Medication via phone

I  remember the first time one of my children texted me a photo of a skin lesion. It was not a photo of my own child’s skin, but that of a college roommate’s, and the message was something like: “Hi, Mom, is this anything to worry about?” There was no identifying information — I couldn’t actually tell what part of the body I was looking at — and there was certainly no medical history. I tried to take it as a tribute — friends sitting around a dorm room, showing one another funny lumps and bumps, and up speaks my offspring: “Oh, my mom will be able to tell you what that is!”

The intensity with which teenagers live on and through their phones is hardly news. Many parents find themselves trying, and often failing, to legislate phone use at the table and at bedtime. So going away to college does mean, among many forms of independence, phone freedom. Telemedicine has been much in the news as researchers investigate how technology can extend the reach of medical services and a host of startups and app developers look for ways to incorporate medical care into our relationships with our devices.

And so in pediatrics, there is discussion about the potential for making health part of that adolescent connectedness. Some research shows that adolescents are open to at least certain aspects of medical care delivered by phone and a variety of efforts are underway to incorporate texting into health and mental health services for adolescents, to extend the reach of counseling services and even to provide help to teenagers in crisis.

Useful documentation
It’s a truism in pediatrics that teenagers are often frustratingly vague about their symptoms — how long, how severe, getting better or worse. Their readiness to document their lives via cellphone can be highly useful since what used to be hard-to-pin-down stories in the office are now often illustrated. “Even when it’s not long-distance communication, it improves communication because they think to use the phone to take a picture of the rash that they can show you when they come in to see you,” said Dr Cindy Osman, a clinical associate professor of pediatrics at New York University.

It also seems to be a truism in pediatrics that parents who work in medical fields develop a strong sense of what you can diagnose by text and by telephone. One pediatrician friend told me a story about getting a my-throat-hurts text from her college-age son and assuming it was a viral infection, likely to get better by itself, until he called and she heard his changed tone and the amount of pain in his voice, and sent him to get the strep test he needed. Miki Conrad, who worked as a critical care nurse in Olympia, Washington, for 35 years, has four children, now in their 20s and 30s, who have been texting her with their medical questions and sending photos, since they left for college. “They sent a lot of photos — oh, I kicked so and so in the shin, look at my toe,” she said. “And then pretty soon they started to send photos of their friends’ rashes, injuries.”

Patrick K FitzGerald, the vice president for entrepreneurship and innovation at Children’s Hospital of Philadelphia, said that “to some degree we are all self-diagnosing nowadays,” using various sites and tools on the Internet. The question, he told me, is how hospitals can incorporate that into their patient care “so people are getting the right care at the right price.” Dr James P Marcin, a pediatric critical care specialist at the University of California, Davis, was the lead author on last summer’s American Academy of Pediatrics policy statement on telemedicine and how it can be used to improve access to care for children.

Reducing barriers
The recommendations included a general push in the direction of reducing barriers, increasing research, and compensating physicians who provide medical care through devices, along with warnings about the dangers of fragmented medical care. “Adolescents live on and through these devices, and people are trying to evaluate the pros and cons of doing medically related activities on these devices with a lot of varying success,” James said, pointing to sites that allow teenagers to discuss how they live with chronic diseases, while warning that these might not always offer the most reliable advice. “I think that as providers, we need to work with the developers of these technologies and the teenagers we’re trying to serve to come up with something that works better for them.

Miki, whose children are athletic, has diagnosed broken toes from texted photos and reviewed photos of turf burn from indoor soccer. “They’re not kids who call me every day or text me every day,” she said. “I almost welcome their little gross photos of things — it made me know they were doing OK and they did know if they had some kind of physical problem they could just call.”

I feel the same way, I guess, although I often end up saying, “If it’s really bothering you, you might want to let a real person take a look.”