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February 24, 2014

Stuff You Should Know About Symptom Checkers

There is increasing coverage and discussion in the press about the empowered consumer and all the tools that are now available for people to use to help be empowered. The symptom checker is one of the key tools that consumers should use as it helps make sense of all the data such as symptoms, abnormal test results or abnormal readings from the various monitors that are now available.

There is a great regular Podcast series called “Stuff you should know” hosted by Chuck Bryant and Josh Clark and, earlier this month, they released a Podcast called “Will computers replace doctors?”  The full podcast is 36 minutes long and can be accessed from this link.

We have edited this to produce an abridged version if you want to listen to just the segments related to diagnosis and using diagnosis decision support tools or symptom checkers. Click here to listen to the edited podcast. A full transcript of the edited version is also provided in italics below.

As Chuck and Josh observe, there is an increasing desire by people to monitor their health and take more control in how they interact with their doctor. Most consumers have done some research, internet searches, etc prior to their visit to the doctor.  This engagement by the healthcare consumer can lead to a more productive visit and assist with the outcome of the visit.  No longer are they going just to be told what’s wrong with them but want to have a meaningful exchange with their physician based on what they have learned; asking questions like “what else could this be or what are the treatment options" etc.

A proven symptom checker, like diagnosis decision support mentioned in the blog, enables healthcare consumers to enter their symptoms and receive back a list of diagnosis possibilities, including both common and rare conditions.  Having a list of likely diagnoses to discuss with the doctor rather than just sitting passively waiting to be told what the doctor thinks engages the healthcare consumer to care about their care and, in turn, are more likely to engage in their treatment as well.

Diagnosis decision support for physicians and symptom checkers for consumers are formidable tools for both in helping to get to the right diagnosis and treatment as soon as possible but also in facilitating an informed conversation between the patient and physician.

symptom checker discussion For Patients Go to Symptom Checker

Narrator: Welcome to Stuff You Should Know from howstuffworks.com.

Josh:    Hey, and welcome to the podcast. I'm Josh Clark. There's Charles W. 'Chuck' Bryant. Our guest producer Noel is here. To me, and I don't think it's over confirmation bias, it seems like there really is a growing desire among just average ordinary people to be able to track their health...

Chuck:             Yeah.

Josh:    ...their well being, their activity...

Chuck:             Yeah.

Josh:    ...and to do it easily.

Chuck:             Yeah...

Josh:    Yeah. It seems to me this desire to kind of say hey, this is my health. This is my body.

Chuck:             Yeah.

Josh:    I want to know more about it.

Chuck:             Totally.

Josh:    Like, I don't want to necessarily cut out doctors, but I want to decide if I should go to the doctor if it's time or not.

Chuck:             Yeah.

Josh:    And, I want to use data to do that.

Chuck:             Yeah. I imagine I frustrate a lot of doctors, because I'm one of those obnoxious people that goes in and is like well, here's what I think I have based on my research.

Josh:    There's nothing wrong with that.

Chuck:             Yeah...

Josh:    That is what... You're an informed patient.

Chuck:             True.

Josh:    That's exactly what you're supposed to do, and if you're getting on your doctor's nerves then go see another doctor.

Chuck:             Yeah. I mean there's two sides to this. There's diagnoses and treatment. Some programs... A little bit of the history. This goes back to the 1970's at the University of Pittsburgh. They developed software to diagnose problems. Mass General since the 1980's has been working on their DX plan which provides ranked lists of diagnoses. Whereas the... What's the computer, the Watson?

Josh:    Watson, who won at 'Jeopardy.'

Chuck:             Yeah. That's more based, it looks like, on treatment options than diagnosis at this point.

Josh:    It's both.

Chuck:             They're using these... Well, yeah, but they said it's not... They haven't... I don't think they want to leave it alone with diagnosis yet...

Josh:    No.

Chuck:             ...and to do its thing.

Josh:    There's already something out there for diagnosis that's meant to support physicians.

Chuck:             I know we looked into this one, sort of a savant diagnoser. Is that a word?

Josh:    I don't know.

Chuck:             Diagnostician?

Josh:    Diagnostician, yeah.

Chuck: Dr. Dhaliwal in San Francisco is sort of legendary for diagnosing things to the point where he does it on stage as almost like a parlor trick.

Josh:    I would love to see it.

Chuck: I would, too. They give him 45 minutes and a bunch of symptoms basically, like really confusing, because they're trying to stump him.

Josh:    Right.

Chuck:             Generally, he comes out on top. But, he even uses a diagnostic program called Isabel.

Josh: Right.      That's the one I said earlier that's already here.

Chuck:             Yeah. Doctors are using these to help themselves out. But, he says that he's never had Isabel offer a diagnosis that he has missed.

Josh:    Right.

Chuck:             He's like the dude, though.

