The digital doctor’s bag.

Listen to this as a podcast courtesy of the IFMiL or Catalan Institute of Medical Education and Leadership.

When you think of the traditional image of a doctor outside of the hospital or the consulting room, he or she always carries a bag. Much like Mary Poppin’s carpet bag, it is full of magical instruments. Apart from a stethoscope, this could also have included a sphingometer to measure the blood pressure and maybe a couple of syringes to administer an all curing medication. Times have changed, and today we have different instruments, but their objective remains the same: to be a diagnostic aid at the bedside. This is especially true in rural and remote areas where a transfer to a local hospital may be complicated and time-consuming. However, it is also true for patients with decreased mobility in an urban setting. These are the patients who already receive the home visits instead of coming in to see their GP at the surgery.

The concept of the digital doctor’s bag describes a combination of digital medicine devices linked to a smartphone or tablet. It also includes decision aid apps and even the EHR or electronic health record. The EHR means that the HCP has access to all the patient’s notes and results on the go, even those of other specialists.

Emergency visits, whether by a GP or a prehospital service, also benefit from having a digital doctor’s bag. This may mean the difference between transferring a patient to a hospital or keeping them at home. The obvious example is an ECG being recorded and being sent straight through to the cath lab and cardiologist on call. If the patient doesn’t fulfil cath lab criteria, they may well be transferred to their local hospital instead of being sent further afield. But some of the devices are used by the HCP in situ. The portability and decrease in the cost of hand-held ultrasound machines have made them very much more accessible. Ultrasound does remain operator dependant and rule in not rule out. Traditional stethoscopes are replaced by digital stethoscopes which record and analyse heart sounds to provide a visual representation. Listening then becomes optional. Portable spirometers as an add on to a smartphone which then adds the information to the patient’s own records can reduce clinic visits for chronic patients. They can also empower patients to identify and manage their exacerbations in combination with their HCP at a distance.

Digital dermatoscopes are another welcome addition to the doctor’s bag. Working with high quality augmented images, you can diagnose yourself, send to dermatologist colleague for a second opinion or even let the AI do it for you. In 2018 Haenssle et al. concluded that deep learning convolutional neural networks outperformed even dermatologists when it came to melanoma identification(1) and that all HCP no matter what their level could benefit from this technology.

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