Florence feels more like a friend than a computer system
The diabetes and endocrinology team in Sandwell began using Florence in 2013. Dr Pete Davies recalls one of the first patients to sign-up;
“She was a bubbly, intelligent middle-aged woman and high blood pressure was not the main reason for seeing her in my endocrine clinic. Nevertheless, she signed up with enthusiasm and it was really magical to follow improvements in her blood pressure control following the introduction of an extra blood pressure lowering drug.”
However, things did not continue to go smoothly, the patient’s blood pressure graph showed cycles of good and then high blood pressure, suggesting she may not be taking the medication as indicated, “It felt good to be able to send the patient a text asking if everything was okay on the drug, and to enquire whether they were experiencing side-effects.”
Dr Davies then observed her blood pressure levels improve, only for this cycle to repeat. It was then that he noticed an alert icon on her record, this was one of Florence’s in-built wellness scales and it was showing very high levels of self-reported distress.
“When I saw the lady back in clinic she was the same bubbly, lively person and we dealt with her chief problem before I got around to asking her about Florence and her blood pressure. She told me that she was enjoying using Florence, she had had no side-effects from the new tablet and casually said that it was just that she wasn’t too good at taking tablets. I then asked her about her high distress level score, she paused; I sensed she was struggling over a decision. But then she talked.”
What came out was shocking. She described a long history of suffering domestic violence and abuse, never before revealed to anyone, concealed even from her children. This became her first step on the road to getting professional help and ultimately beginning a new life with support from our local agencies. The next few clinic appointments were scheduled as a foil so she could have privacy to get crisis centre and psychological support to safely leave her abuser. “It took some time for her to reach the decision to accept help, like many women in her situation she said she felt blame and worthlessness.”
Dr Davies was amazed that he got to meet with her again after she had started her new life, “I asked her why she chose to ‘tell’ the Florence computer about her distress, when she couldn’t tell people. Her response was that Florence to her was a person, and she felt she could trust Florence.” Dr Davies also discovered the chilling reason why her blood pressure kept going up-and-down cyclically. Her husband worked away during the week, so she felt happy and able to take tablets until she knew he was coming back; then she said she would wish she was dead, she stopped tablets, watched her blood pressure go higher and prayed that she would have a massive stroke to end things.
Since then the Sandwell team have been big users of Florence, especially blood pressure, weight management and blood glucose control algorithms. The diabetes and endocrinology team won their trust’s Transformation award in 2014 and have gone on to champion Florence and other tools of connected health, using these to build closer relationships with their patients.
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