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Quant-Friendly Doctors


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Exploring the intersection of self-trackers and doctors, a la Quantified Self..

Thoughts from a practicing physician and engineer Paul Abramson MD (@paulabramsonMD) in San Francisco.


Published in: Health & Medicine, Business
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Quant-Friendly Doctors

  1. 1. Quant-Friendly Doctors @paulabramsonMD My Doctor Medical Group San Francisco
  2. 2. Defining the Need: The Self-Tracker• Things that only doctors can order• Professional guidance and interpretation• How to present data to the doctor?• How to have collaborative relationships with doctors?
  3. 3. Defining the Need: The Doctor• Reliable feedback from patient• Time and resources• How to help the complex patient?• How to help patients change behavior?• How to have a more satisfying and sustainable medical practice?• QS = “The real health care reform” ?
  4. 4. Types of Self-Trackers1. “Hardcore Quanters”2. “Quant-Ready Patients”3. “Pre-Quant Patients”4. “Misguided Quanters”5. Others 1. “Googlers” – self-diagnosis by search engine 2. “Random Quanter” – dabbles, doesn’t persist 3. “Pseudo Quanter” – reads, writes, doesn’t track 4. “Quantophobe” – fear of ‘becoming obsessed’
  5. 5. Hardcore Quanters• Know exactly what they want from a doctor: tests, devices, prescriptions• Good insight into health• Don’t want guidance or management• Doctor’s role: reality check & facilitator – Is patient sane? – Are medical bases covered? – Are proposed experiments are safe & potentially helpful? – Facilitates patient’s agenda: “Yes”
  6. 6. Quant-Ready Patients• Often motivated by a vexing health problem• Ready for a collaborative doctor-patient relationship• Interest in greater self-understanding• Doctor’s role: physician and research mentor – Identify problems amenable to self-tracking – Help design experiments – Identify the right tools – Review and interpret data (close the loop)
  7. 7. Pre-Quant Patients• Passive “fix me” paradigm• Motivational interviewing to elicit opportunities for change• Self-tracking as an alternative paradigm when they are ready• Doctor’s role: supporter and motivator – Meet patient where they are – Provide good medical care in the interim – Introduce concepts of self-tracking, feedback loops, individuality, autonomy
  8. 8. Misguided Quanters• “He’s orange” An 94-pound adult focused on elimination diets, food allergies, and symptom tracking• “Extreme materialist” A patient with obvious social-emotional problems focused only on physical parameters• Doctor’s role: identify and steer – Harm reduction model – Meet patient where they are, unless imminent danger
  9. 9. Example: Pre-Quant• 92-year old woman, homebound• Complains of “I can’t sleep,” poor memory, anxiety, depression• Passive attitude: “help me”• Caregivers say she does seem to be sleeping• How to figure this out?
  10. 10. Options• Give her sleeping pills – Cheap and easy – Stops the complaints – Creates an addict• Get a polysomnogram (in lab) – Expensive – Inconvenient – Rich data from single night
  11. 11. More Options• Bedside audio recorder – Pick up snoring and apneas – Time consuming to review• Fitbit or Jawbone (accelerometer) – Sleep quantity, not quality – Confounding variables• Zeo (3-lead EEG) – Sleep quantity and quality – Relatively nonintrusive – ?Motion artifact and data reliability
  12. 12. Zeo Data
  13. 13. Quant-Ready• 48-year-old computer engineer• Severe episodes of fatigue, nausea, anxiety• 6 medical specialists – tests unrevealing: “go see a psychiatrist”• Patient asks: role of environmental, dietary, emotional contributions to symptoms?• Highly motivated to do something different
  14. 14. Current Options for Self-Tracking:Symptom Diaries and Spreadsheets
  15. 15. Current Options for Self-Tracking: Sensors and Apps
  16. 16. Technical challenges• N-of-1 experimental design• Sensor technology• Tools to collect subjective data• Standard data formats and APIs• Platforms to aggregate disparate data• Visualization tools to find meaning in data
  17. 17. Medical practice challenges• Common vocabulary to enable quant-patients and doctors to communicate• Innovative medical practice design – Direct practice model• Case reports and use cases• Research documenting cost and outcome benefits
  18. 18. Q: How can doctors best engage with self-trackers?Q: How can self-trackers find adoctor open to this approach?
  19. 19. More Opportunities• Community of quant-friendly doctors• Communities of self-trackers – Quantified Self – Society of Participatory Medicine (e-Patients)• Educational materials to help patients and doctors learn about self-tracking
  20. 20. Doctor Medical Group San