An Australian company has developed a smart phone app that remotely records cardiac rhythms. It can capture atrial fibrillation, a wide complex QRS and maybe even an early MI. But a smart phone saving a life isn’t the only medical app that is paving the way for the future of medicine. The monitoring and treating of diabetes, hypertension and PTSD is also now available. According to industry estimates 50 percent of the more than 3.4billion Smartphone and tablet users will have a mobile health app by 2018.¹ Growing at 20 percent a year both consumers and physicians recognize consumer medical apps value for improving health and increasing compliance.² But to every yin there must be a yang.

My yang came about a month back when I was in the Guatemala rainforest getting in touch with my explorer side when I realized I lost my phone. Has that ever happened to you? I panicked… what was I going to do? How would I get back? And how would I take pictures. But mostly I feared private information, access to my bank accounts and passwords being compromised. It’s hard to believe that for 30years of my life I travelled and survived without a cellular phone but now it felt like I had lost my wallet or worse… fortunately about an hour later a taxi returned with my phone. “Muchas gracias” I said in my poor accented Spanish. I was thankful but it made me stop and think...how has the smart phone changed my life and the world?

As a 3^rd year resident I got my first mobile phone. It made my life a lot easier, now if paged I could immediately call back and not have to stop at a phone booth. (Millennials: Note phone booths were the glass enclosed closet located on street corners. We would put quarters into a pay phone and make a call to a landline.³ But I was embarrassed to talk in public on a cell phone, it seemed rude. So I would politely step outside even if it was below freezing to take a call. To this day I still feel uneasy talking on the phone publically. I would contrast this to the loud smacking power broker sitting next to me on the plane who has no concerns letting the whole aircraft know about his indigestion from the French onion soup he had for lunch.

However, over the last decade the phone has morphed from a device designed for remote verbal communication to a self-contained entertainment, information and pleasure toy. Early phones had primitive messaging but the insemination of the phone by the internet has birthed the smart phone, I would venture to guess it is probably the single most identifiable device responsible for changing the world the greatest over the past 50years. I remember, 15years ago travelling through the rural country side of an Eastern Bloc country after the fall of communism and local village people curiously gathered around me to see what I was doing on a hand held Blackberry. Fast forward to the present and regardless of age culture, religion, color or creed the smart phone has become a staple appendage even in the most remote corners of the earth. It connects all highlighting the similarities between all humans.

However, when 23rd century historians look back how will they categorize the impact the smart phone has had on society and the profession of medicine? There have been enormous strides made in humanity, safety, information gathering, dissemination and education all because of the smart phone however, could the smart phone also be the strongest mood altering substance since opium? I am going to suggest the “Hydrocodon-phone” is a 21st century drug, with dangerously addictive properties. Look no further than the 1.6million car accidents per year and nearly 4000 deaths per year attributed to those who “DU I phone.⁴ And if you think that mature reasonable adults are capricious with their phones...try pulling one out of the hands of a teenager. All struggle with discipline and moderation when it comes to primitive urges but it can be especially wrenching for teens who lack maturity of temperance. The Hydrocodon-phone has all the elements of an addictive drug: mood altering, increasing tolerance and withdrawal symptoms. The Hydrocodon phone offers the perfect escape for an uncomfortable or socially awkward moment. And nowhere is this more apparent than when getting into an elevator…today not only is it rare to get an acknowledgment or a “hello” but a troubling invisibility is approaching. Politely engaging in conversation about the weather or staring blankly up into space is no longer necessary, now we can take a hit from a four inch screen satisfying an urge to feel immediately at ease. And for those who need a quicker high a screen can be wrist mounted for quicker delivery of soma.

