The Royal College of GPs' James Mackenzie Lecture 2021

PRSB Chair, Professor Maureen Baker, gave the annual James Mackenzie lecture at the RCGP’s AGM in November.

If you looked at your phone right now, you would be able to monitor your BPM, sleep schedule and daily step count in little more than two clicks. In this sense, we are all already self-directed patients, meaning that we are using electronic wearables and handheld devices to track our health in our everyday lives and from the comfort of our own homes.

Last week, I had the honour of delivering The James Mackenzie Lecture to my colleagues at the Royal College of GP’s AGM, on the topic of the self-directed patient and the future of medical wearables for self-management of health. On researching the work of the eponymous GP, Sir James Mackenzie, I discovered that the cardiologist invented the first polygraph and used the device to record his own atrial fibrillation. In this sense, medical self-management is not new.

Today, however, the methods and tools used for self-management look very different. Over 80% of the world’s population now has a smart phone, which means that concurrently, most of us own a health wearable that can track various elements of our well-being. We all have the capacity to be self-directed patients by using existing devices that we are already well-versed in, which has many potential benefits and risks for both the individual and society.

There are many benefits to medical wearables. They have the potential to democratise healthcare, empowering patients with the information and knowledge needed to become an active participant in their own care. For the individual, this means understanding how to self-care where appropriate and control chronic conditions without having to wait to see a doctor. For wider society, the prevalence of health wearables could result in a healthier population more in tune with its lifestyle choices and their impact. For clinicians, wearables could help us to detect disease earlier.

However, many in the profession would be right to raise concerns over the reliability and validity of results from smartphones and consumer electronics for medical analysis. It is also possible that the use of health wearables could lead to an overdiagnosis based on an abundance rather than quality of numbers and observations, which side-lines the person and their individual needs and priorities in favour of metrics.

The answer to these concerns cannot be to reject wearables entirely. Indeed, the first wearable medical device has already been authorised: Withings ScanWatch is the first FDA approved medical wearable and monitors the user’s heart rate, ECG, sleep and blood oxygen. Whether we like it or not, wearables are here to stay and it is up to GPs to put forward our case for their safe regulation and use for the benefit of patients. If we fail to do this, the medical wearables market will continue to grow without medical input.

As people gain greater access to their own medical data, we need to ensure that they also have ability to turn the information they receive into knowledge. It is not enough to know the facts about your own condition, people must be able to analyse and assess those facts through observation and true understanding. Mobile devices, such as symptoms checkers, are critical here as they allow the user to input details of symptoms together with other relevant information such as age and then return possible conditions related to the user’s symptoms. In 2021, the ideal self-directed patient has access to high quality information that allows them to know when to seek professional help. 

When it comes to medical devices, GPs are on the frontline. We are the first port of call for patients when they record an unusual heartrate or are failing to get 6 hours of sleep a night, and we will be the clinicians monitoring and managing medical wearables. It is imperative that we take on this responsibility and begin to dig deeper into the risks and benefits of medical wearables so that we can make a clinical case for their use and continue to provide safe care for patients in the information age.

Watch Maureen’s lecture in full here

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