What if the doctor had watched but never?

This new system for monitoring and collecting patient data has recently been made wireless. It is being tested on patients at a hospital in Birmingham, England, but it and similar remote systems may be used in patients’ homes in the future. The more I read about this topic, the more I realize that remote patient monitoring can fundamentally change medicine: speed up medical response and improve health outcomes; redevelopment of care areas; but it can also change in ways that we may not welcome The idea of ​​a doctor like me.

To watch closely Since ancient times, patients have been the universal duty of all physicians. For thousands of years, doctors have used their senses to assess the condition of patients. Even now, our doctors are trained to recognize the hard and sweet breathing of a diabetic patient, the slamming of a glass bottle when there is a blockage in the intestines, and the cold and clammy sensation of the patient’s skin when the bloodstream s ‘stopped. But the systematic recording of digital observations is a surprising new phenomenon.

In the late 1800s, the instrument was designed to measure a set of standardized health indicators. These are the four main vital signs: heart rate, respiratory rate, body temperature and blood pressure. Just before the turn of the last century, these vital signs (also called observations) were systematically recorded for the first time after First World War They are often used. Research on these charts shows that when these vital signs are normal, people hardly die; the heart does not suddenly stop. But for nearly a century, the art of interpreting these so-called obs paintings was as mysterious as reading tea to the untrained.

Then, in 1997, a team from James Paget University Hospital in Norfolk, England developed an early warning system that nurses can use to quickly convert vital signs into scores. If the score exceeds the threshold, it is a sign that a doctor’s help is needed. Such systems have been regularly promoted for use in adult patients, but it is not clear whether they are suitable for children, as children have different physiological responses to disease than adults.

Heather Duncan was familiar with the early warning system for adult patients in 2000, when she was working as a general practitioner in South Africa with a keen interest in children’s health. Usually, observations made in hospitals are unrelated to observations made in primary care clinics early on. But Duncan tried to connect these two sets of data – from the community and the hospital – to create a more meaningful, ongoing story about what happened to the patient. She has taken the trouble to review the records of her most critically ill children, tracing their vital signs, from their first record in a primary care setting to their discharge or death in hospital. “I noticed the kids had cardiac arrest or entered the intensive care unit, and we actually missed the opportunity to take further action,” she recalls.

Her nagging feeling that she could do more for these children was later confirmed by the UK government. Confidential investigation into child deathsHe found that more than a quarter of children in National Health Service hospitals died from preventable causes. In 2003, Duncan completed an intensive care study at Toronto Sick Children’s Hospital, where she and pediatric intensive care physician Chris Parshuram developed the Pediatric Early Warning System (PEWS), a bedside scoring system designed for sick children.

Duncan is now a pediatric intensive care physician at Birmingham Children’s Hospital. Last October, I found her on Zoom. Duncan was working from home, wearing an oversized cream wool sweater, welcoming autumn to England, her hair was done in a loose bun, and she wore blue-rimmed glasses to match her eyes. She speaks with an elegant South African accent and a calm demeanor. Working in such a stressful profession is definitely an asset. His hospital adopted the PEWS score in 2008 and saw reduce The number of children who died after cardiac arrest – from 12 in 2005 to no deaths in 2010.