{"id":46756,"date":"2020-03-03T13:32:12","date_gmt":"2020-03-03T12:32:12","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=46756"},"modified":"2020-03-05T16:42:39","modified_gmt":"2020-03-05T15:42:39","slug":"amitha-kalaichandran-can-we-crowdsource-a-diagnosis","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/03\/03\/amitha-kalaichandran-can-we-crowdsource-a-diagnosis\/","title":{"rendered":"Amitha Kalaichandran: Can we crowdsource a diagnosis?\u00a0"},"content":{"rendered":"<p><span style=\"font-weight: 400\">Two recent US initiatives: the <\/span><i><span style=\"font-weight: 400\">New York Times<\/span><\/i><span style=\"font-weight: 400\">\u2019 <\/span><a href=\"https:\/\/www.nytimes.com\/interactive\/2018\/11\/16\/magazine\/netflix-diagnosis-series-ann.html?rref=collection%2Fbyline%2Flisa-sanders%2C-m.d.&amp;action=click&amp;contentCollection=undefined&amp;region=stream&amp;module=stream_unit&amp;version=latest&amp;contentPlacement=9&amp;pgtype=collection\"><span style=\"font-weight: 400\">rare disease column<\/span><\/a><span style=\"font-weight: 400\"> and a TBS series called <\/span><a href=\"https:\/\/www.chasingthecurelive.com\/\"><span style=\"font-weight: 400\">Chasing the Cure<\/span><\/a><span style=\"font-weight: 400\"> are pointing to an emerging trend in the media: the idea that medicine can crowdsource ideas to diagnose difficult cases. But, can it be used to help diagnose patients, and what are the potential pitfalls?<\/span><\/p>\n<p><span style=\"font-weight: 400\">Reaching a correct diagnosis is the crucial aspect of any consultation, but misdiagnosis is common, with some studies suggesting that medical diagnoses can be wrong, up to 43% according to <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27867079\"><span style=\"font-weight: 400\">some studies<\/span><\/a><span style=\"font-weight: 400\">.\u00a0 This concern was the focus of a <\/span><a href=\"https:\/\/www.who.int\/features\/factfiles\/patient_safety\/patient-safety-fact-file.pdf?ua=1\"><span style=\"font-weight: 400\">recent report<\/span><\/a><span style=\"font-weight: 400\"> by the World Health Organization. Individual doctors may overlook something, draw the wrong conclusion, or have their own cognitive biases which means they make the wrong diagnosis. And while hospital rounds, team meetings, and sharing cases with colleagues are ways in which clinicians try to guard against this, medicine could learn from the tech world by applying the principles of \u201cnetwork analysis\u201d to help solve diagnostic dilemmas.\u00a0<\/span><\/p>\n<p><a href=\"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2726709\"><span style=\"font-weight: 400\">A recent study<\/span><\/a><span style=\"font-weight: 400\"> in <\/span><i><span style=\"font-weight: 400\">JAMA Network Open<\/span><\/i><span style=\"font-weight: 400\"> applied the principle of collective intelligence to see whether combining physician and medical students&#8217; diagnoses improved accuracy. The research, led by Michael Barnett, of the Harvard Chan School of Public Health, in collaboration with the <\/span><a href=\"https:\/\/www.humandx.org\/\"><span style=\"font-weight: 400\">Human Diagnosis Project<\/span><\/a><span style=\"font-weight: 400\">, used a large data set from the Human Diagnosis Project to determine the accuracy of diagnosis according to level of training: staff physicians, trainees (residents and fellows), and medical students. First, participants were provided with a structured clinical case and were required to submit their differential diagnosis independently. Then the researchers gathered participants into groups of between two and nine to solve cases collectively.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The researchers found that at an individual level, trainees and staff physicians were similar in their diagnostic accuracy. But even though individual accuracy averaged only about 62.5%, it leaped to as high as 85.6% when doctors solved a diagnostic dilemma as a group. The larger the group, which was capped at nine, the more accurate the diagnosis.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The Human Diagnosis Project now incorporates elements of artificial intelligence, which aims to strengthen the impact of crowdsourcing. Several studies have found that when used appropriately, AI has the potential to improve diagnostic accuracy, particularly in fields like <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6268174\/\"><span style=\"font-weight: 400\">radiology<\/span><\/a><span style=\"font-weight: 400\"> and <\/span><a href=\"https:\/\/www.thelancet.com\/journals\/lanonc\/article\/PIIS1470-2045(19)30154-8\/fulltext\"><span style=\"font-weight: 400\">pathology<\/span><\/a><span style=\"font-weight: 400\">, and there is emerging evidence when it comes to <\/span><a href=\"https:\/\/www.nature.com\/articles\/s41746-019-0172-3\"><span style=\"font-weight: 400\">opthamology<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/p>\n<p><span