Interview with Shiv Gaglani of Medgadget

We spoke with Shiv Gaglani, a medical student and editor at Medgadget who set up and ran the Smartphone Physicals in the Hive at TEDMED last month, to reflect on his experience. This is what he said.

1) What did you learn at TEDMED that will affect your work/life going forward?

Shiv Gaglani: Outside of the few talks I did see, the true highlight of TEDMED for me was meeting the delegation. Fortunately the Smartphone Physical was the perfect excuse: I literally had the ear of dozens of participants (as I took a picture of their ear drums using the smartphone otoscope). These ranged from company executives and hospital administrators, who had interesting and positive thoughts about the Smartphone Physical, to medical and even high school students who were inspired by what technology has already made possible. Some of these conversations will stick with me moving forward and in some cases some of the connections will last much longer than the four extremely busy, yet gratifying, days that are TEDMED.

2) What did you think of the Smartphone Physical? What were the highlights of your experience administrating the physicals? How did people react to the apps, accessories, innovations?

Shiv: The experience and reception to the Smartphone Physical surpassed my expectations. We knew what we were doing would be popular, but the attendees almost ubiquitously gave positive feedback, as depicted in the word cloud comparing the traditional physical to the Smartphone Physical.

It was interesting to see which devices really lit up the imaginations of the participants. Some were excited by the easy-to-use blood pressure monitor and pulse oximeter and understood immediately the implications for turning patients into accurate data collectors. Others’ eyes lit up, both literally and figuratively, when we were able to show them for the first time a picture of their optic discs. Parents understood how the smartphone otoscope would help them allay their fears when their children had ear infections. The smartphone ECG captured the imagination of many because of the cool underlying technology as well as the fact that during TEDMED we actually found a few potential cases of undiagnosed arrhythmias and hypertrophy. And finally the smartphone ultrasound showed people how easy it may become to peek inside their own bodies; in two instances we even were able to see the youngest TEDMED participants, enjoying the experience from within their mother’s abdomens.

3) How about the exam room set up? How did Empath, Pocket and Regard affect the Smartphone Physical?

Shiv: Definitely! My team was really impressed with the overall space that Steelcase Health set up, and specifically the equipment. Since we are all medical students or professional we are used to dealing with exam room beds, chairs, and desks that are hard to operate and interfere with the clinician-patient interaction.

Empath was really easy to adjust, allowing us to go easily from a seated position to a slightly reclined position. This allowed us to use the smartphone ultrasound to visualize the “patient’s” carotid arteries, which is important for blood pressure measurements. Many of the patients were pleasantly surprised by the Empath as well because of the heating and massage elements (at certain break points, we TEDMED ‘docs’ snuck a quick sit on the Empath as well).

The Pocket enabled us to mount our iPads and conveniently enter data throughout the Smartphone Physical experience. Rather than sitting behind a desk on a computer, we formed a triangle where the vertices were the clinician, the patient on the Empath, and the device/tablet on the Pocket. It also helped that it was mobile and vertically adjustable – given the large demand for Smartphone Physicals, we were able to set up mobile screening stations outside of the exam room.

Finally, Regard as a whole took into account the 21st century patient. It ranged from the comfortable seating to the multiple outlets and work stations that enable patients to stay connected and engaged rather than uncomfortably isolated while waiting to see their clinician. My whole team was pleasantly surprised by how enabling Steelcase Health’s space was for the Smartphone Physical.

4) What was your reaction to the Hive?

Shiv: Having attended TEDMED 2012, I thought this year’s Hive was even better! It was such an enjoyable area to be in that many attendees didn’t mind missing the talks in the main auditorium. Of course we think that the Smartphone Physical was a top feature of the Hive, but there was a lot of other activity, ranging from up-and-coming health start-ups to the Great Challenges area and the Emotiv brain-monitoring area. It also was conveniently stocked with drinks and food so many in my team were glad to do 4 or 5 hour shifts to keep up with the demand for Smartphone Physicals (now, if only they could get a restroom closer to The Hive…)

5) Where do you see physical exams going in the future?

Shiv: One of the motivations behind The Smartphone Physical was to address some of the problems with the current physical exam. Many of us have witnessed or undergone exams in which the clinician hastily “went through the motions” and generated inconclusive or, worse, unreliable data. For example, I’ve seen very few clinicians actually measure blood pressure using the two-step procedure and after waiting for their patient to be seated (with both feet flat on the floor) for 5 minutes. Part of this is because the average patient visit duration has decreased, leading to cursory physicals, and another part is that, in the age of blood tests and CT Scans/MRIs, the physical has lost value. However, it is still a very meaningful part of the clinician-patient relationship and combined with proper knowledge of patient history can lead to the correct diagnosis more often than not. The Smartphone Physical is meant to show that not only can we make the physical more accurate through technology, but we can also engage the patient so he or she is able to see and understand what the clinician is seeing. For the first time the patient can see his own ear drum or retina, and thus is more likely to understand what the clinician means when she says, “you need to control your diabetes because it’s damaging the vessels in your eye.” In summary, I think the physical exam is here to stay…it’s just undergoing a 21st century makeover with the aid of technology and education.

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