An Eye for an i(Pod Touch)

Many physicians are technology-averse, for both good and bad reasons. On the one hand, doctors, regardless of their political or social beliefs, tend to be conservative in their practice of medicine as is often required: although we have to function with a considerable degree of uncertainty, we cannot be too quick to jump to conclusions based on incomplete or insufficient evidence. This conservative stance sometimes extends to the adoption of new techniques, technologies, and ideas. On the other hand, technology can be overused with little potential or demonstrated benefit. Medical technology is generally very expensive, and its overuse is at least partly responsible for the unreasonable expense of modern medical care. Many doctors are quick to adopt new technologies to get a competitive edge over other practices; however, these trendy advances may not be true advances with respect to benefit for the patient.

One medical technology that is now commonplace is the medical PDA (personal digital assistant), a miniature computer held in the palm that carries medical applications and access to medical resources on the web (such as Up to Date, Access Medicine, and Epocrates). These devices, if designed and used well, can be incredibly useful: instead of thumbing through a textbook or running off to find a computer, a physician can find answers to a variety of questions that may come up minute-by-minute in the practice of medicine: What is the current standard for empiric antibiotics for aspiration pneumonia? What are the current guidelines of treatment for moderate-to-severe asthma? Are there potential drug interactions between the patient’s current medications and the medications I plan to give? I know I learned this in my Pathology course in medical school, but what in the world is systemic lupus erythematosus? If the hospital is particularly tech-savvy, these devices might also be able to view patient charts, lab studies, and imaging studies such as X-rays, CT scans, and MRIs.

However, the adoption of this technology is far from universal, and the devices (much like diagnostic sets) are often neglected for a variety of reasons. For example, some of these devices have poor interfaces, poor battery life, or are poorly designed to accommodate the pathways of thought underlying a physician’s diagnostic process (e.g. these programs are often designed by programmers, not health care professionals). At other times, the physicians simply forget to carry the devices with them for lack of developing this habitual behavior: I once followed a physician with a few other students, and we spent a few minutes desperately probing our minds for a simple, basic science detail that could have been quickly and easily answered with the physician’s PDA (which sat on his office desk). Still furthermore, I wonder if there is an underlying machismo that remains in medicine about the nature of medical knowledge and the use of tools: that all the knowledge we need should come from our brains or our superiors (e.g. attendings, residents, etc.), and that “devices” are simply crutches for a poor student. I could not disagree more. With no intentions of being arrogant (the bastard mimic of true confidence), I think I can hold a candle to most other medical students at my stage of development and that I am striving in the right direction toward an ideal balance of qualities required for excellence in medicine (intelligence, perseverance, decisiveness, humility, confidence, compassion, personability, empathic ability, cooperativity, leadership, resilience, etc.). Again, I think if I can do a little more to help my patients (i.e. by not relying solely on my memory or supposition or that of others to ascertain true medical fact), I will try my best to do that. The goal is not to be an Inspector Gadget, but rather, to take the opportunity to make my abilities and actions better informed, more sensitive, and more discriminative. There is a line between reason and excess, and this is well within the realm of reason if used well.

After some thought, I decided to go out on a limb and invest in a relatively new device that is not yet commonly used as a medical PDA: the iPod Touch. While I have long been a fan of Apple, I have been less than pleased about Apple’s recently corporate policies regarding the iPhone and its phone-less cousin. I was partly inspired by the story of a physician in private practice who is attempting to use his iPhone to run his one-man portable practice. Nonetheless, after doing some research that yielded mostly inconclusive results and posed new questions, I decided to give it a shot. Here are some of the results of my initial attempts to transform this device into a customized medical PDA:

ipod1.jpg

Meet the iPod Touch! Note the WebApps (Safari bookmarks on the home screen) leading to Gmail, Google Reader, and Access Medicine.

ipod2.jpg

My primary objective: to develop a system of storing and reading PDFs on the iPod Touch. While hopefully Apple will allow the development of such a system with its recently previewed Software Development Kit (to be available publicly in June), I am currently able to read PDFs in the Mail program through my Gmail account. With the ability to keep 200 e-mails in the program’s memory and read PDF attachments (at least up to 2 megabytes) offline, I suspect I will be able to keep up to 200 attachments in the program’s cache without having to load the files with a Wi-Fi connection. Access Medicine allows one to “print chapters” of its various texts, and I currently have the 2007 edition of Harrison’s Internal Medicine – all 364 chapters. Ogod – I’m going to have to e-mail myself 364 times. That’s ok, I already e-mailed myself 100 times this weekend, and I can load all 100 PDFs offline. Apparently I’m just that compulsive.

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The iPod Touch does wonderfully reading PDFs in landscape mode, but you can also read in portrait mode as well. Landscape mode can barely fit the full width of the 8.5″ x 11″ pages with the text being very small but still readable with the incredibly clear and bright screen.

ipod4.jpg

Is that ARDS in your pocket, or are you just happy to see me? Actually, this is a schematic of the pathogenesis of ARDS (acute respiratory distress syndrome), courtesy of Access Medicine. The site’s image bank selects images, tables, and charts from the various texts published by the company. I can load this images as photos into the iPod Touch’s photo system, giving me quick access to this information.

ipod5.jpg

NEJM rocks, but hey, I’m biased. The most respected of medical journals has an excellent series of videos on its website that are designed to provide an initial video-based, guided training for various medical procedures. Need to learn how to put in an arterial line? Want to learn the fundamentals of repairing lacerations, performing a paracentesis, or inserting a chest tube? Look no further. These videos are custom formatted for the iPhone, iPod Touch, and iPod video.

ipod6.jpg

The beauty of the Apple Store? Free engraving. Here’s look at you, kid.

Other thoughts on the iPod Touch as a medical device: The clincher is that Apple demoed a version of Epocrates, one of the most popular and widely used medical software packages, on the iPhone at its March 6 SDK conference. The company that makes Epocrates is committed to bringing it to the iPhone and the iPod Touch (which runs all of the same software). The device is well on its way to supplementing my knowledge base in the 10-15 minute downtime periods during my clinical clerkships (my third and fourth years of medical school), and it has other uses too! I can easily check and send e-mails through my Gmail account (synchronized to my Tulane e-mail account), read RSS Feeds (syndicated/customized news) through Google Reader, and access and edit my calendar to keep track of my schedule (synchronized to the Tulane course calendar). Of course, it’s an iPod, so I can also play music, watch TV shows and movies, check the weather, maintain a database of contact information, set an alarm (or use the stopwatch or timer features), use the calculator, write To Do and grocery lists, and surf the web. I’m eager to try out Up to Date when I’m on the medical campus, although that resource will be much more useful for me later in my training and when I actually have the fundamental experience and knowledge to guide the treatment of patients. Lastly, the iPod Touch is ideal for me (who does not need a new cell phone or cell phone plan) as I do not need to pay for the phone capabilities or the data plan, and New Orleans has a plethora of options for free wireless internet access in many areas of the city.

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