Did you know that you can buy rapid strep throat diagnosis kits on Amazon? Probably the same ones you just schlepped to an urgent-care clinic to have a health care provider poke you with. The next time you stop at your local pharmacy, you can also buy the same temporal artery thermometer my pediatrician uses to scan a kid’s forehead for fever. While you’re there, you can pick up a glucose meter. Maybe you want an automated external defibrillator to keep in the kitchen? (I kinda do.) That’s no problem—the Internet can bring it to your house.
That’s in addition to the stuff you already know about—the pregnancy tests (likely as good as the ones I have in my OB/GYN clinic), the ovulation predictor kits, the blood pressure cuff, and more.
Combined, these technologies give you a diagnostic power not seen previously outside of a medical office. All the things I’ve mentioned are really just new versions of old technology, the way your iPhone is a new version of that card-punch monster computing machine that used to fill a room. They are devices or tests or pieces of treated paper that provide information about your body that we’ve been able to get for a while, but now they’re smaller, cheaper and (generally) better than the enormous laboratories or machines that used to get you that information.
I’m not saying you should buy all these things; after all, I’m a trained physician, so I know how to use these gadgets. I also have young children, so my house is a mucus-slimed germ factory of possible strep infection, often requiring multiple diagnostic assessments in any given week; your house might not be. But you can buy all these things, and overall that’s new and different. It might be new and different and terrible, or new and different and wonderful, depending on the situation.
Here is Fictional Scenario No. 1: A 19-year-old woman is 37 weeks into her first pregnancy. She has a slight but persistent headache, and because she lives with her mom she has access to a blood pressure cuff. She gets a reading of 142/96, which is lower than her mom’s, so she thinks it’s probably normal. Until, of course, three days later, she has a prolonged seizure at home, gets rushed to the hospital, and is diagnosed with pre-eclampsia, which has progressed to eclampsia. Of course, had her prenatal care provider known about the elevated blood pressure three days prior, that reading would have provoked further evaluation and likely initiation of the only cure for pre-eclampsia or eclampsia: delivery of the pregnancy. And that would hopefully have prevented the patient’s advance to a critically ill state.
That blood pressure cuff was, in this story, new and different and terrible. This is the health care provider’s nightmare scenario: a patient with some information—but not enough, not, crucially, enough—who gains the false confidence from her new home technology and does not pursue the care that could have averted a severe illness.
Here is more mundane Fictional Scenario No 2: A 47-year-old patient has a history of anxiety and asthma. She buys a pulse oximeter that fits on her finger and uses light to measure how much oxygen there is in her blood. She buys it on a whim, thinking it will reassure her, on the way home from her manicure. She doesn’t know that her chic navy-blue nails make it impossible for the machine to get a good read, and she stares at the number she sees—she knows it should be 97 percent, or 100 percent, not the 63 percent she’s seeing. She is scared. She calls an ambulance. She is taken to the hospital. She is, of course, not having an asthma attack. She has spent thousands of dollars of her own and her insurance company’s and possibly taxpayers’ money and wasted a lot of time (and possibly undergone a lot of avoidable, potentially harmful interventions).
But then there is Fictional Scenario No. 3: A 24-year-old misses a period. Fifty years ago, she would have had to go to her doctor to find out if she was pregnant, but today she just pees on a stick in the privacy of her own bathroom. Because she knows early and because she was well-counseled after being diagnosed with chlamydia six years ago, she knows to be concerned when that vague pressure in her abdomen becomes a constant stabbing pain. She heads to an emergency room, where an early ultrasound confirms an ectopic pregnancy—a pregnancy in her fallopian tube—that, left alone, could have ruptured and caused massive, occasionally life-threatening bleeding and possibly required surgery, which might have impaired her future fertility. Instead, because she is there early, she gets a series of injections and close surveillance by her gynecologist and gets better. And that is new and different and very wonderful.
And that’s the trick, right there, I think. You’re probably reading this on some sort of fancy technology with a screen, so you know already: It’s not the technology, in the end, is it? It never has been. It’s the information. Technology is just the way to get it to you. And part of that information is the information about the information—the permission and the power to know when and how to act on your new knowledge and when not to.
Because here is Fictional (but sadly not uncommon) Scenario No. 4: A pregnant patient comes in, reporting that her baby hasn’t moved for three days. She’s at term, 38 weeks; she’s scheduled for a prenatal visit tomorrow. The sinking feeling in her heart and in yours as you reach for a fetal heart monitor, hoping to hear something, something—that’s very real. The sight of that nonmoving fetal heart, the knowledge that we are two or three days too late; the delivery of the otherwise perfect—perfect but dead—baby: That’s something you only have to hear about once to never, ever want to have it happen again.
So let’s make it into Nonfictional, Very Real Scenario No. 5; we can do that, you and I. Now you’re a pregnant patient of mine, and at 28 weeks, I will give you written and verbal instructions on fetal movement counts. I will probably give them to you two or three times over the next three months, because if you’re in my office, you have a high-risk pregnancy, and because I think this is important. There are multiple protocols, but the one I use has patients hang out with their pregnant belly three times a day; if you get to four movements in less than an hour, then huzzah and go about your day. If you get to an hour without four movements, you can do a few things to get some movement going, and you can wait another hour. But if you have gotten to two hours without four movements, then I say: “Come into the hospital. Do not pass go. Do not collect 200 dollars. Just come see us.”
It is not new technology, my little piece of paper, and my little speech about fetal movements. But like the blood glucose monitor and the strep tests and the pee sticks, what it is is information; information about what is normal and what is not. More than that information, it is permission to take the information that your body is giving to you seriously. It’s permission to take your own perception seriously; to know when something is normal and relax; it’s permission to appropriately call on and utilize our vast health services for something as silly as fetal kicks.
And used properly—used with proper counseling and context—this little thrice-daily ritual is a powerful tool for the prevention of stillbirth. And this, I think, is the lesson of our new age, which is also the lesson of our old one: If you have information and know that you have information, you can do something powerful. The technology alone is new and different but neither wonderful nor terrible; although it’s nice to have your information on a screen, with two decimal places. That makes it feel real and legitimate today in a way that can be hard to achieve. But the technology isn’t the point; the knowledge is, and the power to use it is. And you knew that already.