Doctors, engineers, and medicine
There is much that doctors and engineers can teach each other. I gained this insight after two years of exercising and talking with a doctor friend four to five times a week. Doctors can help us engineers sharpen our listening skills and be more empathetic with the users of our designs – we can be notoriously tone-deaf. Engineers can help doctors embrace one of our core principles: if the fix (cure, treatment, etc.) doesn’t work and work well, then stop relying on it and find a better solution.
Consider, for example, the diagnosis, treatment, and control of high blood pressure (hypertension). The scope and costs of hypertension are staggering. The CDC estimates 116 million US adults (47%) suffer from hypertension, that between 24 and 36% are undiagnosed, and less than one quarter have it under control. More than half a million deaths in the US listed hypertension as a primary or contributing cause in 2019. Research suggests that hypertension was a contributing factor in about half of all strokes. The economic costs are estimated to be between $130 and $200 billion per year.
How effective are legacy diagnostic, treatment, and follow-up strategies at controlling hypertension? Research and performance data on treatment efficacy suggest that there are broad opportunities for improvements. A recent study published in the AHA Journal concluded that uncontrolled blood pressure “is highly prevalent in patients with pharmacological treatment for hypertension. More than 90% of stroke in this group occurred in those with uncontrolled BP.” More broadly, researchers have identified poor patient compliance during diagnosis, treatment, and post-treatment monitoring as a key contributing factor.
Patient noncompliance is aggravated by cumbersome, uncomfortable, and time-consuming protocols based on multiple office visits and older cuff-based ambulatory pressure monitoring (ABPM). Patients monitored with legacy technologies are fitted with a hip-mounted monitor and pump that inflates a wearable cuff every 15 to 30 minutes. They then return the device to the clinic after one to three days and their data is downloaded and sent for analysis, which can take several days to a week. Doctors review the results and use the analysis to formulate patient-specific treatments, monitor patient response, and adjust dosage as needed.
Sounds logical, but – Is it working? Studies estimate that 30% of patients quit ABPM monitoring before completing the protocol and, of those clinically diagnosed with hypertension, 50% stop all treatment within a year. The results speak for themselves. Existing protocols based on legacy technologies have proven broadly ineffective yet remain in place in part because there have been few practical alternatives. Thankfully, new technologies have introduced more effective, patient-friendly, and financially sustainable alternatives. I will share a representative solution and use cases in my next posts.