How did we survive the 80s/90s without counting to 10,000 and logging every pizza slice?

By Dr. Eddie Chaloner - Consultant Vascular Surgeon

An upside to getting older is that one has seen lots of confidently stated predictions fail to come true. So, when I read in the Financial Times that wearable medical technology would cause ‘the doctor-patient relationship to undergo the medical equivalent of the Protestant Reformation’, my eyebrows did rise a couple of millimetres. https://www.ft.com/patrick-mcgee


Wearable medical devices are not new – we were using them when I was a medical student in the 1980’s to document 24 - hour blood pressure measurements and ECG traces, albeit with rather clunky bits of equipment which were uncomfortable to wear. Recent technological advances in miniaturisation, wireless connectivity and battery longevity have extended the scope of wearables and vastly increased the size of the commercially exploitable market.


Lest I be thought a Luddite, I have absolutely no doubt that wearable medical devices can generate clinically useful information and have a significant place in the present and future practice of medicine.


My scepticism focuses on the assertion that digital wearables equalise the asymmetry of information that exists between a specialist doctor and the patient. The purpose of my article today is to differentiate between marketing hyperbole and reasonable expectation.


The COVID 19 pandemic has accelerated the use of all medical digital technologies. A recent survey of 8,000 Americans run by Rock Health and Stanford University https://rockhealth.com/insights/digital-health-consumer- adoption-report-2020/ found that wearable medical devices were used by 43% of the respondents in 2020, an increase of 10% on the prior year. What is not yet known is how long this shift in behaviour will last – previous surveys have shown that a substantial proportion of users, stop wearing devices after a few months.


Further interesting insights from this survey were that wearables were being used by more people to monitor specific health conditions such as diabetes, high blood pressure and obesity than in the pre-pandemic phase, where most devices were used as general fitness trackers. Clearly, some of this shift has been driven by the difficulty in accessing routine healthcare during the pandemic, but the trend appears to have legs. As with many areas of life, COVID has accelerated already existing trends.


The survey observed that the biggest user group were the affluent middle aged and that older people had lower utilisation rates. My expectation is that as the 50 somethings grow older, their use of digital devices will persist into the coming decades.


Rather than replace doctors, the next generation of wearables should help to inform medical advice to patients. Dr David Nickelson of the digital health consultancy Nerdery has provided insightful commentary around the use of wearable technology in disease prevention and the financial incentives that delivers for health insurers and governments. https://www.medicaldevice- network.com/analysis/the-next-phase-for-medical-wearables It is notable that technology giants such as Apple and Amazon are interested in this market. https://www.theverge.com/2020/8/27/21402493/amazon-halo-band-health- fitness-body-scan-tone-emotion-activity-sleep


So, I have no doubt that wearable medical devices are here to stay and will play a bigger part in healthcare delivery in the coming decades. My issue is with the notion that such data gathering will replace the role of the specialist doctor as the primary decision maker in interpretation of information and advice to the individual patient. Information technology has made medical expertise more widely available to the general population and that is a good thing for everyone.


However, the specialist physician is able to contextualise the information and provide relevant advice to an individual patient. The notion that ‘wearables could mean the doctor no longer knows best’ is an extrapolation too far. In the final analysis, as with most aspects of medicine, it all boils down to a question of trust.


Who do you trust to make a decision about your individual health and well-being?


A miniature device connected to an algorithm via a commercial app, or a specialist doctor with a lifetime of clinical experience? My choice is to stick with the Loxley network, supported by health intelligence. www.drloxley.com


Published by By Dr. Eddie Chaloner, Consultant Vascular Surgeon MA(Oxon) BM BCh FRCS(Edin) FRCS (Gen)


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