By: Dr. Michael Kerr

Mutiny is afoot!

I’m leaving the sinking ship that is Apple.

Sure, sinking might not be the best description of Apple at the moment. Perhaps after the release of the iPhone 5 and more record sales it would be more apt to say buoyant on green seas of cash.

So who in their right mind would be thinking about leaving Apple?

Well, I just did.

I’m going to try and document my swap from the shiny things with apples on them to bigger shiny things with little robots on them. There’s a lot of stuff out there on people making the switch. Despite my best efforts to find it, there’s not a lot from a medical perspective.

Hopefully as we go along some questions will be answered, and those thinking of swapping will get an idea of what they might be getting into. High end smart phones cost a pretty penny, so it’s probably a good thing to make an informed decision.

Before we get going a few caveats should be made. Firstly, a lot of this is personal experience. As always, YMMV (your mileage may vary). What works for me, what I use my phone for, and what I feel is important might not gel with some readers. Discussion about Apple versus Android tends to end up in flaming torches and waving pitchforks, so before we go putting on our Sunday best war paint, I think it might be worthwhile getting an idea of where I’m coming. Hopefully this might avoid any misunderstanding and give you an idea of where my biases stem from.

I’m a junior ED registrar (similar to post-graduate year 3 residency) in sunny Australia. Whilst I might be a tadpole in terms of medical experience, when it comes to technology in medicine, I’m pretty sure that I’ve mastered the use of my opposable thumbs. I’ve come from a background in web design, science, and briefly splashed in the business management puddle. In my med school days I was an early adopter of mobile technology in medicine. We’re talking when people actually knew what Palm PDAs were. When Pocket PCs were big enough to change your car tyre on.

Excuse the Apple hyperbole, but the iPhone was revolutionary. For the past few years I’ve enjoyed progressing from the iPhone 3G to 4. I’ve found it invaluable in both my studies and practice as a junior doctor. If I was forced to choose between my smart phone or my stethoscope, I’d probably take the phone.

I feel it holds that much importance in my day to day practice.

In my opinion, iOS and iPhone offered a phone and infrastructure better suited to the medical fraternity. It was, and remains, focused on user experience. It blends technology to purpose, and does so as seamlessly as possible. Yes, yes, I realise this sounds like it came from an Apple keynote, with some annoyingly catchy jingle playing in the background. But it’s true.

Smart phones have a unique application in point of care use in medicine. We’re often working in stressful circumstances, with limited time, and limited resources. We don’t always have time to pull out a 20kg text book (that’s 44 pounds for those of us with strange accents). We don’t have time to sit in front of a computer and read a fifty page Up-to-Date article. Almost all of us have a smart phone now. Even the Luddites amongst us are using them as flint and steel to start fires. For a long time, I’ve felt the iPhone was the choice for this situation. Being able to be at the bedside and have a clinical question answered quickly is vital.

The App store is massive. The medical section is burgeoning with useful references, calculators, scoring tools, patient education tools, anatomy apps etc. Thanks in part to the closed ecosystem, there is also often higher quality than what’s offered elsewhere. Combine this with the sleek user interface and amazing user experience and you’ve got one handy device.

Here’s how I typically use my phone. As a junior doctor, I’m acutely aware of my shortcomings, and even more so the potential to address some of these with mobile technology.

A 50 year old male presents with acute shortness of breath. You go in to see him, and start the usual history, examination, assessment, and management. After getting the most urgent considerations out of the way I’ll then have some time to think. I’ll often pull out Diagnosaurus and flip through the differentials of shortness of breath, sure it’s not the rarest presenting complaint, but as Atul Gawande pointed out (1) sometimes checklists are good things and help us make less mistakes. I’ll have one or two differentials closest in mind, so I’ll flip through Epocrates and remind myself of the pathophysiology at play here. Unsurprisingly, I’ll find that they even have a guide to the urgent evaluation of shortness of breath. I’ll skim through the pertinent history and examination of an acute PE like garlic to a medical vampire-lawyer, I’ll remember to include the significant negatives on my documentation.

Not stopping there, I’ll pop up the PERC rule, Well’s criteria, and have a think about those as well. I’ll look at the ECG and no doubt forget the most common findings in PE — actually I won’t, thanks to Amal Matu’s free and excellent teaching page (2). No worries, ECG guide is open in seconds and I’ve already read the PE section with the evidence based references. This is just the tip of the iceberg; I’ll be writing more on other things I’ve found smart phones invaluable for later.

I’m getting point of care, evidence based information. It’s helping me to learn on the spot. It’s quick, seamless, and there are a whole lot of possibilities thanks to the massive range of apps on the store.

So why switch? Why not stick with what I know? Why not stick with Apple?

Android is catching up. Perhaps already has. iOS apps are making it over to the Play store. The hardware has caught up. I recently played with my brother’s Samsung Note (he’s also a doctor). It was big. It was shiny. And it was pretty cool. The response times were similar to that of an iPhone. Scrolling was smooth. Apps loaded quickly. He had an impressive range of medical apps. He had customised the hell out of his phone to tailor his needs, perhaps a bit more than I was able to on my iPhone 4.

Because I was so happy with my iPhone, I realised I’d missed out on much of Android’s improvements.

Then the new iPhone 5 was released. I was reading all the rumours. Waiting to be Wowed again.  The release event came and went. I sighed. My expectations were too high. Sure the phone was a sensible advancement on the 4S, I just expected something more.

I started looking around to see what else there was. I started reading reviews on the new android phones coming out. Late nights were spent watching YouTube reviews on the Samsung Galaxy Note 2.

I felt dirty. I was drooling over phone reviews.. and I was watching them on my iPhone. I started to notice the little scratches in the screen some more. The backing plate that I’d replaced suddenly didn’t seem quite so shiny. Its curvy corners that were once so appealing started to seem bland and boring. I convinced myself I needed a change.

Whilst I’ve got an itchy eBay trigger, I’m typically someone that wants to know what I’m getting into before forking out a decent amount of cash. I couldn’t find any in-depth opinion pieces on people who had recently made the switch, so I figured I’d give it a go and see what it was like.

I don’t feel the divide between the two big smart phone options is as great as it once was. It was once big enough that I’d occasionally peek over the edge, shuffle back, and put my head firmly in the sand. I think it’s shallow enough now that I just might be able to step over it.

Over the next few months I’ll be writing about my experiences with Android and ultimately who I end up going with. As I mentioned in the beginning, YMMV.  Also, Apple fanboys, please read this full article before passing judgment.

(1) This is the book I was referring to. Good read. About reducing errors in medicine.

(2) Amal Mattu’s tumblr is a free and awesome learning resource.

Mick is a junior ED registrar currently working on the Sunshine Coast, Australia.  He graduated from the University of Queensland. He is currently planning to locum and travel before settling into a training program in either Australia or the UK. He has a passion for mobile technology and its use in medicine, and feels that it is currently underused in a clinical setting.