Your doctor doesn't want you to see this -- diagnosis using AI
symcat.com
symcat.com
http://symptoms.webmd.com/coresc/landing#/introView
For example, I can click Arm -> Armpit -> Lump or Bulge and see the possible conditions.
Armpit doesn't even exist in your system. Which would be fine if I already knew how to self diagnose a swollen lymph node. Of course, if I didn't, I would still need a doctor to tell me what search term to use on your site.
I can understand if the system is early in development, but if it doesn't do anything for the layman why would my doctor care if I saw it?
The AI component is the fact that we train our algorithm based on clinical data from real patients (started with CDC data -- 500k at the moment and counting as people use the site).
I've had bad experiences with the WebMD symptom checker like most people I've spoken to. Try typing in "chills" and you get "Lyme disease, acne, Bubonic plague" (no joke).
WebMD makes money on advertising, so they unfortunately direct you to the pages that are going to keep you on the site for longer. You may find what you have using their symptom checker, but it is really optimized to keep you clicking.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1307157/
http://en.wikipedia.org/wiki/Clinical_decision_support_syste...
In fact, it makes me wonder if the submitter of this article is an affiliate for the site this story links to. His only activity is made up of 3 submissions that seem to be related to this site http://news.ycombinator.com/submitted?id=cmonsen
It's an interesting site but it's sad to see HN being gamed like this.
I was surprised at the results. I was disappointed that there wasn't some gentle friendly persuasive advice about going to see a real doctor quickly. Yes, I know there's a disclaimer on the front page, but I feel this is a missed opportunity.
You're going to tap into that hard to reach market of people who might have a serious problem but who are reluctant to see someone. You have a great opportunity to educate them; to let them know that there's probably nothing to worry about but that early intervention is crucial; and that this is what happens at these types of examinations.
But: It's a really cool tool, and I look forward to seeing how it develops!
That's exactly where we're going. We want to direct patients to the right doctor/level of care and are incorporating triage guidelines towards that end.
Thanks!
We're still building out our recommendations, so you can expect ours to also alert people to see a doctor when appendicitis is likely.
I entered (but do not have) "bloody feces" as a test case, it gave me 4 options for symtoms that they think I meant, none even anywhere close. Hint: if they're black and stinky you need immediate medical help, if the blood is red and sparse it's probably piles - THIS IS NOT MEDICAL ADVICE.
Is this an alpha test?
There's a good paper on it that explains most people feel that it just directs them to a primary care physician. We'd like to offer value to those people as well and match them to exactly the physician who can help them (ie OKCupid for patients-doctors).
I put in "tired" and got a list of: depression, diabetes, hypothyroidism, atrial fibrillation,anxiety ,multiple sclerosis, congestive heart failure and gastroesophageal reflux disease.
If I click on "increased risk," I get: valley fever, muscular dystrophy, hemolytic anemia, intracranial abscess, thalassemia, gallbladder cancer, polycythemia vera, and autonomic nervous system disorder.
Nowhere does it ask me if I happened to get enough sleep...
Maybe they need a big button that says "Are you really worried right now?" and if you click it, tell you logical steps and routine you need to be following long-term for the results to "feel more normal" - otherwise to not use to self-diagnose.
It would also seem like a better approach would be to have a prior that's much lower for the internet and is never updated based on user searches, then continue hand-entering real records for quality control purposes. Otherwise, sooner or later some internet community (4chan, SA, etc) will get carried away and start manipulating your system to make everyone think they're dying of elephantiasis.
WRT abuse, we're going to require the log-in and user consent before collecting any data and allow people to maintain, in effect, their own medical record. We can monitor for abuse (eg someone who seems to visit a hospital thousands of times / day).
One word of advice though. Hating on docs might be a good idea PR-wise, but only if you're going after patients who hate on their docs, but that's not your market, your market is the docs. This industry is always going to be regulated and that's a good thing. So, don't try to fight them, join them and help them make money. It doesn't take a brain surgeon to know this could be a money maker for them.
You also need all the data you can get. Data on symptoms, diseases, drugs, side effects, off label usage, ... You need the FDA, you need the docs and you need the patients. While docs are all about sharing data, they only do so within their community. That's the part that needs to open up. And stay open. The patients are the easy part, they know sharing data is going to help them.
Docs aren't against systems like what you're trying to build. Systems like this are already being used when you get PET scans. There're hundreds, if not thousands of spots on the photos and an algorithm helps them narrow down the results. It's a huge time saver and it obviously helps the patient. The money's in making sense of all the data and offering solutions.
You will also be dealing with companies like GE. An example. The docs are your friend, so let's say they measure your bone density and they're willing to give you the results, what do you think GE is going to do about that? You're in their market and they will fight you with package deals! You'll be up against Google as well because they will offer the docs a free version of your product, ad supported.
Your system needs more data. I tried it but the diagnosis was wrong, stayed wrong and eventually no diagnosis was given. You need photos. You need all the help and data you can get.
Most people believe that their doctor gives them a diagnosis and are 100% certain of it, but in reality medicine is a highly probabilistic domain. There's a great article about a family's story with misdiagnosis in their child (http://www.slate.com/articles/double_x/doublex/2011/07/how_f...). The diagnosis was initially strep, but it soon became evident that the diagnosis was the much more rare Kawasaki disease. Symcat is an attempt to let patients know about both (ie "This is probably strep, but you should continue to monitor because Kawasaki disease can also cause this and the only way you know is if your symptoms persist").
We would love to get more docs on board and we've been working with physicians at Hopkins to make this as useful to patients as possible.
Completely agree that this lives on the quality of the data. We would like for users to contribute their data (a la patientslikeme). We also are exploring partnerships with health care providers and data stores for getting additional data.