Like any drug that has medicinal value, if abused it can lead to destruction. And the isolated cocoon weaved to protect an awkward back side may diffuse into an uncontrollable self-indulgence that can destroy relationships. As we are transported to a virtual world instantly connected to all others minute by minute, we become occupied but not present in the moment. And while the phone today is an amazing advancement in long distance connections allowing instant sharing of a story with hundreds if not thousands of people around the world, and for maintaining ties with family and friends overseas. The irony is that nothing steals an intimate moment from the one closest than a phone. How hurtful or insulting when a phone is placed face up at the dinner table? Your meaningful story can be swiped out and dismissed by a confidant more interested in the next Facebook alert. According to researchers at Baylor University nearly 50 percent of respondents have felt insulted by “phubbing” a new word meaning being snubbed by a loved one because of phone interruption. At least 23 percent felt it had a negative impact on the relationship even leading to feelings of depression in over a third.⁵

And how we communicate has changed more in the last 5years than in the 2000year leap it took to go from hieroglyphics to alphabet letters. We have an emerging generation that communicates better in 140 characters, emoji’s and acronyms than in spoken words. Although I am sure the early 1900’s had comparative dilemmas when the telephone encroached on the written word, but there is something so uniquely one dimensional about communicating via the smart phones that it can’t be overlooked. Texting and social media allow communication on a time frame that best fits one’s schedule as opposed to a phone conversation that forces engagement in the moment. It is impossible to have a one way phone conversation. I have to admit I am a fan of the “communicate when you wish” aspect of texting, a great tool for multitaskers. It allows a say when we feel like it.. and if we want to fire off a quick note and selfishly not wait for a response we can do that too. For the ADD and those always needing to get in the last word, what could be better? It seems that human culture has finally caught up with them. But what will be the impact on human interaction and socialization when the influence of the smart phone is fully realized?

Will the disuse atrophy of interpersonal communication skills and an inability to be alone with our thoughts slowly erode our evolutionary advantage to reason, actively ponder, reflect and imagine? From Einstein to Freud to Jobs many of the greatest advancements in human culture stem from those who learned to experiment with detailed thoughts in their minds to create manipulate and extend the boundaries of science.

Closer to the here and now, how does and will the smart phone impact aesthetic medicine? For many it already is providing an important added measure of comfort allowing an ability to see post operative concerns in real time. Soon it may be an acceptable standard for performing imaging and virtual consults from anywhere in the world. And just as orthopedic surgeons are reporting a burgeoning business of carpal tunnel phone syndrome, there is some thought that aesthetic physicians will be seeing more patients with NWPS (neck wrinkle phone syndrome) secondary to looking down to view a phone.

Perhaps the phone will be able to determine where skin damage lies, measure laxity and help to virtually schedule a laser or chemical peel. Perhaps a phone will allow patients to capture and create an idealized 3-D image of a nose that can be printed and delivered to offices only needing to be inserted under the nasal skin in a quick procedure. A smart phone doing surgery is fortunately hard to conceptualize, thankfully so as if it could we might be out of a job. Yet crazier things have happened…The future of how the phone will affect our field is fascinating to consider…and while we continue to praise the phone and its aid in medical convenience, diagnostics and monitoring we have to be cautious. In aesthetics as in life the most important contributor to well-being and patient satisfaction distills down to effective and meaningful communication. Embracing the emerging value of the smart phone to the advancement of our field is prudent. However, equally critical is to not overlook the need to master the art of empathetic face to face communication. Maybe it’s time to occasionally put down the phone and better engage those in front of us. How we interact, treat and advise those who rely on us maybe the keystone to not only securing our profession’s future, but to maintaining a sense of serenity as well.

None.

Author declareas there are no conflicts of interest.

None.

1. Mobile Medical Applications. FDA. 2015.
2. Joseph C. Easy on those apps: Mobile medical apps gain support, but many lack clinical evidence. Modern health care. 2015.
3. https://www.youtube.com/watch?v=p0B1ufyXOds)
4. http://www.textinganddrivingsafety.com/texting-and-driving-stats
5. http://www.huffingtonpost.com/entry/cell-phone-hurts-relationships-phone-snub_us_560c0cdee4b0dd85030a1c4e