Tuesday, July 23, 2013

On Checking Your Symptoms Online Before Seeing Your Doctor: I Told You So

Of all the horrid, hideous notes of woe,
Sadder than owl sounds, or the midnight blast,
Is that portentous phrase, “I told you so.”

Lord Byron (1788-1824), Canto IV

In today’s WSJ, Laura Landro says you ought to check symptoms online before seeing your doctor, “A Better Digital Diagnosis: As Online Symptom-Checkers Improve, Health-Care Providers Says It’s OK to Search.”
Landro lists these online sites with symptom-checkers which can search and list possible diagnoses.
  • Isabel.com
  • WebMD.com=
  • iTriage.com
  • Mayoclinic.com
  • A.D.A.M., com
These sites offer lists of likely diagnoses to match your symptoms.  The lists are not foolproof, but they are good and improving . In 2007, Mark Graber, MD, president of the Society to Improve Diagnosis,  co-authored an article in the Journal of General Internal Medicine, “Performance of a Web-Based Clinical Diagnostic Support System, “ in which symptom-checking listed  the correct diagnosis in 48 or 50 complex cases.
By the way, I told you so in the following blog, written in 2011.
Medinnovationblog, January, 2011

Seek and Find: Health Reform and Googling of Disease and Health
Attempt the end, and never stand in doubt.
Nothing’s so hard, but search will find it out.
Robert Herrick (1591-1674), Seek and Find

I would like to make a two-pronged immodest proposal:

1) that Google or a similar company aggregate data on diagnostic patterns of disease and make it available to physicians and similarly,

2) That Google or  another company aggregate data on the state of a person’s heath and make it available to the general public.

I know this is doable because I have done it on a small scale, as described in the last chapter in my book, “An Innovator’s Personal Experience and Vision” (Innovation-Driven Health Care; 34 Key Concepts for Transformation (Jones and Bartlett, 2007).

I described how, using data from physicians’ offices, in a clinical laboratory in Minneapolis, we were:

1) able to list the correct diagnosis among the top 5 diagnostic possibilities based on abnormal tests in multitest profiles more than 80% of the time;

2) able to make a person’s health understandable to the public based on an algorithm for health using the health quotient (HQ) as the physical health analogy of the IQ, the instrument for measuring human intelligence.

We realized two elemental things:

• That most diseases – especially chronic diseases – manifested themselves in clear-cut diagnostic laboratory patterns.

• That present and future health often rested on physical measurements – blood pressure, pulse, body mass index (a function of body weight and height), waist and hip measurements, blood chemistries, and a past personal or family history of heart attacks and strokes.

Our algorithm classified patients as being in superb health (HQ of 120 or more), average health (HQ of 20 to 120), subpar health (HQ 50 to 70), and poor health (HQ 50 or less).
The state of one’s health and disease are, of course, closely related, for example, obesity, hypertension, hyperlipidemia, and diabetes often precede heart attacks and stroke. Our point was that seemingly mundane data, when aggregated, has diagnostic and predictive power.

In that chapter, I stated, ” “Think for a moment about the power of Google, the Internet’s largest and fastest growing search engine. Type in a combination of search terms into its search box. Immediately a list of prioritized possibilities will appear. Although the Google logic may be awesomely complicated, it is amazingly simple to use. Google is the quintessential ‘disruptive innovation.’”

I have written that aggregated clinical data mining could be one of the keys to U.S. health reform (“Data Mining and Innovation: Keys to U.S. Health Reform,” Healthleadersmedia. com, June 27, 2006).

I still believe this to be the case, but only if the data is used to open the minds of doctors and patients rather than to enforce regulations and judge performance. Also physician and patient privacy must be protected.

The field of clinical innovation using existing, easily accessible data, is wide open and awaits the skills of an innovative web-based company to fully develop. Today, much more data is available via EHRs and PHRs (Personal Health Records). This data would further enhance diagnostic and health accuracy.

Tweet:  Patient online symptom-checking  is a  powerful diagnostic tool for listing the correct diagnosis. Bring your list to your doctor visit.

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