David Kerr: Signals from the crowd—making a diagnosis

David KerrFor very many years making a medical diagnosis was based loosely on the application of the principle of Occam’s Razor otherwise known as diagnostic parsimony—look for the fewest possible causes to explain a patient’s symptoms. However, with the increase in longevity of the background population, Occam’s Razor was eventually superseded by the Hickam’s Dictum which states that “patients can have as many diseases as they damn well please.” Here the idea is to consider that multiple symptoms are more likely explained by a collection of common diseases rather than a single rare one.

Hickram’s Dictum has since been extended even further due to the pervading influences of health consumerism and fear of litigation. The modern doctor is much more likely to order a number of investigations to rule out multiple conditions irrespective of whether they are common or very rare. This can result in patients undergoing repeated painful and expensive tests leading to frustration for both the sufferer and the healthcare professional. It is also expensive and in principle bad medicine.

Nowadays we have a growing number of so-called ePatients. These are “health consumers” who use the Internet to gather information about a medical condition. The e in ePatient apparently stands for “being equipped, enabled, empowered, engaged, equal, emancipated, and expert” and, according to Wikipedia, e-Patients report two effects of their online health research: “better health services, and different relationships with their doctors.” This group are also calling for “medical education to take the e-patient into account and to prepare students for medical practice that encompasses the e-patient.

So in terms of the art and science of turning a collection of perplexing symptoms into a diagnosis we will also soon have “crowdsourcing diagnostics.” According to a recent report, a technology start-up has received more than $1 million in seed funding to develop the idea of using the “wisdom of crowds” for making medical diagnoses. On this particular site you can “use your personal experience, intuition, and online research skills to help solve the world’s most difficult medical cases” and “not only win cash, prizes, and status, but also save lives.” Reassuringly the idea is not to make a diagnosis per se but to make “diagnostic suggestions” about rare and unusual conditions that can be discussed with healthcare professionals. On the site, users can sign up to be either a patient or a medical detective (otherwise known as an “MD”). All the information about a medical quandary: symptoms, family history, and test results are uploaded and cases are then presented to the MDs, who can suggest a diagnosis and bet on the likelihood of their diagnoses being correct.

Whether crowdsourcing diagnostics will ever catch on remains to be seen. It will probably be of more value for detecting side effects from recently introduced new medicines or for suggesting topics for clinical research. When it comes to the personal experience of seeking a diagnosis most individuals are probably still keen on seeking the views of a well-trained, experienced, and caring professional and in confidence.

David Kerr wears many hats, sometimes at the same time—diabetologist, editor of Diabetes Digest, researcher, and founder of VoyageMD.com, a free service for travellers with diabetes. You can follow him on Twitter (@GoDiabetesMD) and Linkedin. He holds a small amount of stock in CellNovo (a new insulin pump company) and Axon Telehealth.

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