Wearable fitness trackers are likely to have been on many people’s Christmas lists this year. Marketed simultaneously as fashion accessories and the answer to our obesity problems, wristbands and other gadgets that monitor and analyse our calorie consumption and exercise levels have recently shot up in popularity. And this is predicted to grow further in 2016.
Some argue that wearable fitness trackers and mobile health apps might not only help us monitor our own health but also enable our doctors to gather more information about us. This could allow them to offer more effective, personalised treatment and even intervene in our health without us having to report concerns first.
The problem is little is known about what impact these technologies can actually have on health and care. Even if it emerges that fitness gadgets and apps can change our eating and exercise habits for the better, we don’t really how doctors will respond to these technologies or how they could change our relationships with healthcare professionals.
Will the data collected act as a carrot that encourages us to become more active or as a stick for our doctors to beat us with when we don’t follow their advice? What will this do to the privacy and trust that underpins medical practice? And how might technology erode the social and caring aspects of medicine, so that a consultation becomes the equivalent of a text message exchange?
Several studies have examined how patient monitoring technologies could play a significant role in managing long-term and often complex health conditions, with varying results. In one study looking at how a mobile phone-based diabetes service influenced prescriptions, the effects on doctors’ behaviour were actually modest. By contrast, research into mobile phone-based monitoring for heart failure led to patients taking greater care of themselves. But the patients were also concerned about long-term surveillance and dependency on the technology. And their doctors were worried about increased workloads because of the frequent alerts and volume of data they received.
This suggests that rather than simply acting as a tool to help our doctors, digital health technology has the potential to separate us from them. It might improve the frequency and content of communications and is particularly promising for the delivery of care in rural and remote areas, but the trade off is less human contact. Connections are not conversations and technology might actually interfere in the quality of our relationships with our doctors.
More frequent opportunities for communication might in theory create more chances for personal relationships, but if it’s mostly done through electronic messaging then interactions may actually become standardised, even when that is not an explicit intention. This creates the possibility that diagnosing and managing illnesses could become robotised, leading to a situation where doctors stop listening and using their intuition and patients stop communicating how they really feel.
Interactions between doctors and patients are the cornerstone of medical practice and their relationships have even been described as sacred. If these are radically transformed and most healthcare becomes delivered through technology rather than traditional practices, we may lose our appreciation for good bedside manner. How this might impact on health outcomes is yet to be explored.
Our relationships with healthcare professionals could also be damaged if we feel they are effectively spying on us, or that the data being collected could be shared more widely. Sending messages via the internet is not the same as a quiet conversation in a private room. Recent high-profile online security breaches show that we are also still trying to understand whether we can really make our data secure. This has particular implications for sending and storing large amounts of personal heath information via the internet.
We’re still in the early days of digital healthcare and we’ve yet to determine how serious these issues may or may not be or whether other problems will become even more pressing. But the ubiquity of remote monitoring technology and the need to do more for less that will come with an ageing population and a growing number of people with chronic conditions will increase the urgency to find out.