Josh:    Yeah, and he also admits that he's like a freak of nature.

Chuck:             Right - go ahead, quiz me.

Josh:    Exactly.

Chuck:             Yeah.

Josh:    He also reads case histories for fun, that kind of stuff. He's not...

Chuck: He really puts the time into it.

Josh:    ...a normal physician. He's a complete and total outlier.

Chuck:             Yeah.

Josh:    If every physician were like this guy then there probably wouldn't be this conversation going on right now.

Chuck:             Yeah, you're right.

Josh:    But, most physicians aren't, and it's not just with current medical research that they're just not aware of because they haven't had time to pick up 'The Lancet' the last few months.

Chuck:             Yeah.

Josh:    It's also their training, too. Like, if a doctor's in practice for 20 years... The human brain tends to create habits, because it likes to expend as little energy as possible. It's trying to be as efficient as possible. I think the same thing happens with medical practice. You're trained. You understand. You come out of medical school with a lot of book learning. Then, you put it to practice and you kind of find your niche. Along the way you forget a lot of the stuff...

Chuck:             Oh yeah.

Josh:    ...that you haven't done in 20 years or haven't learned about in 20 years. It's not just current stuff. It's old stuff, too.

Chuck:             Well, here's a scary stat. One in five diagnoses in the United States are incorrect or incomplete. One in five. A lot of times it's not that the doctor's a jerk or not any good. But, like you said, they just maybe haven't seen these cases that were written about in some obscure medical journal that the computer has scanned and indexed.

Josh:    Dr. Dhaliwal himself says even with me a lot of it is intuition...

Chuck:             Yeah.

Josh:    ...and intuition can be wrong.

Chuck:             Yeah. I have this one stat, too. It says according to an expert - I'm not sure what that means, it sounds hinky - only 20 percent of the knowledge of physicians used to diagnose is evidence based. So, that means 80 percent is intuition?

Josh:    Yeah.

Chuck:             I like the idea of intuition to a certain degree, for sure.

Josh:    Yeah.

Chuck:             But, there's also got to be, like, data backing it up.

Josh:    Sure, right.

Chuck:             You know.

Josh:    So, in your perfect world then it sounds like we still have physicians, but they go back and double check themselves using a program. Okay. Tell me your alarming stat.

Chuck:             All right. Johns Hopkins did a study that found as many as 40,000 patients die in intensive care each year in the US due to missed diagnosis. 40,000.

Josh:    Man.

Chuck:             And, another study found that system related factors like lack of teamwork and communication or just poor processes...

Josh:    Yeah.

Chuck:             ...were involved in 65 percent of diagnostic error, and cognitive factors in 75 percent with premature closure as the most common - which is basically just sticking to that initial diagnosis and not being open minded to other second opinions.

Josh:    Yeah. There's this thing called 'anchoring bias' that was in that 'New York Times' article...

Chuck:             Yeah, yeah.

Josh:    ...with Dr. Dhaliwal. The guy who created this program that's now around to support diagnostics where a physician will say I think it's this, but let me put in the symptoms and ask Isabel...

Chuck:             Yeah.

Josh:    ...which is the name of the program. It's named after the guy who created the program's daughter.

Chuck:             Oh, man, that story's rough.

Josh:    Yeah. When she was three, he took her to the hospital and the doctors said well she has chicken pox. She did indeed have chicken pox, but that's all they looked at.

Chuck:             Yeah.

Josh:    They completely missed a pretty nasty case of necrotizing fasciitis...

Chuck:             Yeah.

Josh:    ...which we've talked about before.

Chuck:             Oh yeah.

Josh:    Flesh eating bacteria. She almost died from it and was disfigured from it as a result.

Chuck:             Yeah.

Josh:    Her father who was a money manager said I'm going to take whatever computer programming skills I have and put it toward this program Isabel which is meant to say yes you're right with this diagnosis I agree with you, or have you considered these other diagnoses.

Chuck:             Yeah.

Josh:    He said had Isabel been around and his daughters' doctors consulted it they would not have missed the necrotizing fasciitis.

Chuck:             Well, it makes sense - as an assist, you know. There's this company called Lifecom that said in clinical trials if you use a medical diagnostic program as an assist those engines were 91 percent accurate without using exams or imaging or labs even.

Josh:    Really just symptoms.

Chuck:             Yeah.

Josh:    That's crazy. That's really, really, really good.

Chuck:             But, as an assist then I think it's kind of a no brainer...

Jason Maude

Jason Maude

Jason is the CEO and Co-founder of Isabel. Prior to co-founding Isabel, Jason spent 12 years working in finance and investment banking across Europe. His daughter, Isabel, fell seriously ill following a misdiagnosis in 1999 and this experience inspired Jason to abandon his city career and create Isabel Healthcare Ltd.


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