style=\"font-weight: 400\">However, an issue with crowdsourcing and sharing patient data is that it\u2019s unclear how securely patient data are stored and whether patient privacy is protected. This is an issue that <\/span><a href=\"https:\/\/www.nature.com\/articles\/s41746-019-0172-3\"><span style=\"font-weight: 400\">comes up time and time again<\/span><\/a><span style=\"font-weight: 400\">, along with how commercial companies may profit from third parties <\/span><a href=\"https:\/\/www.thestar.com\/news\/investigations\/2019\/02\/20\/medical-record-software-companies-are-selling-your-health-data.html\"><span style=\"font-weight: 400\">selling these data<\/span><\/a><span style=\"font-weight: 400\">, even if presented in aggregate.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">As such, while crowdsourcing may help reduce medical diagnostic error, sharing patient information widely, even with a medical group, raises important questions around patient consent and confidentiality.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The second issue involves the patient-physician relationship. So far it doesn\u2019t appear that crowdsourcing has a negative impact in this regard. For instance, in one study over half of patients <\/span><a href=\"https:\/\/www.jmir.org\/2016\/1\/e12\/\"><span style=\"font-weight: 400\">reported benefit <\/span><\/a><span style=\"font-weight: 400\">from crowdsourcing difficult conditions, however very few studies have explored this particular issue. It\u2019s entirely possible that patients may want to crowdsource management options for instance, and obtain advice that runs counter to their physicians\u2019 and theoretically this could be a source of tension.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The last issue involves consent. A<\/span><a href=\"https:\/\/www.medscape.com\/viewarticle\/844097#vp_1\"><span style=\"font-weight: 400\"> survey<\/span><\/a><span style=\"font-weight: 400\">, presented at the Society of General Internal Medicine Annual Meeting in 2015, reported that 80% of patients surveyed consented to crowdsourcing, with 43% preferring verbal consent, and 26% preferring written consent\u00a0 (31% said no consent was needed). Some <\/span><a href=\"https:\/\/www.cmpa-acpm.ca\/en\/advice-publications\/browse-articles\/2017\/social-networks-in-healthcare-opportunities-and-challenges-for-a-connected-future\"><span style=\"font-weight: 400\">medico-legal recommendations<\/span><\/a><span style=\"font-weight: 400\">, however, do outline the potential impact on physicians who crowdsource without the appropriate consent, in addition to the possible liabilities around participating in a crowdsourcing platform when their opinion ends up being incorrect. Clearly these are issues that have no clear answer: and we may end up in a position where patients are eager to crowdsource difficult-to-diagnose (and treat) sets of symptoms, but physicians exercise sensible caution.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">It\u2019s often said that medical information doubles <\/span><a href=\"https:\/\/www.elsevier.com\/connect\/medical-knowledge-doubles-every-few-months-how-can-clinicians-keep-up\"><span style=\"font-weight: 400\">every few months<\/span><\/a><span style=\"font-weight: 400\">, and that time is only shortening. Collectively, there\u2019s an enormous amount of medical knowledge and experience both locally and globally that barely gets tapped into when a new patient reaches our doors in any given hospital or clinic. Applying network intelligence to solving the most challenging, as well as the illusory &#8220;easy,&#8221; diagnosis, may give patients the best of both worlds: the benefit of their doctor\u2019s empathetic care with the experience and intelligence of a collective many,<\/span><span style=\"font-weight: 400\"> but the potential downsides deserve attention as well.\u00a0<\/span><\/p>\n<p><i><span style=\"font-weight: 400\"><strong>Amitha Kalaichandran<\/strong>, is a physician and journalist based in Toronto, Canada. Follow her on Twitter at <a href=\"https:\/\/twitter.com\/DrAmithaMD\">@DrAmithaMD<\/a>.<\/span><\/i><span style=\"font-weight: 400\">\u00a0<\/span><\/p>\n<p><em><strong>Competing interests<\/strong>: None declared<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Two recent US initiatives: the New York Times\u2019 rare disease column and a TBS series called Chasing the Cure are pointing to an emerging trend in the media: the idea [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/03\/03\/amitha-kalaichandran-can-we-crowdsource-a-diagnosis\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":45318,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1357],"tags":[],"class_list":["post-46756","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-us-health-care"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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