Patient, heal thyself at home

The development of intelligent monitoring products and diagnostic software is making home diagnosis easier and more accurate, but Michael Evamy thinks we could be treading on dangerous ground if we get the designs wrong

More than 60 years ago, the introduction to The Concise Home Doctor Encyclopedia of Good Health was published by the Educational Book Company. Before plunging into a 1400-page, ruddily illustrated rampage through the bodily functions and malfunctions, it announced the arrival of a “New Medicine”, a philosophy that would recognise symptoms no longer as signs of disease but as signs of the body’s resistance to disease.

The noble ambition of the Concise Home Doctor to encourage mass DIY diagnosis was never realised. Who could possibly tell whether a stomach ache was actually the pain of an appendix about to burst? Syrup of figs would not be a lot of use.

We know when something is wrong but rarely know what it is, or how serious it may be. So we visit the surgery or call the doctor out. Our dependency on the medical profession is a dependency on information. Most of us aren’t hypochondriacs, but too much of doctors’ valuable time is wasted by call-outs for trivial complaints. And how many hours of patients’ time are wasted by travelling to consult a GP to find there is nothing wrong with them?

Remote diagnosis may be one answer. A trial of a videophone network in sparsely populated Montgomeryshire has been reducing the time spent by consultants on the road. Eight general practices, covering 65 000 patients, have been equipped with a minicamera on a PC, and connected to Bronglais Hospital in Aberystwyth by ISDN link. Instead of travelling 128km to the hospital, patients with skin complaints have been diagnosed by a consultant at the other end of the line.

The test, funded by BT and IBM, has now been widened to encompass other ailments. The potential for cutting consultant waiting lists is enormous. Soon we may all have the opportunity to open wide in front of the camera.

The only problem with such a system is that it does not save GPs’ time; they have to operate the camera. If patients were more independent and could diagnose themselves up to a point, a remote pre-screening process of sorts would be introduced from the GP’s surgery, and trivial cases would be filtered out earlier.

The Concise Home Doctor was on the right track in 1932, but its design was fundamentally flawed: the alphabetically ordered headings were the disorders themselves – diphtheria, diplegia, dipsomania and so on – not the symptoms. You needed to know the name of the disease before you could diagnose it.

It is simple to envisage how skilled software and interaction designers could produce a computer version of the home doctor which incorporated a structure of questions about symptoms, the answers to which would lead the user to a tentative diagnosis and, if needed, a recommendation to contact a doctor. Sadly, it is equally simple to imagine how, in the wrong hands, all the sensitivity of a human doctor could be designed out: imagine a red light flashing and a screen bearing the message “YOU HAVE TUBERCULOSIS. CALL THE AMBULANCE AT ONCE”.

The British Medical Association has no ethical quarrel with the home doctor concept; it produces its own family health encyclopedia. “The potential is huge,” says a BMA spokeswoman. “Some GPs already have diagnostic computer programs, but there is a limit to what they can do before you need – literally – hands-on advice.”

The new New Medicine may be here, however. Experts predict a rash of home doctor computer software, as well as new books and telephone hotlines for the PC-less majority. The number of self-diagnostic kits available over the counter is also set to grow. The BMA’s primary reservation with any self-diagnosis system is that, without essential counselling, patients may be falsely reassured or worried. A kit-test for cholesterol might indicate a high level, but without taking into account a range of other information such as diet and family history. A patient who uses a kit to test themselves negative for HIV may continue to use contaminated needles. The task of communicating these life-and-death issues powerfully on packs or on screens will fall to the designer.

As Government support for the NHS ebbs away, a consumer healthcare infrastructure is emerging in which machines will augment the skills of health workers. New devices in development will allow self-diagnosis or, perhaps even better, remote diagnosis by professionals.

The Scanmaster, a desktop electronic “nose” first developed by Array Tech Chemical Sensors of Chesham for use in the quality control of perfume manufacture, is now being adapted by doctors to detect traces of certain disease bacteria in human breath. A low-power torch-size version is in the pipeline. Dr John Slater of Birkbeck College, University of London, is involved. “In the future it could be tailored to special requirements. In diabetes monitoring, for example, doctors have found that the smell of acetone on patients’ breath is strong. There’s a push to get away from in-vivo (invasive) testing techniques.”

Manufacturers of consumer healthcare products like this could do no better than employ the kind of visionary design skill which went into the award-winning NovoPen insulin syringe, designed by Sams Design.

Japan is a huge market for DIY diagnosis. The country’s “greying population” is exerting a huge burden on the health service, and any device that can monitor the condition of patients with disability or a recurrent illness such as diabetes is valuable. The “intelligent toilet” has been available for a while. It analyses urine samples, monitors pulse and measures blood pressure, then transmits data at regular intervals to the patient’s GP.

There are natural hazards in such equipment that design can overcome. “There is a chance that an elderly person or someone who is partially sighted would be troubled by it,” says Dr David Gann, a technology analyst at Sussex University’s Science Policy Research Unit, who has surveyed “telemedicine” devices in Japan. “I don’t think the designs are there yet, in the user interface or the icons. There are not standard icons that are used across the board in home automation technology, so that causes confusion.”

Gann has also seen a Japanese diagnostic chair, which, attached to a telephone line, will give a quick diagnosis of heart condition and other vital signs, measuring through contact points. “It can quickly pick up how serious the situation is and alert the necessary help,” he explains.

Gann believes these machines have potential here, but wisely sounds a note of caution: “It’s a question of understanding what the technology can do, why it can be useful and what balance of technology and social provision is required. You can’t substitute social care for technology, especially for the people – the disabled and elderly – who would benefit most from these machines.”

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