The ability to self-manage our health could break down barriers to efficient healthcare, but only if doctors embrace the technology

Healthcare is the fastest rising cost to taxpayers in advanced western economies. The ability to self-manage our health is one of the best ways to rein in the rising costs. And the obstacles to bringing these costs down for consumers are often the medical practitioners who insist the only way to practise is to exchange letters with each other, to write illegible prescriptions and to refer patients to specialists for information they can now gather on their smartphones.

Dr Eric Topol, an American cardiologist and professor, raised the ante on this in his 2015 book The Patient Will See You Now: The Future of Medicine is in Your Hands. His observations about digital disruption in the healthcare system offer an insight into how doctors have been slow to embrace new technologies. Topol was alerted to this when he received a text message from a patient with a screenshot of an electrocardiogram he’d run on himself from a smartphone app. “I’m in afib [atrial fibrillation]. Now what do I do?” the patient asked.

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Topol is brutal in his assessment of what this means for doctors. “The digitisation of human beings will make a parody out of ‘doctor knows best’,” he says. “We’re all essentially surgically connected to our smartphones and we’re still in the early stages of realising their medical potential. But they should be a real threat to the medical profession.”

Topol uses a portable pocket ultrasound plugged into his smartphone screen so he can show a patient what their heart is doing. “Normally a patient is tested by an ultrasonographer who is not allowed to tell them anything,” he says about some of the diagnostic benefits now available. And at the preventative end, he’s an advocate for how information can change behaviour.

Seeing your glucose every minute on your phone, it really changes your lifestyle Dr Eric Topol

“Seeing your glucose every minute on your phone, it really changes your lifestyle. You ask yourself, ‘Do I really need that piece of cake? No, because I don’t want to stress out my pancreas.’”

Topol’s experience with the text message diagnosis (and remember it was the patient’s not his) is played out now thousands of times a week. Although not always with the extreme conditions of a patient in cardiac arrest.

US media reported the experience of Izzy Causa, a Virginia mother, who noticed her 11-month-old Jack’s eyes becoming red with a yellow discharge. She used a service called Teladoc offered through her health fund to reach a physician by video call on her smartphone. Within minutes, the condition had been diagnosed as conjunctivitis (pink eye) and within half an hour an eye drop prescription was ready for collection at a local pharmacy.

Compare that with the typical procedure of taking a child with worrying symptoms to a doctor. First, if it’s a weekday, you have to wait for the surgery to open. Then, you have to hope for a same-day appointment, go to the surgery, probably see a doctor 30 minutes later than you had booked (because emergencies happen), then go to the pharmacy, hand over the script and start the treatment hours later.

Why wouldn’t patients go for the convenience of a digital diagnosis if it was on offer?

Mainly, because it’s not. Doctors remain committed to their existing work practices and specialists to the cartels that have limited their ranks for decades – even though two out of three patients are self-diagnosing using Google before they make a medical appointment.

What digital technology offers patients is the means to break through these traditional barriers to efficient and affordable healthcare; it offers patients the power that every other category of consumer has in the 21st century.

In Australia, some of this is already in evidence. Take optometry. Spectacles were once an expensive necessity prescribed after careful diagnosis by a specialist who made more money from helping choose the right frame than from testing your eyesight through a combination of lenses, letters and kaleidoscope-type colour devices.



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Now, many shopping centres have at least two spectacle stores. Patients walk in between grocery and shoe shopping to have their sight tested and then get to choose frames for as little as $50 (or free if they’re in a private health fund). The testers are optometrists – many of them students admitted to university with the highest school scores and they are also the salespeople helping you choose which set of frames you will buy.

Is this the best use of some of our brightest young people? Of course not. But the traditions of optometry [and] the restrictions that made it a lucrative career path for the sharpest minds has been usurped by technology. Indeed, it’s only a matter of time before the testing done in the shopping centre can be done on a smartphone or tablet. As can be the selection of frames and payment.

So what hope for optometrists? Like many other professionals, they need to move up the food chain. In Australia, they have won some of the prescribing authority once held exclusively by the more highly qualified (and restricted in numbers) ophthalmologists. But this has been a decade-long battle for a small step that just makes sense as digital technology changes how all our professions function.

Pharmacy is another example. Like optometry, it attracts the best students who traditionally have studied for five years to work in stores dispensing medicines prescribed by doctors. Unofficially, they provide low-level advice but are limited in what they can do for a patient who walks in from the street. Over time, their role has diminished and (like optometrists) their businesses have become more about selling cosmetics, non-prescription and so-called natural medication (often of dubious worth) than about selling medical products.

How do they stay relevant? The key for them is to offer more of the service that busy general medical practices can’t offer. For example, influenza shots are already available to adults at pharmacies. Why not children? How about tetanus shots or other vaccinations? Or blood samples? Digital technology has broken down barriers and encouraged consumers to look for best value, and provides ways to offer it.

New technologies are also helping to lower costs and this provides opportunities to help tackle systemic health problems in remote communities. The Cape York region of Australia is one of the most disadvantaged places on the planet. It is home to a number of Aboriginal communities, rife with alcoholism, poor health, poor educational outcomes and a seemingly unbreakable cycle of despair. Dropping off the Edge, a report by Jesuit Social Services and Catholic Social Services Australia, defines the disadvantage – inhabitants have lifespans up to 25 years less than average Australians, they are more likely to end up in the criminal justice system and they are far less likely to end up in paid employment.

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The solutions to this are complex and interwoven. But one clear problem is with education and, at the heart of the poor educational outcomes, is the prevalence of a health problem related to hearing. About one-third of children in Cape York cannot hear properly because of a condition medically described as otitis media with effusion (OME), more commonly known as glue ear.

Audiologist Kristen Wallin spends her life running hearing clinics in Cape York. “Having good speech and language is the most important foundation for a positive education and having a positive education is the best foundation for improving health outcomes and employment opportunities,” she says in an interview with Indigenous news site, Nacchocommunique.com.

Australian governments have invested more into fixing this problem but the key is still to have audiologists like Wallin on the ground to diagnose, then treat glue ear or other ear infections. The tool she uses to do this is an otoscope (which cost from a few hundred to a few thousand dollars) plus her time and the cost of driving, flying or (in some cases) boating around the remote communities.

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But digital technology can offer an alternative. Texas A&M University students have designed an otoscope produced on a 3D printer, which can be plugged into a smartphone for remote diagnosis. This puts the diagnostic tool and the skills to read it instantly in the hands of everyone with access to a smartphone and broadband.

So, in this case, the technology and access to the internet can be a simple and affordable step to begin cracking a complex problem. And not just in Cape York but in every disadvantaged part of the world where hearing loss is a personal and social problem with serious economic costs. The World Health Organisation estimates 350 million casualties of hearing loss through infection. And the answer is now on the phone! The positive benefits of this can flow right through the healthcare system – if allowed.