Is it possible to follow up post-op patients via smartphones? What about regular patients?
One problem that “higher centers” (tertiary or even secondary care hospitals) face is that they often lose patients to follow up. Most patients reach these geographically far off centers when they were critical and their family would pay anything to let them see the light of another day. But, once they have been fixed up and starts going about their daily life, they forget the advice at discharge (or even their condition at admission), and do not or cannot (for financial or social reasons) return for follow up. If at all they visit a doctor again for minor complaints, that would be a doctor in a nearby clinic or primary health center.
Patients who undergo surgeries, are preferably discharged and ambulated early - to avoid hospital acquired infections and other severe complications like deep vein thrombosis. But, they also need regular wound dressing and follow up. It would not be practical for some people to commute every other day or twice a week for dressing.
Can patients with smartphones follow up via a dedicated app?
A friend of mine suggested this idea to me today. Would it be possible to build a dedicated app/service which patients and doctors can install on their phone and use for bidirectional follow up?
A simple explanation of how it works would be this:
Patient gets discharged as soon as possible after surgery with an app installed on their phone and a login ID and password provided to them which would connect them directly to their doctor(s). Once they are home, the app through a series of questions (subjective and objective) keeps track of the patient’s condition, new complaints, resolution of symptoms, etc. The app can also suggest follow up dates and give advice on diet, exercise, and any other aspect that a patient would be interested in.
On the days that the patient needs dressing they can go to a local hospital or clinic, and record photographs/videos of the wound which they can upload to their surgeon via the app. Accordingly they will be given further advice.
I immediately recognized some pain points in this idea.
- Not all patients have smartphones.
- For wounds, appearance can be deceiving. It is not easy to figure out if a wound has discharge of pus or collection of pus underneath from a photograph of the superficial skin. It will take a doctor or nurse who has the knowledge of wound dressing to express the pus and instruct the photograph or videograph be taken at the right moment.
- Internet connection can be flaky. It is not always possible to upload photos/videos real time. And so, immediate feedback on the wound and appropriate wound dressing would not be possible many times.
- Although it sounds simple, building such an internet based app/service takes considerable amount of developer time and resources. Maintenance is a larger worry.
More importantly, if a competent doctor is available at a local hospital, more often than not, the doctor present is a better judge than anyone else in deciding what the patient needs next. If the doctor feels that the patient should go up to the tertiary care center, they can always be referred.
It can at least help with queries and concerns
As a doctor, no matter how much clarifications and explanations you give a patient in the short time that you are with them, they can still ask a question which you could not cover. Can our app solve this problem? Can it figure out problems of the patient before they arise? Can it keep track of pain score and alert the doctor when it is getting worse? Can patients ask queries on the app and get response from the doctor?
You could even use WhatsApp for this (although I would never use WhatsApp).
But is it practical?
- A doctor is probably already busy in their hospital life that the only time they get to their phone (apart from when they are answering or making official phone calls) is during their personal time. Would they want to use this time to answer queries from patients?
- If it is possible to set aside an hour for doctors for this specific task, would a simple phone call to the patient be much more efficient and human?
Rather than specific advice it is only reassurance that many patients need. The apprehension of having underwent a surgery can be allayed only by the calming touch of a doctor. It is not always possible to replace this with technology.
But it is not always possible to do this. For a doctor to touch a patient, they must be at arm’s distance from each other. One of the greatest contributions that technology has made to humanity is that it allows people to connect (texting, voice or video call) from insane distances. It is indeed possible to use this between doctors and patients. The technology already exists. What is required is the will and the love.