iDoctor? Comments by Dr JB Lim

The blogger note:  In response to a request to comment on a video report entitled "iDoctor: Could a smartphone be the future of medicine?" (see http://www.msnbc.msn.com/id/21134540/vp/50582822#50582822 )

the blogger’s most learned e-buddy Dr JB Lim comments as follows:

From: lim juboo

Sent: Saturday, March 9, 2013 1:57 AM

Thank you. I have seen this on television over CCTV News sometime back.

This is not something new. The use of electronic gadgets in medicine, both for diagnosis and for treatment has already been there over 35 years ago, starting with the use of x-rays by a certain doctor called John Hall-Edwards in England in January 1896.

Subsequently many other electronic devices such as defibrillators, ECG, EEG, EET, ultra-sound, CAT, MRI, PET scans, etc, etc. have all been invented for medical use. This is not something new to us. All these electronic devices have been there and in use for more than half a century already.

The only difference is that these electronic machines used in hospitals are much bigger, heavier and much more expensive than using cell phones.

Even now you can also buy a pocket size ECG electronic gadget in Malaysia which is no bigger than your palm. It costs about RM 1,500, but it cannot give much details of the PQRST waves as it has only one lead (apply directly to the chest wall).

You can’t compare this RM 1,500 hand held ECG device to a 12 lead ECG machine used in a major hospital. All these cell phone medical devices cannot be compared to those much larger ones which are far more sensitive, specific and provide a lot more details.

I told this to a cardiologist at IJN 3-4 months ago, and he too has heard of this. He told me it is a waste of money buying it. A medical company wanted to sell me one nearly 2 years ago. What do I want it for?

I have also heard about hand phones being used to test blood many months ago, but I am not sure how accurate, specific and sensitive they are? It is something like a home glucometer currently being used by diabetic patients to look at their blood sugar at home.

Similarly there are also very small cholesterol meters that are used by some obsessive people to test their blood cholesterol at home.

But all these home devices can never give detail readings like HDL and triglycerides, their ratios, etc. Neither can home glycometers tell sugar tolerance indexes like hemoglobin A1c test (HbA1c) which is a much better test because this test is more useful in assessing long-term sugar status in our body. Sugar levels can fluctuates up and down like blood pressures all day long depending on physiological-biochemical states.

Even if you detect an anormaly in your blood or in other parts of the body, you still have to go to a hospital where much larger and much more expensive and elaborate tests need to be done. There is no escape.

In any case, the end point in health care is not about diagnosis using hand phones, but how do we as physicians, doctors and healthcare professionals educate our patients and the rest of the population to achieve an ever-lasting health that is free of disease for the rest of their lives. That is what we all want. Not using hand phones to measure this and that inside our blood, heart, liver and other organs. All these hand phones can never make us healthy no matter what they read.

Even if we find something abnormal inside our body using a hand phone, we still need to go to a good hospital to investigate further. There is no escape. We can’t depend on hand phones to make a home diagnosis and treat ourselves using these devices. These devices are only good for rough monitoring, but they are way, way out for making any specific diagnosis.

Electronic devices can never, never replace a doctor who is a human, and who can understand a patient (as another human being) much, much better than any machine, whether big or small, expensive or cheap.

The most important thing in health care is the quality of life. How do live a life that is disease-free in order to achieve longevity? That’s what everybody wants in life. Don’t you want that too?

Machines can never, never replace good lifestyle, and proper nutrition in order to maximize optimal health. That’s what we should aim for, and not depend on a hand phone to replace bad lifestyles and poor health. Hand phones can never, never do that for us no matter what they measure.

That is truth, nothing but the truth, the whole truth.

This is my qualified professional comment, and is far, far, far from being a BOGUS one.

jb lim

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Dr JB Lim elaborates later upon a feedback that queries: "The seperate 'ECG-device' to be attached to the smartphones are said to be marketed around US$150 in the video. The RM 1,500 price you quoted was 2 years ago. Now should be much cheaper":

I really do not how much these devices cost now. It was not 2 years ago, but just a year ago a hand held ECG device marketed by Omron in Malaysia cost around RM 1500. It may be cheaper now. I do not know. I do not think many doctors will buy them.

At RM 1500, this is the same price of a combined glycometer and a cholesterol hand held meter marketed by Boehringer Ingelheim over 4 years ago. The cholesterol meter measures just the total cholesterol. It does not break down the cholesterol fractions (LDL and triglycerides and their ratios) as we want. So we still need to take the patient’s blood and send it to a proper laboratory.

None of these two home devices provide a detailed assessment of the sugar status or the lipid profile of a patient. You still need to go to a hospital to determine the GTT (glucose tolerance test) for impaired glucose tolerance (IGT), and the hemoglobin A1c (HbA1c), glycerated haemoglobin or glycohemoglobin test to determine the long term sugar status. These home glycometers cannot do this job.

In fact an insulin assay is even better. But insulin assays cannot be done in an ordinary clinical lab of even a big hospital like Kuala Lumpur Hospital or Selayang Hospital (examples) for routine diagnostic examination because insulin assay is so very expensive and time consuming. This assay is used only for research purposes, and can only be handled in a highly sophisticated medical research laboratory like those at the Institute for Medical Research. Sometimes they need to be sent to Australia, United States or to England.

Where can a hand held phone do that when even a big hospital clinical laboratory cannot handle the analysis?  No way can all these “hand phone medical devices” replace a proper medical laboratory manned by highly qualified scientific officers to help interpret the results. No way! No way! These people who make all these hand phones must be dreaming including that doctor featured in the video. He talked rubbish. He must be from the hand phone company.

We already have a lot of problems with all these electronic devices, example, the blood pressure measuring machines used in the homes. They always (without fail) give a consistently lower reading by as much as 10 – 15 mm of mercury compared to the traditional mercury or an aneroid sphygmomanometer. This is a very serious error that gives a patient and the doctor a false sense of hope, security and belief.

Even with the traditional blood pressure set used by GPs studies, in the UK and elsewhere showed doctors never clean and overhaul their instruments. They just use them over and over, and over again without cleaning or servicing them.

As a result, the mercury in the tubes gets oxidized. The mercury scum which is lighter need now to be pumped up higher to balance the blood pressure in the patient’s arm. This gives a false reading that the patient blood pressure is high, let alone the “white coat hypertension” effect of going to see a doctor to get a blood pressure measurement done using his never serviced before blood pressure sphygmomanometer.

Added to this insult, he will just take 1 or 2 readings with his old instruments without even giving his patient 1 -2 hours of rest in his clinic after going there fighting the traffic jams outside. Then he will say your blood pressure is ‘high’ and starts to medicate you unnecessarily.

All these are endless problems patients have to endure, and now with all these hand phones acting like a doctor?

I think all the medical schools need to close down, and people need only to buy a hand phone to diagnose and treat themselves.

Even when a doctor is sick, he still needs to see another doctor to be treated. Imagine a doctor consults a hand phone instead? What rubbish is that?

I can go on writing volumes and volumes on this, but it is a waste of my time.

Dr JB Lim

(Note:  All the pictures posted by the blogger are for illustration purpose and do not necessarily reflect the content of the articles and/or the intention of the author.)