By David Sack, MD

I read a few months ago that the number of available iPhone apps had exceeded a million, with new apps now appearing that are intended to help sort through the mountain of other apps. We have reached the age of meta-apps.

Parenthetically, I have always loved that “meta”concept. In college, when people asked why I majored in philosophy despite the fact that I was pre-med, I explained that my intention was to become a metaphysician.

In any case, there are now many thousands of medical apps, and the number seems to be growing arithmetically! (Perhaps it was exponential at first, but I suspect the viral replication phase for apps has peaked, so anyone who uses the term exponentially at this point probably needs to review their 8th grade algebra.) In spite of this seeming  plethora of handy apps, there are still a few I have yet to encounter and would like to see created, although I will probably receive some comments on this post alerting me to the fact that some of what I am looking for has already been produced.

So here are, in no particular order, 7 apps I would like to see:

1. Hold-It for Docs. Do  you play the “hold for the doctor” one-upsmanship game of who waits for whom when you try to reach a colleague on the phone? How often has your secretary buzzed you in the exam room to say “Dr. So-and-So is on the phone for you”, you pick up with “Hi, Tony, how are you?” and Tony’s secretary says, “Just a moment, Dr. Sack,  I’ll put him on”?  Then you wait for your colleague to come on the line. You want to sound welcoming to your referring physicians but by that time you feel like an idiot repeating your greeting with an enthusiasm made stale by the wait. Why not call back at your convenience? But then you’ll still face a long wait on hold, assuming you call yourself. Instead, have your receptionist make a policy of saying you are on another line, promise a call back in a minute, and have her let you know of the call. Then, with this app on your iPhone, you tell Siri to place the call.  After you have had a couple of chats with that doctor, this handy add-in learns to recognize your colleague’s voice, monitors the line, and switches to speakerphone only when Siri recognizes him or her.

2. Visit-Minder 1.0 This deceptively simple timer can save valuable minutes with each encounter and your patient will be none the wiser. Taking a thorough history can be distracting if, like many physicians,  you are somewhat compulsive. That wall clock is fine for reminding you that you are running late, but what if you had a way of really budgeting your time within the visit? With this attachment, your a bluetooth device (hardware is extra) senses by signal strength when you enter the exam room and starts a timer that you can set to vibrate after specified interval of your choosing. Keep your phone on vibrate and you will be discreetly reminded that the family history need not include second cousins once-removed and it is time to move on to the exam…or the formulation and plan…or whatever. Multiple intervals can be set.

3. Drug-Buster Pro I haven’t yet decided what this one does but I really like the name. Can I copyright it? Don’t you dare steal this idea, because I already e-mailed it to myself in a postmarked sealed virtual envelope.

4. iNterrogator. This one requires a small external attachment. Analogous to the Square (TM) card readear attachment, this device can interrogate a pacemaker and email a printout to your cardiologist. Actually, this might be a serious good idea. Might even be on the market. Medtronics, are you listening?

5. Global Risk for Google. No, this is not your father’s game of world-wide domination. This pocket prognosticator shouldn’t be too difficult for Google to produce with their army of saavy statisticians. You’ve seen risk calculators for cardiac events, breast cancer, prostate cancer, life expectancy, and numerous other gizmos. But none of them are really adequately individualized or global in nature. We need something that will pull together all the relevant data for your patient and then, in the same way that mathematical models test whether their conclusions are influenced by altering assumptions, inform you and your patient of how much impact any given measure will have. The app would need to be able to pull in not only their medical data and lifestyle parameters, but shopping habits off Amazon, your facebook visits, the patient’s motor vehicle registrations, and where they spent money on their credit cards. Given the nature of the snooping that Google is up to already, it really doesn’t seem as though it would be that difficult! Heck, if Google can predict what products you will buy, why not have them predict when you will buy the farm?

Here’s how it would work: You have your pateint punch in a few passwords that will be safely stored by Google, enter a few items off the history, physical and labs, and poof! Their own individualized Kaplan-Meier curve.  I know we are supposed to ask about seat belt use, but does that really matter if your patient is 68, has COPD, still smokes and drinks, and rides a Harley to your office? Will quitting smoking make a difference? Will having a colonoscopy matter? Why not have the means to provide him with an honest answer!

6. ePocrates Translate (apologies to ePocrates).  Everyone knows what a great utility ePocrates has become. I can’t live without it. But suppose you want to tell your patient the 10 most common side effects of the drug you are recommending? Why waste time reading it to them or having them fiddle with their reading glasses as you scroll? And if there is a language barrier?  This little add-on matches ePocrates with a text-to-voice translate tool that allows you to read the list in Spanish, Chinese or Cambodian, and you can set the speed anywhere from deliberate and thoughtful up to Viagra commercial voice-over.

7. PhonyPage 1.0. Most docs have had the experience at one time or another  of being trapped in the exam room with a patient who won’t stop talking and can’t be distracted, interrupted, or in some cases, even conversed with on a rational basis. Some of us have kind clairvoyant medical assistants who detect the problem and interrupt us for some “urgent matter” to get us out of the exam room. For the rest of us, there’s PhonyPage. On your iPhone, pressing the home button twice calls up Siri. But how about an app that emits a beeper-like tone when the button is pressed 3 times in rapid succession? Make an excuse that you have been paged for an urgent matter and dash.  Our slogan: Three strikes and you’re out of here.

These suggestions are meant to be at least partly tongue-in-cheek. But maybe some enterprising app-maven will run with one of them. I’ll let you know in my next few posts  if I hear of anything.

David M. Sack, MD, is a Fellow of the American College of Physicians. He attended Harvard and Johns Hopkins Medical School. He completed his residency at Lenox Hill Hospital in New York City and a gastroenterology fellowship at Beth Israel-Deaconess, which he completed in 1983. Since then he has practiced general gastroenterology at a small community hospital in Connecticut. He blogs at prescriptions.