If you are ill and you don’t know what’s going on, see a doc (or a nurse practitioner etc). Uninsured (yeah - that’s me till 2 months ago.) - then it will cost a packet. Which is good as you’ll be encouraged to figure out what’s normal for your body - which is what needs to happen anyhow.
Remote diagnostics is a hard game even if a doc is doing it. A rules engine just isn’t up to it. It’s not just a game of checklists. This thing might be better (It’s down right now) - but nothing is as good as being in a room with the patient, having some EQ, asking questions, and being able to view symptoms with your own 2 eyes.
I’m probably just thinking that /very/ large sacrifices may be needed, even just for diagnostics.
-- Heavily edited
I tend to agree with your wife (I'm a 4th year med student at Hopkins), which is why I'm building my own.
I think it's easy for websites to just say "if you are concerned, see a doctor" but I also believe that to be the problem. Obviously, if it were costless (time, money, opportunity cost) people would go see a doctor, but they in reality are weighing those costs. We'd like to make it easy for people to weight the risk vs. the benefits of seeing a doctor.
Moreover, for too many people "seeing a doctor" means going straight to the ER. There they wait for 4 hours (nat'l average) and are frequently told to follow-up with a doc anyway. We want to let others know that there are other options (eg urgent care centers) and let them know when such care is clinically indicated.
Learning medicine is all about learning diagnostic algorithms
Although the linked site failed completely (as far as I can tell, because its buggy!), the WebMD that was linked elsewhere correctly diagnosed my condition in less than 2 minutes. It took a real MD 2 hours+ and that included an (unnecessary) X-ray.
I don't think it's comparable to remote diagnosis being hard - that is very dependent on how doctors recall information, and visual information or feedback may be very important to them. An expert system has no such limitations.
Granted, appendicitis is pretty rare but I would've expected something higher.
On the plus side, it would've coached me towards Diverticulitis with a "Call 911 and go to the emergency room now" which would've led me to the right place/right conclusion (at one point when I was in pain, I'd thought I'd sleep on it but decided against it -- lucky for me, I didn't and went right to the hospital ... when I got there, they said it was about to burst.)
I have a side gig helping docs transition to EHRs. I started by helping an immunologist family member back in 2003. She's on her second EHR now. So far, her transitions have been the first and second most difficult of the bunch.
Right now it looks like SymCAT has the same problem as every EHR I've seen: the immunology side of allergy/immunology must be considered explicitly in your design, or the system will never work well. In immunology, you get weird sets of symptoms, you get multiple problems presenting, you get unusual systemic interactions and feedback loops.
For example, I just cruised through a few of the signs a less articulate person (not a medical pro) with common variable immunodeficiency might mention, along with a history of asthma. When I also include my "itchy scalp" (because you offered it in the "related" section) a bunch of potential diagnoses are excluded. None of them were correct, but a few were on the right track.
You're asking people to come up with their own symptoms and have a clue about which terminology will work. In practice, a big portion of the difference between a good doc and a mediocre/bad doc is the ability to construct a usable history from poor reporting. Via interview. Patients often do not have the tools to make connections (or ignore them) between symptoms.
That said, good luck. It's a great problem. If you get this right, it will be huge. Again, I'd encourage a public side for marketing and a different kind of input, but put your money on licensing.
You point to a challenge for any patient-facing patient decision aid -- getting the language right. We are building on the work of the U of Utah and building a robust consumer health vocabulary based on query data.
https://twitter.com/aheadresearch doesn't seem to exist.
It's a good title for gossip newspapers. It's not good for HN.
You can enter symptoms in the first question, and then move on to the second question. At this point, regardless of the timing selected, some of the symptoms drop off.
In my case, at the end, "What are my chances of having..." reported 0% for the correct diagnosis. This is not good.
What is worse: the condition is in your database and described perfectly there, including the details that would allow for a correct diagnosis.
Did you try starting from each condition, and measuring how often you get the diagnosis right? Correcting for the prevalence of each condition as needed - in my case its a common one so there didn't seem to by any reason not to get it right.
Also, it would be nice if the conditions page would tell you how often this condition happens (if needed by asking age group/sex).
What will be helpful is to update the algorithm from user input. I'd be interested in hearing about your particular case. We use symptom/disease prevalence in the calculations, so it is usually great at getting common conditions. Maybe you can leave a comment using the feedback form on the website and we can look into why it missed your diagnosis?
It didn't ask me if I was MSM and/or had unsafe sex previously. As such, there was no HIV seroconversion illness mentioned in the diagnosis list.
The recommendation (to see a professional) was correct.
In it's final result it should make a mention of urgency in seeking healthcare and what to do in the meantime.
True, there has been a lot of work in medical expert systems. DXPlain is an old one that tends to come up a lot in our conversations. We have several Hopkins medical informatics specialists advising us and I would say that our algorithm is novel.
Moreover, past attempts have attempted to codify a medical expert's knowledge (eg let's ask this smart doctor we know to determine disease prevalence). We calculated it from clinical data and can continue to learn as more people use it.
design needs some work
Who is the intended audience for the symptoms and conditions directories? Are the numbers next to the entries probabilities of having that symptom or condition for the general population?
And not that it's particularly important, but this entry doesn't seem correct: http://symcat.com/conditions/arsenic-poisoning (it discusses bacteria rather than the element).
Honestly, Google. We need to make sure that it is easily indexed and understood by crawlers. Some med students have found it useful though.
Will fix it, thanks!
"Application Error
An error occurred in the application and your page could not be served. Please try again in a few moments.
If you are the application owner, check your logs for details."