How to avoid misdiagnosis: The online 'doctor' even GPs swear by

By Lucy Elkins for MailOnline

Published: 23:43 EDT, 25 March 2013 | Updated: 23:43 EDT, 25 March 2013

Businesswoman Tracy Posner was never a regular visitor to the GP.

In fact, she only ever went to the surgery for routine appointments such as her children’s vaccinations.

But then she developed severe burning pains in her neck.

GPs are generalists - so, unlike consultants, they may see some conditions only once or twice in their careers

‘It was so painful that I couldn’t sit and watch TV as any slight movement was agony,’ says Tracy, 51, from west London.

‘Then one day I was pulling out the bottom drawer of the fridge and I felt such pain in my head that I couldn’t get up for a few minutes.'

She finally went to her GP — who suggested that she was depressed.

‘I knew I wasn’t depressed — I was crying because I was in so much pain,’ she says.

‘The GP seemed to be focusing on this and ignoring my other symptoms.’

Over a four-month period Tracy saw her GP six times.

‘I felt I was being fobbed off and treated as a hypochondriac,’ she says.

‘And by then the pain was so excruciating, I would find myself panting like women do during labour to try to cope.’

Searching her symptoms on Google, Tracy discovered a possible cause was a tumour, so she decided to pay for a brain scan. This showed that she had a plum-sized tumour growing into her brain.

Two days later she underwent surgery to remove it, but suffered a stroke and spent three months in hospital learning to walk and talk again.

Not surprisingly, she’s found it hard to forgive her GP.

‘Afterwards she wrote me a letter of apology saying: “I have never seen anyone with a brain tumour before,” says Tracy, who is married to Robert, 53, the head of a charity.

‘I felt so bitter. I have since read up on this, and I know that I was displaying classic symptoms of a brain tumour. She should have joined up the dots.’

Tracy’s story is not isolated — according to the NHS Litigation Authority, payouts for misdiagnoses rose from £56 million in 2009-10 to £98 million in 2010-11.

So what’s going wrong? Some of this increase is because people have higher expectations, but there are more complex reasons, says Sir Graeme Catto, a former President of the General Medical Council and President of the College of Medicine.

‘We have an ageing population and most people over 70 tend to go to see their doctor with multiple conditions, and that makes diagnosis harder,’ he says.

Time constraints may also be to blame.

‘Often patients come in with a list of complaints and leave the most important one until the end of the appointment.’

The other challenge for GPs is that they are generalists — so, unlike consultants, they may see some conditions only once or twice in their careers.

The most commonly missed illness is cancer, according to a 2008 study from the University of Birmingham.

So what can be done? The Royal College of GPs has called for longer appointments.

Searching her symptoms on Google, Tracy discovered a possible cause was a tumour, so she decided to pay for a brain scan (file picture)

But some experts believe a new online symptom-checker could help.

In the Vale of York, a group of GPs are testing a system that generates possible diagnoses when a patient’s symptoms are fed in.

The Isabel Symptom checker has a database of 6,000 diseases.

It allows doctors to input a variety of symptoms and in trials it included the correct diagnosis in its final list of suggestions 95 per cent of the time (Google produced an accurate diagnosis 50 per cent of the time).

The 55 practices in the Vale of York have had access to Isabel for seven months.

‘Experienced GPs become used to thinking in a certain way,’ says Dr David Hayward, a GP and board member of the Vale of York Clinical Commissioning Group.

‘This system allows you to think outside the box. We don’t use it for every patient, but it is useful for complex cases.

‘One colleague saw a patient whose blood showed signs of inflammation, and the symptom checker suggested pneumonia.

'The patient had no obvious symptoms of a chest complaint, but when he was sent for an X-ray he did have pneumonia.’

The system costs around £1,400 per practice a year (although there is a free version for patients to use) — but doctors say the costs are recouped because more patients are referred to the right consultant the first time.

The system was developed by Jason Maude, a former City analyst from Haselmere, Surrey.

His daughter, Isabel, almost died when she was three after doctors failed to spot she had necrotising fasciitis, a complication of chicken pox.

‘When a doctor makes a diagnosis, they are taking a gamble on the most likely diagnosis,’ says Jason.

‘I believe doctors should make what is called a deferential diagnosis. This means they have to consider all possibilities’

Sir Graeme is in favour of anything that makes the job easier.

‘Doctors have always used textbooks — this symptom-checker brings that concept up-to-date,’ he says.

Meanwhile, Tracy is now involved with the charity Brain Cancer UK.

‘The number of people I hear about who are initially misdiagnosed is incredible,’ she says.

‘Had my GP had the benefit of a symptom-checker and my condition been picked up earlier, then months of ill health might have been avoided.’

To try the Isabel system go to http://symptomchecker.isabelhealthcare.com