr Nadzariah notes that most vets are happy with their smartphones.
“They usually have great cameras in their clinics, and can always refer to their records there. Maybe mobile vets will prefer tablets,” she said.
Mobile health for all
But electronic tablet use is certainly not restricted to the veterans in the field.
Houseman Tan Lee Yim (not her real name) may not use her Samsung Galaxy Tab 7.0 Plus daily, but it comes in handy for the QxMD clinical calculator and reference material that is otherwise too heavy to carry.
“I read medical books when I have some spare time, and use it to search for information that is needed immediately. Updated information improves health-care quality, but don’t let other applications distract you,” she urged.
As for surgical houseman Pang Wei Soon, his Samsung Note 1 phablet is indispensable.
Almost everyone at his training place – Hospital Sultanah Aminah, Johor Bahru – has a tablet or a smartphone, as it is a “prerequisite to be effective”.
“They are of especial use to the medical field as we always need instant information at our fingertips. Doctors were already using palmtops (handheld PCs) before the smartphone craze caught on in society,” said the 25-year-old.
“Without a tablet, we either have to hog the ward computer for Internet access or ask others to search for answers,” he added.
To him, the scope of medicine is so broad that no one person can possibly know it all. Hence, Pang uses his phablet to look up everything from diagnoses to drug dosage.
“Even the specialists, when they get stuck, will tell us to go Google the causes for such and such and we will investigate it for them,” he said.
Apart from easy access to the Internet, apps on his phablet include Medscape, NICE guidelines, medical dictionaries such as Taber’s, and e-book reference material that would otherwise weigh about 2kg each physically.
“Medical texts are extremely numerous and voluminous. If I were to convert all the material in my Note into physical form, it might be heavier than a car!” he joked.
However, he is quick to caution that a tablet – along with any old ultrasound, X-ray, or MRI scan – is just a tool that is operator-dependent.
“We still need a doctor to know what to look for and how to apply that information. The tablet can’t give you a decision: I still have to rely on my own clinical judgement to apply the provided information onto a patient,” said Pang.
Another gripe is bad battery life, as his phablet barely lasts a 12-hour shift and a secondary phone is needed for work-related calls.
And though the US FDA has already approved the first mobile radiology app (Mobile MIM) back in 2011 for doctors to view medical images and make diagnoses, Pang hopes that tablets themselves will someday become advanced enough to perform Doppler ultrasounds, X-rays, and more.
And while junior doctor Poulomi Choudhury has yet to use a tablet when dealing with a patient, the Malaysian sees its benefits at her work in Rumah Sakit Hasan Sadikin at Universitas Padjadjaran.
“Doctors here use tablets to catch up on their reading and as a tool to explain about diseases, disease progressions, anatomical locations and defective parts to their patients,” said the 24-year-old based in Bandung, Indonesia.
There, they use diagrams, pictures and human body maps to help patients understand explanations on treatment and disease management.
“Some patients don’t really understand even simple explanations, so we draw and show charts, pictures or 3D images to make it easier for them,” Poulomi explained.
Must-haves include Medscape, Google search, medical e-books, and even Scribd for slides with interesting pictures or explanations of a particular disease.
“Sometimes the patients are fascinated by the doctor’s full efforts to explain their problems with a tablet, and they actually feel more important,” she said.
To help them learn better, the junior doctors are also encouraged to use smartphones and tablets to look up reference material during discussions with a specialist consultant.
However, Poulomi feels that doctors must use tablets correctly, and not make it look like they are uncertain about the subject matter.
“Every day is a learning process, so it’s okay to be unsure. But if the doctor needs to check up on something, they should excuse themselves for a short while and look it up!”
She also suggested the use of short and compact videos to better explain procedures to patients, as being a five-star quality doctor mandates good communication skills.
“A doctor should make every effort possible to ensure patients understand their problems. So if we need to take an extra step and make things interesting, why not?” she concluded.
> An enhanced version of this story is available for download in The Star Editor’s Choice, Mar 14, 2013 issue. The app is available free from the App Store or Google Play.