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July 24, 2013

Could a smartphone physical be in your future?

As my attending physician walked in with the next patient, I quickly stuffed my iPhone into my pocket. There was a strict "no cellphone" policy in the pediatric clinic where I was working as a third-year medical student. If my attending had caught me, I would have received a stern lecture about how cellphones were not to be used while patients were in the room.

We proceeded to examine the patient, a young boy named Tim, who had an earache. As part of the routine physical exam, I used my otoscope - a device first described in 1363 - to examine Tim's eardrum. Unfortunately, it was difficult to see the characteristic cone-shaped membrane. The more I maneuvered the otoscope, the more Tim yelped in pain. I finally gave up and admitted that I couldn't find the eardrum. Tim had been subjected to enough agony, and we sent him home with a course of antibiotics for a presumed ear infection. My attending later confessed that after 10 years of practicing, she still sometimes had trouble seeing the eardrum.

I remembered Tim's eardrum when reading the 2013 program of TEDMED, an annual conference in Washington showcasing the most promising medical advances in the country. A medical technology blog that I write for had organized an exhibit called "The Smartphone Physical" to showcase smartphone apps - many of them already commercially available - that doctors could use in a physical. As part of the exhibit, the team used CellScope, a mobile phone attachment to show attendees a picture-perfect magnification of their inner ear canal - much clearer than I'd seen with my otoscope.

I recently mentioned the device to a pediatrician. "That'll be the day," she replied.

 Many doctors share her skepticism of smartphones in medicine. Less than half of attending physicians in a recent survey reported using smartphones for patient care. Many doctors worry that these technologies will hurt their relationships with patients. In a 2012 essay in the Journal of the American Medical Association, Georgetown University physician Caroline Wellbery warned that "these devices deprive us of the very essence of presence. . . . We may be surrendering our capacity to be in the moment."

But what if these technologies not only make physicians' physical exams easier but also improve our interactions with patients? Smartphones can offer doctors a more reliable exam while increasing patient involvement in their care. Within the next decade, the smartphone physical might replace the traditional physical exam. Even now, the long-standing "routine physical" may no longer be so routine.

The traditional physical exam may be overrated when it comes to picking up diseases. A chest exam done as part of a physical, for instance, has been found to pick up only half of all pneumonias. A study found that stethoscopes wielded by young doctors correctly identified only one-fifth of previously diagnosed heart conditions.

So while the traditional physical exam may be hands-on, it's probably time to find ways to improve it; to me, smartphones offer that possibility.

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