When the Body Sends a Message

The Hiddenness of Health in an Age of Measurement

A 70-year-old woman checks the ECG readings from her smartwatch 916 times in a single year. She has paroxysmal atrial fibrillation and has been prescribed anticoagulants because she is at increased risk of stroke. She brings hundreds of printed readings to a consultation.

Bianca Nogrady tells her story in the Nature article “On the right track”. The account draws on a case report co-authored by clinical health psychologist Lindsey Rosman. In the article, the woman illustrates a problem: monitoring devices generate more information than patients and clinicians can readily manage.

But we can also read the story from the woman’s side of the table. She has been told that her heart can beat irregularly without her noticing, and that the condition can have serious consequences. She then has access to a device that allows her to check what her heart is doing. She uses it.

A technical alert has become a task she must resolve.

Here lies a significant problem with the growing presence of biomedical monitoring in everyday life: the work of interpretation can be shifted to individuals without the expertise, support and reassurance they need to undertake it. We receive ever more messages about our bodies. The responsibility to help us understand them must be given an equally clear place.

The Hiddenness of Health

In Über die Verborgenheit der Gesundheit, published in English as The Enigma of Health, Hans-Georg Gadamer explores what we might call the hiddenness of health. When we are well, our attention is often directed towards something other than our health. We work, prepare food, take part in a conversation or go out to meet someone. The body makes this participation possible without constantly demanding our attention.

This does not mean that someone who feels well is necessarily free of disease. Gadamer offers an understanding of how health is experienced, not a method for ruling out hidden conditions. His point is that health also manifests itself as the freedom to be engaged with the world.

The smartwatch introduces a different rhythm. It can make the body conspicuous in the middle of a day when we have barely thought about it. An alert interrupts a conversation. A sleep score greets us before we have had time to sense how the morning feels. What quietly carried us through the day becomes something we are expected to monitor.

A tension emerges between two goods: the possibility of detecting disease and the possibility of living without constant self-monitoring. Health care must take responsibility for both.

The woman who checked her readings 916 times therefore needs more than an assessment of her heart rhythm. She also needs help finding a rhythm for her attention: When is checking useful? Which findings require action? When can she put the device aside with good reason?

Measurement That Can Set Us Free

The Nature article offers a compelling example of how monitoring might also reduce the burden of illness. In the REACT-AF trial, cardiac researcher Rod Passman and his colleagues are investigating whether smartwatch recordings can guide periods of anticoagulant treatment in selected patients with atrial fibrillation.

One group continues with usual treatment. The other wears a watch with an app that signals when medication should temporarily be resumed. The hope is to prevent strokes just as effectively, with less bleeding and a lower treatment burden. The article describes a strategy still being tested. Its safety must be demonstrated before it can guide clinical care.

This example sharpens the argument. Closer monitoring can reduce the burden of treatment. But in the trial, the watch forms part of an organised medical framework. There is a purpose, a treatment plan and a set of rules governing what should follow from the readings.

The difference from monitoring that individuals must manage alone therefore lies in the connection between measurement and care. The information has someone to receive it and an agreed role in guiding action.

Gadamer’s idea of the hiddenness of health helps us articulate the goal: technology should enable people to participate more freely in life, even when this requires closer monitoring of the body.

Who Is Sending the Message?

The title “When the Body Sends a Message” contains a simplification. The body does not send a text message. A sensor records a signal. An algorithm processes it. A product presents the result as an alert.

Someone has decided which differences should count, where the threshold should lie and how the user should be notified. The message is shaped by technical choices and by the company selling the device.

Nogrady points out that companies selling millions of smartwatches have limited commercial incentives to undertake the demanding process of securing approval as medical devices. Approval of a particular medical function or piece of software is also different from approval of everything a product claims to tell us about our health.

This matters for the distribution of responsibility. A product can issue an alert that the user must try to understand, and that a doctor must then spend time assessing. In my view, this chain should also include clear requirements for the sender. Manufacturers must explain what a function has been shown to detect, what its limitations are and what follow-up an alert requires.

