Chapter 11
Handhelds for patients

Guest chapter by Dr Laura Dean

No matter how good the doctor, or how sound the medical advice, patients have great difficulty in making lifestyle changes. The diabetic fights a war against the glucose monitor. The dieter has to avoid the demons of fast food. When everyone faces a daily battle for health, how much can a seven-minute consultation with the GP help?

My mentors, Dr Andrew Sherwood and Dr Keith Redhead, taught me an important lesson: patients do not do what you tell them.

On reflection, I have never completed a course of antibiotics. So why do patients behave as badly as their doctors? People hate having no choice. What truly good GPs do is to empower the patient by giving them options. They allow the patient to decide the best solution for their own problem. With good advice from you, not only can your patient choose the best solution, but they will also be more likely to reach their goal. And they respect you more for it.

A handheld can help with every step of this way. First, you can use your handheld to help provide information to your patient. Second, the patient can use a handheld to help them in the very difficult stages in making changes to their lifestyle. Here are some examples of such software, classified in a way that would have brought tears to my pathology teacher's eyes.

Primary prevention

A perfect use of handheld computers is to keep the patient healthy by helping them maintain a healthy lifestyle. One of the most popular programs is Diet & Exercise Assistant. It gives sound advice on how to achieve a healthy balance by eating a varied diet and exercising.

The patient fills in some personal information - their age, sex and weight. Then it is up to them to decide what weight they would like to reach and over what period. The program calculates how much of an "energy deficit" the patient needs to maintain to reach their goal.

Diet & Exercise Assistant

Each day, the patient uses this program to keep a food diary. On paper, this is notoriously difficult to do, and patients often cheat at the end of the week by just guessing at what they have consumed. However, this program simplifies the chore because it comes with pre-filled lists of nutritional information for many foods. Moreover, the patient can add in other food. So it is relatively easy to choose the meal they have just had from a list.

Now, depending on what he or she weighs, and how busy their job is, the machine calculates the patient's basal metabolic rate (BMR). Finally, the patient enters the details of any exercise they have done.

The program calculates the balance of energy. A deficit of energy will lead to weight loss, while a positive balance will eventually lead to weight gain. This type of programme gives the patient the power to decide how to improve their health. By viewing the numbers, it becomes much simpler to balance input (food eaten) with output (BMR and exercise).
Another use of handhelds is in risk assessment, an area that the human brain is not very good at tackling. For example, when assessing the chances of winning the lottery, people are happy buying a ticket because the outcome can be positive. Negative outcomes, such as the chances of smoking leading to a heart attack, are played down. Perhaps that heart attack will happen to another smoker instead.

A cardiac risk calculator is useful when faced with this type of problem. The patient enters in their details, as they are currently: age, sex, weight, cholesterol level, blood pressure, family history and smoking status. The program then gives the probability of having a cardiac event in the next ten years. The patient can then see what would happen if they were a non-smoker or had lost weight.

You can certainly discuss the effects of taking blood pressure pills. Information is power.

There are also many programs targeted at women, including menstrual trackers and fertility calculators.

Secondary prevention

Handhelds are excellent tools for monitoring chronic diseases such as diabetes.

Healthengage Diabetes is a good tool for diabetics. Again, the user of this programme is in full control. First, the program asks for the target blood-sugar level. Then the user customises it by adding the foods he or she normally eats, any regular exercise and current medications. All the hospital test results can also be stored.

The patient, therefore, keeps track of food intake, as well as the exact time and units of insulin administration. Instead of mysterious, random and isolated blood-sugar results, the user and physician have access to meaningful accurate data. At a glance, each reading can be related to the time it was taken. A high value could have been just after a carbohydrate-rich meal, or perhaps the patient had noted feeling unwell that day; low values, in contrast, could be due to exercise being taken.

This detailed logbook of the control of diabetes can then be printed out or emailed to the GP or consultant.

Healthengage have many other similar products to help patients monitor their disease and stay well. These programmes range from those for people who have diabetes and asthma to HIV and depression.

Being overweight, asthmatic or a 'diabetic pincushion' is not fun. Being told what to do about it can be even less fun. But using a handheld gives the patient a powerful tool for actively managing their disease, and maybe teach their doctor a thing or two in the process.

Further information

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