This piece, “Band-Aid Solutions: Being Sensible About Physiologic Monitoring", appeared on page 30 of the Spring 2024 issue of Chicago Life Magazine.
In medicine, as in everything else, it is not always better to have more data, particularly when you don’t know what to do with it. The reams of data being generated today by personal physiologic monitors may raise our anxiety level without contributing to our health.
It can be viewed using this link: Chicago Life Magazine - Band-Aid Solutions: Being Sensible About Physiologic Monitoring
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In 1984 I made one of my most cost-effective purchases ever. I bought a Toyota Land Cruiser, an SUV built long before SUVs were a thing, famous on every continent (except maybe Antarctica) for its performance and durability on the roughest of outback terrain. Thanks to my new vehicle's prowess at plowing through snow drifts between my country home and the hospital, I caught a number of newborns I'd otherwise have missed because of bad weather. The Land Cruiser paid for itself in about a year. (Wisconsin winters were way more severe in the old days.)
Superb machine though it was, like everything else in the world, including human beings, things still went wrong sometimes. I struggled with a check engine light that no mechanic, not even at the Toyota dealer, could find the cause of. The vehicle ran just fine. One day my wife fixed the problem with a Band-Aid. She put it over the warning light on the dashboard and we never worried about it again.
I told this story to a friend who'd called me the other day, concerned about what the physiologic monitor he constantly wears on his wrist had to say about his pulse. It happened on the third or fourth day in a row of playing tennis, paddle tennis or pickleball. After a game in which his pulse had reached its conditioning target range it did not return to the resting baseline as fast as the books said it ought to. He felt fine. “Is this cause for concern?” he asked.
My friend is the best conditioned 80 year-old I know. Five years ago, before he'd ever strapped a physiologic monitor to his wrist, he was the fittest 75 year-old I knew. I wonder if the device has actually detracted from his quality of life by increasing his anxiety, without helping him be one bit healthier.
The bathroom scale is another instrument that measures a physiologic parameter that may be crucial to health. Daily weight can be especially important when tracking congestive heart failure, for example, because it serves as a good proxy for water retention. Unfortunately, weight measurement also plays right into our culture's endless concern with thinness. I have seen many patients who literally let their bathroom scale decide what kind of day they're going to have. If first thing in the morning their weight is down, it'll be a good day; if up, a bad one.
Then there's the clock as a medical device. My college roommate compulsively kept track of how many hours he slept every night. He had convinced himself that if the total fell below eight hours he was in for a hard day, which became a self-fulfilling prophecy.
Before I retired I made it a point to leave my wristwatch at home when I was on vacation. Losing track of time put me in better touch with some of the natural biorhythms that my modern lifestyle had sacrificed to rigid schedules. Even on vacation I paid attention and still do to roughly how many hours a night I sleep, knowing that if I can keep it in the seven to eight hours range it will enhance my sense of wellbeing and my overall health, including even my weight. I weigh myself now and then too.
A wrist monitor would tell me (somewhat inaccurately) how many hours I've slept each night and it would report (a little more accurately) how many steps I've taken. I'm all for counting steps if doing so motivates you to take more of them; not so much if worry over reaching your daily target becomes yet another stress. (BTW, 10,000 is a pretty arbitrary goal.) If you are prone to heart rhythm disturbances I certainly recommend wearing a monitor to alert you immediately, as well as emergency medical services, when there's a problem.
Nowadays a continuous glucose monitor is de rigueur for managing insulin dependent diabetes. These devices have only recently been paired, via sophisticated software, with reliable insulin delivery systems to make up an “artificial pancreas” that controls blood sugar continuously and automatically, significantly better than is achievable with multiple daily finger sticks and injections. The more blood sugar remains in an ideal range the fewer diabetes complications, including acutely dangerous low and high glucose levels, and in the longer run, risk of loss of retina, limb, kidney, heart and brain. The whole setup feeds data to the cloud, where it makes invaluable information available to patients, health professionals and caregivers for fine-tuning management of this challenging disease.
Physiologic monitors continuously generate tons of data that are sliced, diced, graphed, and stored in the cloud. These devices can be programmed to share this data with healthcare providers. Studies have not yet been done that outline a general path for well patients to collaborate with health professionals in using most of the uploaded gigabytes in ways that actually make people healthier. Speaking for my colleagues and me, we'd just as soon you didn't share so much.
Here's a little follow-up on the Land Cruiser. We had it repainted jungle green, a hue our sons favored. They drove it until they graduated high school, including, we learned later, racing it around a vacant field on a home-made obstacle course filled with jumps and muddy holes. After the boys left home, behind the wheel of the impractical replacement vehicles they'd chosen for themselves, I sold the old Cruiser to a cellist friend who needed an inexpensive, reliable way to haul his instrument. When I visited him a few years ago the vehicle was parked on the street in front of his Denver home. Barring a few rust spots on the faded jungle green body, with new tires, battery and clutch, the SUV was still in tiptop shape at 200,000 miles. I didn't think to look for the Band-Aid on the instrument panel.
