It wasn’t too many years ago that the humble medicine cabinet simply contained some plasters and aspirin. Nowadays, it seems to be bulging at the seams with all kinds of tablets and a variety of home diagnostic equipment.

During the pandemic, we all know it became harder to see a clinician. So, many a household rushed out to get a pulse oximeter and a thermometer to see if they actually had COVID or not. Other equipment may have been a BP monitor or am-I-a-diabetic-as-yet kit. Furthermore, this turbo-charged home first aid box is not the only place where we can look out for our health, as many people have now extended their medicine cabinet to their wrists. Yes, that clever smartwatch can do all kinds of wizardry to help you monitor vital signs.

But the nagging question is, can this uncalibrated and usually cheaper kind of monitoring equipment be trusted?

I was talking to a GP the other week about this very subject. Someone had told me that they were feeling really grotty and had central chest pain. Their resting pulse was 150, but all was well because their Apple watch confirmed that they were not in VF… This person was 17 years old, and also my son.

I had, once upon a time come from a clinical background, and knew that central chest pain wasn’t good. The pain was radiating through his chest, but not going down his left arm, and he had no shoulder-tip pain. The pain was, in his words, 7 out of 10, and lasted for no more than five minutes, coming on after lifting or exertion. He wasn’t grey, but he was clutching his chest and obviously in lots of pain. I confirmed his pulse manually and yes, it was actually racing and regular and, it was not some technological glitch.

Our first port of call was the NHS website, which said don’t bother A&E if the pain lasts for less than 15 minutes; contact your GP instead. This was late in the evening, so we both decided to heed the advice and call the GP first thing in the morning. I got through to triage the next day, and the GP called me back almost immediately, horrified that I hadn’t called an ambulance the evening before… So, I duly took my son to A&E.

Several blood tests, an X-ray and ECG later, we were told that it wasn’t a cardiac problem and sent, with a flea in our ears, back to primary care. However, a few days later, the same problem occurred.

What to do now?

I contacted the GP again and, this time, we attended a F2F appointment and my son had a recheck of his ECG. But when the GP pressed on the centre of his chest, he hit the roof in pain…  “Ahh,” she said, “that’s almost certainly an inflammation of the sternum, or costochondritis in great Scrabble speak.”

So, the moral of the story is this: trust that bit of uncalibrated equipment that not only can tell you the time, take a call and inform you how many steps you have not done that day, it can also tell you if you’re about to depart this earth!

As you can imagine, all of this got me thinking – especially when it came to planning a policy to support the CQC’s GP mythbuster 102: Pulse oximetry and monitoring vital signs outside the GP practice. While I was writing, I recalled the recent mini drama and set about trying to expand the policy to incorporate other monitoring equipment that can support the visiting clinician to a care home, or actually what happens when reception gets a call from a worried patient who advises that their home monitored readings are not quite normal.

I also read the success stories that have been told about smartwatches. There are several of them here, and they’re all pretty humbling… If only I’d bought some shares in Apple at the start of the 21^st century!

The policy is now finished and you can find it here Clinical guidance document – Monitoring vital signs outside the surgery [PLUS]. It offers information on vital signs from pulse rate to blood pressure and temperature, and the importance of staff training when it comes to using and maintaining equipment. It also includes all forms of home diagnostic equipment, including smartwatches, but it does have the caveat that any self-tested readings provided by a patient should be double-checked by using the practice’s own equipment.

Progress… well almost!

Mat Phillips

Note:  My son was happy for me to post his clinical history for all to see!