In this day and age, many of us start with an online search when we get sick. In fact, at least one-third of persons living in the U.S. now routinely use symptom checkers for both routine and urgent conditions, including chest pain. In an era when time is at a premium, many of us feel that such symptom checkers can function as a tool for both triage and diagnosis. It’s quick, easy and may help us in a pinch. But, according to results of a new study, doctors are more effective than symptom checkers to obtain an accurate diagnosis —by over two to one—with the suggestion that such computer-based algorithms in symptom checkers could be an effective aid for healthcare professionals to broaden their differential diagnosis. The study was published as a research letter earlier this week in JAMA Internal Medicine. Smartphone equipped with medical apps including symptom checkers and Fitbit to synchronize health data When doctors in the study were armed with a patient’s medical history and symptoms, and then compared with information entered into a symptom checker, doctors arrived at the correct diagnosis 72% of the time, as opposed to 34% for the apps . And 84% of the time, doctors provided the correct diagnosis in their top three choices, compared with only 51% for the symptom checkers. The study evaluated apps from a multitude of online sources—over 23 in all—including WebMD, iTriage, Sharecare’s AskMD and the Mayo Clinic. The motivation for the study arose from the ongoing dilemma of diagnostic error in medicine , addressed in recent Institute of Medicine (IOM) reports, with the hope that availability of computers and mobile technology may help to address this ongoing issue. While previous studies have evaluated computers vs. doctor performance for interpreting EKGs, no previous study has evaluated the diagnostic accuracy of computers compared with physicians. Researchers in the study from Harvard utilized a web platform known as Human Dx which complied 45 clinical scenarios or vignettes, describing medical history and symptoms, that was sent to 234 physicians (internal medicine, pediatrics and family medicine) involved in the study. The doctors could not do a physical exam, or run any hypothetical blood tests or imaging studies. Of the 45 vignettes, 15 were categorized as high acuity, or potentially life-threatening and 15 were described as medium acuity, while the remaining 15 involved a low-acuity situation. The majority of the cases involved routine ailments, while 19 of the 45 described uncommon or rarer conditions. The doctors ranked their potential diagnoses in order of likelihood, as free text responses. It also turned out that the doctors provided the correct diagnosis not only more often, but every time for all 45 clinical vignettes, with greater accuracy for more complex and uncommon diagnoses. The symptom checkers were actually better at picking up on the more common and less serious diagnoses, according to results of the study. But in reality, doctors in the digital age often consult evidence-based websites (e.g. up-todate.com) when faced with a complicated set of signs and symptoms, and use mobile apps developed by such sites that offer a broad differential diagnosis coupled with online links to studies. So the take-home message is that it might actually be better to have a quick consultation and visit with your healthcare provider , especially if you have a multitude of complex symptoms. Symptom checkers as a stand-alone are not ideal, and may not provide the entire picture or cause of a patient’s symptoms. For example, when people use online symptom checkers for vague symptoms such as dizziness, a wide range of potential diagnoses may result, from minor conditions such as sinusitis and inner ear ailments to more serious conditions such as strokes, heart attacks or other vascular conditions. This may trigger anxiety and fear in patients, leading to frantic calls to doctors’ offices, or even land people in the emergency department after an encounter with Dr. Google. That said, if a patient does not have access to a medical professional, a reputable medical website or app may suffice as a screening tool. In short, nothing can replace a well performed history and physical in an office setting , urgent care or emergency department, with access to diagnostic instruments, most physicians would agree. In addition, the “picture” or visual that you have when you first see a patient as you walk into the examination room can be most telling–especially whether a patient is “sick” or ill, as most well trained doctors would agree. That said, what actually constitutes an appropriate “examination” in the digital age may be rapidly changing . The “medicalized smartphone,” with the ability to perform point-of-care lab tests from body fluids, examine your ear for infection or even check your vision, are indeed revolutionary and may ultimately change the playing field. Many are now opting for a Facetime type of examination, which may provide a visual, but unfortunately may not completely reveal the underlying cause of a patient’s myriad symptoms. As newer modes of technology make their way into the medical setting, like augmented and virtual reality utilizing various body sensors that may enable such a revolution—we may be on the cusp of a new paradigm shift in what constitutes an appropriate medical examination. More importantly, this study clearly illustrates a need for higher fidelity health informatics telemetry to clinicians and caregivers for more effective screening and assessment for the earliest signs of illness that may require transfer to an emergency department or evaluation by a healthcare provider in the home setting. As we enter into the era of ‘The Connected Patient”, “remote screening of initial symptoms will be an important healthcare mandate, especially as the aging of America comes full circle with nearly 80 million seniors by 2030,” explains Rich Able, chief strategy officer, Intuitive IP, based in Seattle. “Enabling seniors and their family members to better connect to their caregivers and clinicians will help to offset the overwhelming strain on our healthcare system.” “Today’s seniors will live longer, more active lives than ever before and will face a wide diversity of health and quality-of-life challenges. Family and clinical care providers will need a new generation of tools to help stay informed, coordinated and, most importantly, connected ,” emphasized Able. “Seniors want to feel independent and live at home as long as possible,”explains Able. “ Family members want to be well informed and connected to their parent while clinicians and caregivers want real time information on chronic disease metrics, drug therapy compliance and early warning indicators on life threatening emergencies,” he added. IBM’s Watson, a supercomputer delving into the new field of cognitive health—whereby computers can understand, reason and learn—may one day be in your doctor’s office or even home–the consummate virtual assistant–helping to make decisions, armed not only with evidence-based data but the ability to detect genomic clues to optimize outcomes. In fact, such powerful artificial intelligence may one day be part of a package streamed into your home, much like services packaged by Google, Netflix or even Amazon. Dr. Satjit Bhusri, attending cardiologist at Lenox Hill Hospital in New York City, Associate Program Director of Cardiology, and Assistant Professor of Medicine (Cardiology) with Northwell Health has a unique approach to machine learning and human interaction: “As the trusty stethoscope meets the hypersonic ultrasound device, and as artificial intelligence triages diseases faster than the human mind, it is important to remember that technology will never bring the single most important aspect to medical care: the human touch ,” explained Bhusri. ”The idea that one of their own, a peer, maybe even a fellow survivor of their same disease, is there holding their hand, guiding them through their treatment and discussing all available options is something technology will never create. This is the ‘art’ of medicine. The ‘science’ can be replicated, sure, and in fact help in diagnosis and treatment plans, but the humanity of one life impacting another will never be matched,” added Bhusri. But while Watson and other such supercomputers won’t be replacing your doctor anytime soon, as technology makes greater strides, the lines between human and machine may be getting closer sooner than we think. Source
