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On having a therapeutic relationship with your PC

rmhipmt1 July 2009

My kids can expend a fair amount of energy waving Wii handsets around. I have a colleague whose hi-spec laptop could be used for weight training. But, by and large, computers don’t help you exercise. Interesting, then, to learn about this project in which school children were given pedometers and encouraged to record the amount they walked on a website. Different classes in the school then competed to see which would first complete a virtual journey. At the same time the website allowed them to monitor their eating and advised them on healthy living.

These kinds of applications are sometimes called ehealth interventions. We used to talk about something called telemedicine, in which some form of telecommunications technology connected patients with doctors. The problem with that was that the difficulty in healthcare isn’t, for most of us in the West, that the doctor is too far away, it’s that he or she is too busy. Giving patients another way to get at the doctor doesn’t help with that problem. So people started to think about telemedicine as a way of connecting patients with some kind of service that might replace a doctor. NHS Direct is a scheme of this kind. But the assumption was that the transaction would be little more than an exchange of information. Patient sends data up the way, service provider sends advice down the way.

What is interesting about the way ehealth is developing, is that we are seeing applications where the ‘magic ingredient’ in the intervention isn’t advice. In one application patients use mobile phones to send blood glucose measurements to a company. The company then supplies them with feedback based on their measurements. This helps them in their self-management. There are also applications on computers that deal with depression, drinking problems and such conditions. A recent meta-analysis found the web or computer-based tools were effective in smoking cessation.

The interesting idea here is that we can consider ehealth applications where patients aren’t consulting a physician or looking up information, or necessarily receiving any kind of conventional healthcare advice. These applications work because they engage the user in a process which helps them learn to change their behaviour. It’s a kind of therapeutic relationship. But with a PC.