Dr Phil Hammond, GP, lecturer and presenter of the BBC2 programme Trust Me, I'm a Doctor

Last week, I put on a smart shirt. Not the kind you wear to Sunday lunch with the in-laws, but one with a motherboard sewn into the lining.

This allows just about every one of my vital signs to be monitored (e.g. pulse, blood pressure, temperature, respiration rate, voice tone, scrotal skin resistance) and then transmitted instantly via the internet anywhere in the world.

Smart shirts can even analyse the site of impact of an injury, track a wound through the body, identify the calibre of a bullet and tell whether a vein or an artery has been severed (by analysing the colour of the blood).

For those injured in battle, lost in space, stuck up a mountain or sick on an aeroplane, it could give a distant expert the necessary information to give life-saving instructions. That's what the manufacturers say, anyway.

Of course, we've heard all this before.

In a few years, diabetic patients will no longer need to test their blood sugar concentrations by pricking their finger every day. Instead, a glucose sensor implanted under the skin of the thigh could provide continuous monitoring.

Smart toilets will analyse patients' urine for glucose, protein and bacteria and they won't even have to give themselves daily insulin injections.

A computerised implanted reservoir under the skin will automatically adjust the dose and keep the diabetes so well controlled that complications will be minimal.

As a safeguard, all the readings will be monitored over the internet at a distant glucose control centre.

And there'll be a web camera watching you in case you get stuck in the toilet.

To some, this sounds like an inspirational vision of the future. To others it presents a version of Big Brother to rival the worst of Channel 4's excesses.

As a realist, I'd like to know where the money for all this new technology will come from. In an NHS that has problems providing a bog-standard usable toilet, what chance a smart one?

And should we pour money into smart pillows, when patients have to fight to get an ordinary one each?

Still, you can't stem the tide of technology and you can't buck the trend of telemedicine. Anything that helps to spruce up a personal learning plan from the comfort of your own armchair has to be a good thing.

And what price the electronic house call? It may be convenient but I can't see patients buying it.

As a wise old GP once told me: "People who live alone can go for days without any human touch. So just hold their hands."

Doubtless some boffin is working on an electronic hand (as seen on the Addams Family) that can simulate human touch, but it won't be the real thing.

There is already a company offering chemotherapy in a domestic setting, though, and it won't be long before we have heart surgery at home and intensive care in the community.

And if you just needed a straightforward check-up and had the choice of struggling up to the hospital, fighting for a parking space and then queuing for hours in outpatients, or sitting at home in your smart shirt with a cup of tea and a Hobnob, which would you go for?

A word of caution, though. When they finally come onto the market, make sure your smart shirt fits properly.

I was supposed to road-test mine live on BBC1's Tomorrow's World, but not only did it look like a Posh Spice accessory, it was in her size too.

Most unflattering – and it ruined my vital signs.

Guidelines in Practice, March 2001, Volume 4(3)
© 2001 MGP Ltd
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