Exploring the intersection of self-trackers and doctors, a la Quantified Self.. Thoughts from a practicing physician and engineer Paul Abramson MD (@paulabramsonMD) in San Francisco. @quantdoctor http://quantdoctor.com

1. Quant-Friendly Doctors
@paulabramsonMD
My Doctor Medical Group
San Francisco

2. Defining the Need:
The Self-Tracker
• Things that only doctors can order
• Professional guidance and interpretation
• How to present data to the doctor?
• How to have collaborative relationships with
doctors?

3. Defining the Need:
The Doctor
• Reliable feedback from patient
• Time and resources
• How to help the complex patient?
• How to help patients change behavior?
• How to have a more satisfying and sustainable
medical practice?
• QS = “The real health care reform” ?

4. Types of Self-Trackers
1. “Hardcore Quanters”
2. “Quant-Ready Patients”
3. “Pre-Quant Patients”
4. “Misguided Quanters”
5. Others
1. “Googlers” – self-diagnosis by search engine
2. “Random Quanter” – dabbles, doesn’t persist
3. “Pseudo Quanter” – reads, writes, doesn’t track
4. “Quantophobe” – fear of ‘becoming obsessed’

5. Hardcore Quanters
• Know exactly what they want from a doctor:
tests, devices, prescriptions
• Good insight into health
• Don’t want guidance or management
• Doctor’s role: reality check & facilitator
– Is patient sane?
– Are medical bases covered?
– Are proposed experiments are safe & potentially
helpful?
– Facilitates patient’s agenda: “Yes”

6. Quant-Ready Patients
• Often motivated by a vexing health problem
• Ready for a collaborative doctor-patient
relationship
• Interest in greater self-understanding
• Doctor’s role: physician and research mentor
– Identify problems amenable to self-tracking
– Help design experiments
– Identify the right tools
– Review and interpret data (close the loop)

7. Pre-Quant Patients
• Passive “fix me” paradigm
• Motivational interviewing to elicit opportunities
for change
• Self-tracking as an alternative paradigm when
they are ready
• Doctor’s role: supporter and motivator
– Meet patient where they are
– Provide good medical care in the interim
– Introduce concepts of self-tracking, feedback loops,
individuality, autonomy

8. Misguided Quanters
• “He’s orange”
An 94-pound adult focused on elimination
diets, food allergies, and symptom tracking
• “Extreme materialist”
A patient with obvious social-emotional
problems focused only on physical
parameters
• Doctor’s role: identify and steer
– Harm reduction model
– Meet patient where they are, unless imminent
danger

9. Example: Pre-Quant
• 92-year old woman, homebound
• Complains of “I can’t sleep,” poor memory,
anxiety, depression
• Passive attitude: “help me”
• Caregivers say she does seem to be sleeping
• How to figure this out?

10. Options
• Give her sleeping pills
– Cheap and easy
– Stops the complaints
– Creates an addict
• Get a polysomnogram (in lab)
– Expensive
– Inconvenient
– Rich data from single night

11. More Options
• Bedside audio recorder
– Pick up snoring and apneas
– Time consuming to review
• Fitbit or Jawbone (accelerometer)
– Sleep quantity, not quality
– Confounding variables
• Zeo (3-lead EEG)
– Sleep quantity and quality
– Relatively nonintrusive
– ?Motion artifact and data reliability

12. Zeo Data

13. Quant-Ready
• 48-year-old computer engineer
• Severe episodes of fatigue, nausea, anxiety
• 6 medical specialists – tests unrevealing:
“go see a psychiatrist”
• Patient asks: role of environmental, dietary,
emotional contributions to symptoms?
• Highly motivated to do something different

14. Current Options for Self-Tracking:
Symptom Diaries and Spreadsheets

15. Current Options for Self-Tracking:
Sensors and Apps

16. Technical challenges
• N-of-1 experimental design
• Sensor technology
• Tools to collect subjective data
• Standard data formats and APIs
• Platforms to aggregate disparate data
• Visualization tools to find meaning in data

17. Medical practice challenges
• Common vocabulary to enable quant-patients
and doctors to communicate
• Innovative medical practice design
– Direct practice model
• Case reports and use cases
• Research documenting cost and outcome
benefits

18. Q: How can doctors best engage
with self-trackers?
Q: How can self-trackers find a
doctor open to this approach?

19. More Opportunities
• Community of quant-friendly doctors
• Communities of self-trackers
– Quantified Self
– Society of Participatory Medicine (e-Patients)
• Educational materials to help patients and
doctors learn about self-tracking

20. Contact
about.me/paulabramsonMD
@paulabramsonMD
quantdoctor.com
@quantdoctor
My Doctor Medical Group San Francisco
mydoctorsf.com
office@mydoctorsf.com