My iPhone in the Morning





When an ED patient is unable to walk to a nearby eye chart, Michelle Lin, MD, an assistant clinical professor of emergency medicine at the University of California San Francisco, whips out her iPhone and calls up a free application with the classic Snellen Eye chart. The applications was designed to be viewed from four feet away, just enough that the patients cannot grab her phone.

With the venerable program Epocrates celebrating its 10th anniversary this year, the use of “smart gadgets” in the emergency department is hardly news. Enthusiasm for the iPhone, however, with its ubiquitous commercials claiming “there’s an app for that” has emerged as favorite with its big screen and clear display.

In an article about iPhone apps for emergency physicians, Dr. Lin and her colleague Eric Silman, MD, a resident in the UCSF emergency medicine program, wrote: “Emergency physicians are the modern-day Batman of the hospital. We solve most problems with tools carried around our waist. What is the newest and most prolific tool on our Bat Belt?

Leon Gussow, MD, an assistant professor of emergency medicine at Rush University Medical College in Chicago, Illinois, and an Emergency Medicine News columnist, said the reasons behind using the iPhone are practical: “Easily available data and the ability to follow-up (e.g., web searches) if more information is needed.”

Not that the iPhone is perfect, he cautioned. “Some of the apps have cumbersome interfaces,” he said. “Typing in large search terms and then scrolling through the information returned can be tedious.” His favorites: Medical Calculator, MedCalc, Epocrates, and PubMed.

Eye Chart is the main application used by Dr. Lin. “I can’t imagine why everyone doesn’t use it. It’s free,” she said. Epocrates, the free medical drug reference available in a variety of platforms, is also available, although she concedes she does not use it because it requires such frequent updates.

“In the emergency department, we do things on the fly,” she said. “We need to know the answers to only a few questions.”

The Palm had garnered a large group of adherents in the past, and she said she sees allegiances split between devices that use the Palm platform and those that use iPhone. “Institutionally, we are more of an iPhone group,” she said.

Dr. Lin said the current enthusiasm for iPhone and mobile apps in medicine will only increase. “It is bound to make a bigger stamp,” she said, noting that medical applications are only the beginning. “There are so many ways to use the iPhone besides bedside clinical care.” Sending information to consultants is one. “You can take a picture of an open fracture, and send it to the consultant electronically,” she said. The emergency physician can take picture of an EKG and email it to the cardiologist consultant.

She’s even seen the iPhone used to convince people that they have a scalp laceration that needs suturing, even when they are reluctant and perhaps even inebriated. “You take a picture with the iPhone and show it to them,” she said. The sight of the wound is usually all they need.

iPhones can be teaching tools as well. “During down times when you are teaching medical students and residents, you can pull up PDFs, images, and even videos that are appropriate. You could say, ‘Watch this video from the New England Journal of Medicine on lumbar puncture. I’ll be back in 10 minutes, and we’ll do one.’ The potential is limitless,” said Dr. Lin.

Patients also make use of their phones, she said. She has seen patients take photos of their x-rays and say, “I’ll just hold onto this.” That way if they have trouble getting their x-rays sent to the doctor’s office later, they have a copy.

A new application called Bump enables one person to send an image or a contact to someone else when they just bump iPhones. If the developers can make it possible to “bump” PDFs between iPhones, that could be used to transmit teaching information or even patient instructions or education. “There is creative stuff going on. Make of it what you want,” she said.

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