My life as a Glasshole

Dr Grimes wearing Google Glass

It was from the future and I had to have it.

When Google announced ‘Google Glass’ to the world in April 2012, it seemed that we were on the cusp of having a revolutionary new technology that would deliver the Internet directly into our brain. A nightmare for some, but for me this was the stuff of feverish dreams. I started to imagine myself as a cross between Bones, Geordi La Forge, and the Terminator, dazzling patients and colleagues alike with near-magical feats of high medical technology, whilst addressing my life-long problem of putting names to faces.

For those that have somehow avoided the rise, fall and rise again of Google Glass, I should first explain what it is.

A vision of the future: A hipster future.
A vision of the future: A hipster future.

Glass is a head mounted computer, which uses a prism to display a small screen to the wearer, and a bone-conduction speaker behind the right ear. The input is from a combination of head movements, spoken commands, button presses and ,creepiest of all, blinks. The net result is it makes the successful operator look a little like they’re breakdancing from the shoulders up. It can take photos record video, show text, notifications, directions and overlay images into the visual field of the operator. Whilst it does have the capability of direct wifi connection, it does for the most part rely on being paired via Bluetooth to your mobile phone.

The medical uses for such revolutionary tech were, of course, limitless and intoxicating. Point-of-view (POV) recording of practical procedures and transmission of video to allow clinicians to obtain real-time expert opinions from a specialist that could be miles away. Reference material and checklists being summoned, hands-free, whilst you attend to a patient in theatre. Even live streaming of patient vitals peri-operatively. Some of this was possible with the supplied suite of applications, whilst others were in development.

The only real problem was how to get hold of one. In the beginning there was a Wonka-esque Twitter campaign to identify the first ‘Glass Explorers’ by using the tag #IfIHadGlass, followed by a drip feed reports of exciting new ground being broken. In April 2013 it was on sale to the public, first in USA and then after what felt like an eternity, the UK. Heroically, I battled £1000 of crippling cognitive dissonance to justify the purchase, booked the appointment, and on July 9th, 2014, bought it. This involved a pleasingly complicated online invite, appointment, and finally a trip to a minimalist ‘pop-up- store near Kings Cross where Glass-wearing hipsters congratulated me on joining them in the future. A quick pint and demonstration to members of the public and I was off to Glyndebourne (where I planned to be the first Glass Explorer to record video from the Figaro garden). As if to underline the magical technology, as I rolled back into Lewes station my Glass headset popped up directions to my parked car, which I had last seen BEFORE I bought the things.

Dr Grimes wearing Google Glass
*robotically* “I need a cough, some stool, and a urine sample”

I set out in earnest the next morning (see above). In my surgery that day I posted a sign on the door explaining that I was wearing Google Glass, and explained to each and every patient what I was doing and what Google Glass did (and didn’t) do. All were offered a Glass free consultation, and to each I said the same thing: I’m trying this new technology to see how it affects the consultation, for good or ill.

I continued to wear Google Glass intermittently for about 3-4 months. I discovered that most people were bemusedly curious and happy to consultant with a doctor that looked like a member of the Borg collective. Outside the consulting room it proved to be a nerd ‘badge of honour’ par excellence, opening up conversations and fast-tracking introductions. Any digital healthcare project I was working on could instantly be taken to the next level by discussing what Glass might do for it Taking POV videos was amazing and having the camera immediately available was genuinely helpful, especially when working hands-free during joint injections. Notifications, in particular, were extremely useful, and were probably the most revolutionary and liberating aspect of using Glass.

It wasn’t all milk and honey though. The battery life was woeful, with the headset barely lasting the morning surgery. When I switched back to using an iPhone the system was much less seamlessly integrated. Wearing prescription glasses also meant that I was going ‘all in’ on Glass when I left that morning, as I didn’t have another pair to change back into.

The biggest issue though was that Glass didn’t really do much that was helpful at all. When you have  two 24 inch monitors on your desk, with a reasonably fast internet connection, a tiny screen washing in and out of focus in your right eye doesn’t quite cut it. Predictably I started to forget I was wearing them until one patient asked if I had a camera on my glasses after I’d undertaken a rather private examination . Fittingly, it was a patient that stopped me wearing them during consultations. A patient with paranoid schizophrenia simply asked – ‘why are you wearing them?’. I couldn’t answer. It seems I wasn’t the only one either. By January 2015 Google quietly closed the Explorer programme, and everyone had a chuckle at my (considerable) expense.

The term ‘Glasshole‘ was coined by the media to describe the kind of early-adopting nerd who was willing to trample over the privacy of others in a race to  ignore the real world. It seems like in my rush to become a dashing superdoc from the future I had, instead, morphed into Dr Glasshole. So, what did I learn during my brief and not terribly spectacular life as a Glasshole?

The technology you buy as an early adopter will almost certainly not do what you think it will do. It may, however, do something you weren’t expecting very well indeed. This might lead you to a new way of doing things that might never have occurred to you in the first place. Notifications are the best example of this. In the months after I stopped using Glass I went on to present a model for using custom notifications to trigger custom events when patients attend healthcare settings in an emergency.