Access to our own data can strengthen autonomy. An unresolved message, however, can leave us dependent on help that the product itself does not provide.

When an Alert Takes Over the Day

In the Nature article, neurologist Anup Patel explains that, in his experience, families often stop using devices that alert them to epileptic seizures because false alarms become too burdensome. An alert puts people on standby. It demands attention and action, even when it turns out to be wrong.

Here the disadvantage becomes concrete. It consists of interrupted sleep, cancelled plans and everyday life organised around the possibility of the next alarm. When families put the device aside, we can also understand this as an attempt to regain a liveable daily life.

Patel also envisages future devices that could warn of increased risk and recommend taking things easy or staying at home that day. Such a possibility could prevent harm. But it also brings technology into the organisation of life itself.

A recommendation to stay at home might mean missing the walk that makes the day worthwhile. It might deprive someone of a long-awaited meeting. Its value must therefore also be assessed in relation to the life it intervenes in. What room for action does it open up, and what does it take away?

Judgement Needs Something to Stand On

Patients are not alone in facing a difficult task of interpretation. Doctors may receive recordings from devices with widely varying levels of supporting evidence. Noé Brasier, a physician and researcher at ETH Zurich, emphasises in the article how exposed clinicians become when decisions rest on assessments that have not been validated.

Practical judgement requires reliable knowledge, time and arrangements that allow decisions to be scrutinised. It is unreasonable to make clinical judgement the answer to inadequate evidence from manufacturers. Follow-up also requires agreements about how recordings should be assessed and answered, and how the work should be funded.

The Basel Wearable Clinic offers one concrete way forward. Patients can submit ECG recordings from wearable devices and receive a specialist assessment with recommendations. The arrangement has limitations: recordings are sent as PDFs and are not assessed in real time. But it establishes a connection between the device’s message and a medical assessment.

AI can help with the sorting. Some of the work of interpretation is then transferred to another system. This sorting, too, requires evidence, clear lines of responsibility and a route to human assessment.

A Norwegian Inbox

In Norway, too, the encounter between the pace of the watch and the pace of the health service can be difficult. Helsenorge, Norway’s public health portal, explains that written online consultations with a GP are intended for non-urgent matters, and that patients will usually receive a reply within five working days. The usual patient fee applies, subject to the standard exemptions. The service has a clear framework. An alert on the wrist can feel far more immediate.

Imagine a patient sending a description of a smartwatch alert to their GP through an online consultation. The message may take only a few minutes to send. Yet the wait can be filled with uncertainty about how serious the finding is. A digital means of contact does not, by itself, resolve the task the device has given the patient.

Now consider two people receiving the same alert. One knows how the service works, formulates a precise question and has an exemption card that waives patient fees. The other struggles to describe what has happened, is unsure which form of contact to use and must weigh the fee against other expenses. These are imagined situations, but they show how an identical alert can place very different burdens on its recipients. Worry can also carry a financial cost.

A health service for everyone must take these differences into account. The need for help may be greatest among those who find it hardest to formulate a request. People who arrive without their own recordings must also be heard. The ability to document the body and use a digital inbox cannot become the measure of how seriously a person’s symptoms are taken.

Returning to the Day

Now imagine a woman in a situation similar to that of the patient in the case report. She is sitting at the kitchen table with a friend who has dropped by for coffee. Following a consultation, she has a plan she understands. She knows what to watch for, when to make contact and what she can leave alone.

There is no guarantee against illness or worry. But the work of interpretation has become a shared responsibility. She no longer has to determine the meaning of every signal on her own.

For someone who needs it, a measurement can provide good reason to change the day’s plans. The task of care is to make such decisions well-founded and understandable, so that a device does not govern the day through unresolved fear.

Gadamer’s understanding of health gives us a standard against which to judge even the most advanced technology: does it help people return to participation in the world?

The woman leaves the watch alone and pours the coffee. She has been helped to understand when she needs to listen to her body. Now she can listen to the person sitting across the table.