NoMophobia, No More: Weighing the Promise and Perils of Smart Phones in Medicine and Beyond

Steven H. Dayan, MD, FACS

Steven H. Dayan, MD, FACS is a facial plastic surgeon practicing in Chicago, IL. He is Co-Chief Medical Editor for Modern Aesthetics® magazine.

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 myocardial infarction.¹ And this isn't the only life-saving app out there. Apps that monitor and treat diabetes, hypertension, and post-traumatic stress disorder are also now available. Fully 50 percent of the more than 3.4 billion smartphone and tablet users will have a mobile health app by 2018, according to the US Food and Drug Administration.² With a growth of 20 percent a year, both consumers and physicians recognize that medical apps can improve health and increase compliance,³ but to every yin there must be a yang.

My yang came about when I was in the Guatemalan rainforest getting in touch with my explorer side when I lost my phone, Obviously, I panicked! What was I going to do? How would I get back? How would I take pictures? But mostly I feared that private information; access to my bank accounts and passwords would be compromised. It's hard to believe that for 30 years of my life I travelled and survived without a cellular phone, but now it felt like I had lost my wallet or worse. There's a name for this feeling. It's called “nomophobia” (or no-mobile-phone-phobia), and it was up for inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM ) V.

Fortunately about an hour later, a taxi returned with my phone. “Muchas gracias” I said in my poorly accented Spanish. I was thankful but it made me stop and think about how the smart phone changed my life and the world.

From Pay Phones to Smart Phones

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

Sometime during the last decade, the phone morphed from a device designed for remote verbal communication to a self-contained entertainment, information, and pleasure toy. Early phones had primitive messaging, but once they joined forces with the Internet, the smart phone was born. I remember travelling through the rural countryside of an Eastern Bloc country after the fall of communism 15 years ago, and local village people curiously gathered around me to see what I was doing on a hand-held Blackberry. Fast forward to the present where regardless of age, culture, religion, color, or creed, the smart phone is a staple appendage. Everyone seems to have one, even if that is all they have.

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?

Phubbing and Other Phone Faux Pas

There have been enormous strides made in humanity, safety, information gathering, dissemination and education—all because of the smart phone, but the smart phone may 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 1.6 million car accidents and nearly 4,000 deaths per year attributed to those who “DUIphone” (drive while texting).⁴ And if you think that mature reasonable adults are capricious with their phones, just try pulling one out of the hands of a teenager. The hydrocodo-phone has all the elements of an addictive drug: It's mood altering. It increases tolerance and causes withdrawal symptoms. It is the perfect escape from an uncomfortable or socially awkward moment. Nowhere is this more apparent than when getting into an elevator. Politely engaging in conversation about the weather or staring blankly into space is no longer necessary, now we can stare at our four-inch screen and look busy.

Like any drug, if abused the smartphone can lead to destruction. It's not hard to imagine how it could destroy a relationship. As we are transported to a virtual world, we become occupied but not present in the moment. Yes, the phone is amazing in that it allows instant sharing of a story with 100's if not 1000's of people around the world as well as maintaining ties with family and friends overseas, but the irony is that nothing steals away an intimate moment like a phone. How hurtful or insulting is it when a phone is placed face up at the dinner table? Your meaningful story can be dismissed with a swipe. Nearly 50 percent of us have felt insulted by “phubbing” (a new word meaning being snubbed by a loved one because of phone interruption), according to research out of Baylor University's Hankamer School of Business in Waco, TX.⁵ What's more, at least 23 percent of study participants felt smart phones had a negative impact on the relationship even leading to feelings of depression in more than a third.

How we communicate has changed more in the last five years than in the 2,000-year leap it took to go from hieroglyphics to alphabet letters. We have an emerging generation that communicates better in 140 characters, emojis, and acronyms than in spoken words. I am sure that 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 phone that can't be overlooked. Texting and social media allow communication in 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, but that's not the case with texting. I have to admit I am a fan of the “communicate-when-you-wish” aspect of texting. It's a great tool for multitaskers. It allows us to have a say when we feel like it. For those with attention deficits or those always needing to get in the last word, what could be better? Yet, how will this impact on human interaction and socialization?

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?

Closer to the here and now, how will the smart phone impact aesthetic medicine? For many it provides an important added measure of comfort by allowing us 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 the American Academy of Facial Plastic and Reconstructive Surgery reported that one in three facial plastic surgeons surveyed saw an increase in requests for procedures due to patients being more self aware of their looks via social media.⁶ Orthopedic surgeons are reporting a burgeoning business of carpal tunnel phone syndrome, and there is some thought that aesthetic physicians will be seeing more patients with neck wrinkle phone syndrome (NWPS) 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? What if a phone could allow patients to capture and create an idealized 3D image of a nose that can be printed and delivered to offices? A smart phone that performs surgery is fortunately hard to conceptualize, thankfully as if it could, we might be out of a job. Crazier things have happened though.

The future of how the phone will affect our field is fascinating to consider. 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 for 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 securing our profession's future but to maintaining a sense of serenity as well.

1. Alivecor™ http://www.alivecor.com/

2. US Food and Drug Administration. Mobile Medical Applications.www.fda.gov/MedicalDevices/DigitalHealth/MobileMedicalApplications/default.htm

3. Conn J. “Easy on those apps: Mobile medical apps gain support, but many lack clinical evidence.” http://www.modernhealthcare.com/article/20151128/MAGAZINE/311289981.

4. TextingThumbBands.com. Texting and Driving Stats.http://www.textinganddrivingsafety.com/texting-and-driving-stats

5. Roberts JA, et al. “My life has become a major distraction from my cell phone: Partner phubbing and relationship satisfaction among romantic partners.” http://www.sciencedirect.com/science/article/pii/S0747563215300704

6. The American Academy of Facial Plastic and Reconstructive Surgery. Don't Let Tech Neck Age You

7. http://www.aafprs.org/media/press-release/20150324.html