Boldly wearing Google Glass in front a room full of hackers, Dr Keith talks GWYB
Boldly wearing Google Glass in front a room full of hackers, Dr Keith talks GWYB

At the NHS Hack Day in January 2015 I was part of a team that developed ‘Gwyb’ – a contraction of the welsh word ‘Gwybodaeth’, which means ‘Information’. Over 36 hours our team built a working ‘If This Then That’ for sharing medical information which won the patient participation prize. You can download it from GitHub and read more here,  here and here.

You’ll also meet other early adopters and visionaries that don’t let go quite as quickly as I did.

At the Wearables Show in London in February 2015 I met Mr Shafi Ahmed, an innovating surgeon who was pioneering in the use of Glass to record POV footage of surgery which was streamed live to medical students, allowing large numbers to witness a cancer operation in real time and interact with the surgeon. The technology used by Mr Ahmed has been taken further by Advanced Medical Applications . Their ‘Xpert Eye’ system allows wearers to summon immediate expert access from clinicians and specialists using only a browser, which could transform urgent and remote care.

At the Stanford Medicine X Education track Dr Warren Wiechmann presented the astounding work his team had undertaken in using Glass to record not only common practical emergency procedures, but the more nuanced and personal aspects of a simple doctor-patient consultation from a completely new perspective. You can read more here.

It’ll help close down some paths that you might otherwise have spent a long time fruitlessly exploring, which becomes important when you might otherwise commit a lot of time and resources to doing things ‘the proper way’.  The important thing is to try – to commit to innovation and disruption. Just remember that to do so is to risk quite literally looking like an idiot.

My Google Glasses still sit in the drawer at home waiting for their moment in the medical limelight. Until that day, I resort to quietly putting them on when the nights in Seaford are particularly dark and the sky is clear. Standing outside, I speak the words “OK Glass, Explore the Stars“. The screen wakes up, and the constellations magically animate the twinkling points of light above, and for as long as the battery lasts, I’m on the bridge of the Enterprise and I’m *that* doctor again.

Medicine X:Sussex

I’ve been promising to start blogging for so long now it’s gone beyond a joke to my friends and assumed some kind of ghostly constancy: a measure of my failure to put my money where my mouth is and talk more online about my thoughts and wishes for Digital Health Innovation, Medicine, and all things care related. To do so in more than 140 characters at least, as I’ve been tweeting for some time now.

140 characters allows you to say quite a lot, but it starts to become a full time job going through the tweets to replace every ‘to’ with 2, ‘for’ with 4, and so on. Hashtags compete for content. It becomes the conversational equivalent of bouncing on a trampoline and arguing your point with someone through the first floor window.

Why have I finally posted now?

I’ve just spent a mind-expanding and thoroughly stimulating 5 days at the Medicine X conference in Stanford, Palo Alto. Thanks to the kindness of Anne Marie Cunningham (@amcunningham)I was invited to attend the inaugral Medicine X Education conference, and given this opportunity stumped up the cash to stay on for MedX itself: 3 days of ePatient testimonies, workshops, tech demos, and late night chat and carousing that seems to be the staple of this event. The relentless positivity and good cheer, the blue skies and cool breeze, and the genuine warmth and optimism of everyone that I met has left me changed for the better. Its a distinctly un-British state to be in, so before I jump on the plane and start on the process of recompressing I thought I’d make this post. Announce my intentions. Post something that everyone can hold me to.

To understand what exactly I’ll be importing, I’ll let Executive Director Dr Larry Chu (@larrychu) explain:

Medicine X is a catalyst for new ideas about the future of medicine and health care. The initiative explores how emerging technologieswill advance the practice of medicine, improve health, and empower patients to be active participants in their own care. The “X” is meant to encourage thinking beyond numbers and trends—it represents the infinite possibilities for current and future information technologies to improve health

I’ll cut to the chase – Dr Chu promised alot, and he delivered. During the excellent and balanced programme I’ve heard about OmicsLiquid Biopsy, Social Media disrupting medical education, Open Data implemented through the Open Notes programme, and from many patients telling their personal stories about how they’ve overcome the barriers that the existing healthcare system has erected around them. Seasoned with the optimism and promise so typical of the West Coast, I’ve a long list of tasks to action and people to connect with. There’s enough in my Evernote file to last me years.

Ultimately, all this is pointless without being able to deliver on the promise and bring it to my patients in the UK. I’m back in work on Wednesday morning, and I’ll start as I mean to go on with practical, small scale changes to my work that I hope will do their part in making patients feel more engaged in their healthcare. I can then build on this and slowly introduce some of the more significant changes within my practice, and then beyond to local practices and maybe even the NHS as a whole.

Over the coming weeks I’ll be looking in much more detail at some of the incredible advances and concepts that I was exposed to at Medicine X. Do come back to find out more and let me know what you think about it all. You can also follow me on twitter (@keithgrimes) , but do be aware that I have the tendency to swear at times. Particularly when it comes to some of the changes being forced on the NHS.

For now, I’ll just focus on this: Wednesday is the day that Medicine X lands in Sussex.  Let’s see if if I can hold on to this glow until I return to recharge in 2016.