The New 'House Calls' – Doctors Stay in Touch via Smartphone

The image of the doctor’s “house call” – your trusted physician showing up at your door wearing a smile and carrying a black bag, there to take care of an ailing family member – is now pretty much history, something we see only on TV in episodes of “Downton Abbey.” The realities of modern health care, including the space required for modern diagnostic and testing apparatus, the consolidation of medical practices into HMO’s, the ever-looming possibility of malpractice lawsuits, and time constraints placed on the doctors themselves – have largely turned the medical profession into a “You come to us…we can’t come to you any more” scenario.

But caring medical practitioners still recognize the need to stay in touch with their patients, and more and more of them are utilizing high-tech digital technologies to accomplish this. Many of their patients have mobile phones or even “smartphones” (more powerful units that are more computer than telephone, providing two-way visual communications and supporting software or “apps” that perform specialized functions), and doctors are being to make use of them. The ubiquitous technology of modern telephony makes it possible for them to stay in touch from afar, helping them to reach patients who can’t always – or won’t always – come to their offices.

Phones and texting help to reach many at-risk populations

One group of people for whom staying in touch with their doctors via phone is perfect is the elderly, many of whom do not have the resources or the mobility to make as many trips to the doctor’s office as they should. This situation is even more aggravated by the psychological side effects of diseases such as diabetes and depression; the more severe the symptoms, the more patients tend to withdraw and draw inward, and the less they stay in contact with their doctors.

At a number of hospitals and medical centers, doctors have been experimenting with providing care to such patients using an “app” that monitors the frequency of text messages and calls made by such elderly or at-risk patients. If the doctors have requested them to check in every day by phone and the patients’ habit patterns in this regard change, an alarm on the doctor’s phone sounds, reminding them to be proactive and call the patient themselves. Other apps under development at the MIT Media Lab are being used (with the patients’ permission, of course) to track the movements and mobility of people who might be at risk if left on their own.

Another group of patients who often place themselves at risk by not staying in touch with their doctors are teenagers. They often fail to report back to their care providers on the effects of medications provided to them, or on symptoms that are either improving or worsening. So many physicians are increasingly staying in touch with these teens using the media they are already most involved with – texting, computers, and phone calls. Dr. Natasha Burgert, a pediatrician in Kansas City, now “sees” her patients in follow-up visits more often via phone and texting than she does in the office. In addition, she has created Internet-based blogs and forums on which teens can chat about the health issues they’re concerned about and get real information – as opposed to urban legends and misinformation – about subjects such as pregnancy, STDs, and alcohol and drug use. Dr. Burgert says “I do as much as I can to get it on their phones, because that is what they live and die for,” although she adds that she always gets prior permission from parents before doing this, because she doesn’t want them snooping on their kids’ phones or computers to check up on them. For the teens to participate in such high-tech communications with their doctors, they have to know that these interactions are as protected by “doctor-patient confidentiality” as the things they say while in a doctor’s office.

How do you cultivate a proper “bedside manner” over the phone?

These high-tech innovations come with their own challenges, of course. Many things still have to be done face-to-face in a doctor’s office or clinic. But properly used, staying in touch with patients via their phones or computers can be beneficial to both care-givers and care-receivers.

One important aspect of medical practitioners becoming more aware of the benefits of helping patients via their smartphones is in the increasingly important area of health literacy. One of the biggest problems faced by doctors is making sure that their patients fully understand theoretically simple instructions they’ve been given, such as how many pills to take, what times of day to take them, and what never to take them with to avoid bad interactions with other drugs or common foods and drinks. Another area in which health literacy can be increased via the use of smartphones or computers is diet recommendations – such as those that must be followed by people who have been diagnosed as diabetic. Staying in touch via phone can help to make sure that patients are following the advice of their doctors. In fact, many practitioners who do this are finding that patients are often more willing to ask questions of them via text or over the phone that they would be embarrassed to ask in person.

So the use of telephony in medical practice has come a long way since the era of “Take two aspirin and call me in the morning.” These days it’s as likely that your doctor will be calling you for a follow-up consultation as it is that they’ll expect you to call them.

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