The Irish Medical Times - Beyond the Waiting Room: A New Era of Patient Empowerment in the Age of AI
I currently have a tooth abscess from a failed root canal, a common but unpleasant predicament. I was on vacation in Mexico when I woke up with a blister on my gum. I had a traumatic memory of having an abscess as a teenager. At that time, half my face swelled up like a chipmunk. I was in such agony I fashioned a sling from a scarf which I slung under my jaw, tied in a bow on top of my head to prevent even the slightest chin movement. I remembered staying up all night with my makeshift Wee Willy Winkle head scarf tightly in place until my parents awoke and took me to the dentist.
Thankfully, this time around my face behaved itself, no swelling, and the pain was mild to moderate, responding well to painkillers. With Girl Scout proficiency I had even brought some spare antibiotics on holidays with me. Not because I was planning a drug fueled wild party where everyone snorts Amoxicillin three times a day followed by shots of probiotic yoghurts, but to save me in case I encountered a bacterial infection (I have no spleen to fight the microbes).
At some point during my self administered course of antibiotics my abscess ruptured, leaving that sudden taste of death and metal in your mouth. The pain reduced considerably and I was free to continue to enjoy my holiday swimming with dolphins, parasailing, and dancing among the skulls and skeletons at the Day of the Dead festivals. During the dolphin swim the guide asked if I wanted to kiss one of the dolphins, “Absolutely not”, was my firm response. “He has over 100 teeth,” cooed the guide, again, this fact did not entice me. They are beautiful creatures with surprisingly soft skin, but I have to draw a line somewhere - at least buy me dinner first!
Although my abscess has receded and has not impinged on my life (with or without dolphins) it is still sore when I touch my face or put certain pressure on the tooth, a residual amount of infection remains in a pocket of the root. Since returning home I have seen dentists and doctors regarding this tooth and I am now on a waitlist for a consultation.
Part of the delay in treatment is my own reluctance to have the tooth pulled for aesthetic reasons, it sits on the top row near the front. I know there are replacement options but I’m a patient with issues that often has my options close off as they are attempted. I am a little fearful of looking like a toothless pirate for the remainder of my days. In retrospect, maybe I should have asked for that dolphin’s number.
As I wait to be seen, and the weeks go by, I start to weigh my fear of looking like a pirate against my concern of the infection spilling into my bloodstream leaving me open to sepsis (which I can’t fight without a spleen), not to mention infective endocarditis which my cardiomyopic heart and regurgitating valve may struggle to survive.
In the case of my particular tooth I believe the risk of infection moving into the bloodstream is low. But as time goes on, while I wait for an appointment, my cumulative risk increases. I am a product of our siloed healthcare system where my care is spread across different hospitals both public and private. In fact, if this current wait proves too long I may have to seek private care, pulling myself out of the public arena where I have put in a lot of time and effort making myself and my complex history known.
We can all agree our current healthcare system is overburdened, but could an AI driven app allow interested patients with co-morbidities to ascertain their own unique cumulative risk? It could be updated by the patient dynamically as symptoms change, providing suggested time frames on when to seek further treatment.
There seems to be a trepidation about giving patients too much power, insight, choice around their own care. I sense a concern from some corners of the population that if we use an app it could spread fear, misdiagnose, send well-worriers to A&E clogging up the system, or in turn the app could misjudge severity and advise a very sick person to wait, and so on. However, in these times, it's fair to assume most people (or their loved ones) have already googled everything before they left their house, that ship set sail in about 1998 when WebMD hit the internet. Surveys suggest 90% of patients google their symptoms before calling or scheduling an appointment with their healthcare provider.
There are apps used by some hospitals and clinics that are aimed at their own patients with specific diseases to monitor for symptom escalation e.g. heart failure, COPD, etc. However, for those of us with a plethora of complications who don’t fall neatly into one basket of care, who don’t have a nurse they can call, we monitor ourselves and have to make escalation calls based on our own observations - where is our app?
A health risk calculator app would not just benefit patients with co-morbidities, some people who are getting sick for the first time in their lives could use it to work out what warrants a GP visit, versus an A&E trip, versus a Lemsip and an early night. Carers who are not medically trained but look after an elderly or sick relative or friend could use it to gauge how quickly to act.
I’m not suggesting an AI app should replace the advice from a healthcare professional or replace them as your first port of call for treatment. Human doctors and nurses can take into account your presenting problem and your history, while also remaining cognizant of how the system works, what the wait list looks like, how to speed things up, what alternative routes of care may exist, and importantly, when to de-escalate and provide reassurance.
But unless you are closely involved or related to the medic, they are probably not going home with you, they are not seeing you day to day while you wait on a list for specialist attention. The app could simply assess your risk as you wait. Of course, user error and glitches will occur, but the in-person experience is also not without its miscommunication.
I believe the public should have access to a Health Risk Calculator app to assess our danger as we sit on waiting lists, especially for people who are vulnerable.
We use risk calculators to determine our likelihood of heart attacks, developing cancer, people even look at their phones everyday to assess the chance of rain. Maybe if there had been a risk assessor for kissing dolphins I could have had a whale of a time. We’ll never know.
As we continue to embrace innovation in healthcare it's imperative to ensure that these advancements are accessible to all. By leveraging AI driven tools we can empower individuals to make informed decisions about their health, streamline care processes, and ultimately enhance the overall quality of healthcare delivery.
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