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Author Topic: Why doesn't the medical profession make better use of the internet?  (Read 2127 times)

Offline graham.d

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There are quite a few "self diagnosis" sites (for want of a better description) and I think these are all very popular and quite useful. I have a feeling that GP's are not always of that opinion, however, as it can lead to surgeries getting populated by the "worried well" and, worse, people becoming sceptical about their GP's all knowing, God-like status - now, thankfully, largely gone.

This is not what I am referring to in the question however. It is just that the popularity of such sites means that people are willing to spend time discussing their ailments and learning about diagnoses and treatments. This is a huge and underused resource of knowledge that is not being utilised. Clinical investigations and trials are very expensive and often do not yield statistically adequate conclusions. It seems to me that there are a lot of medical issues, large and small, that could be aided by a few websites just asking people to contribute.

There are sites that already try to describe symptoms which may point to a particular ailment. But no use is made of whether or not the results were accurate. Indeed there is no way to report it. Statistics on the accuracy of prediction would seem to me to be valuable data and a good way to hone how to weight particular symptoms in pointing to specific ailments. The efficacy of drugs is another way to gain a much better statistical weight than some trials. Of course these do not replace trials, especially double blind trials, but the potential numbers can become very useful, especially in looking at possible side effects for example. Diagnosis can often, at least at first, be done by having a patient describe a pain; not just where the pain is but also whether it hurts when touched, when breathing or what sort of pain it is. The language for pain description is far from universal (I actually think descriptions of taste for wine tasting is better developed) and this could be made much better honed by questions and answers on the internet.

I won't go on but the gist of this is that this could be done at low cost and, with existing software used widely in market research, could be very well statistically analysed and results collated.


 

Offline JnA

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I think the main problem with self diagnosis is that you may not be accurately describing the pain. Sure your side might hurt, you may even be able to say 'sharply' or 'acute', but how are people to accurately judge if the pain starts at the beginning of manual pressure or at the removal of (which is indicative of appendix pain)   it's as difficult to perform a manual examination on yourself as it is to tickle yourself.    Interpretations is also a big factor.
But I do like the idea of reporting back to build a data base of 'how things worked'  that could provide more useful information.
Also, where's the liability? any professional putting their name to a computerised diagnosis machine would be a very brave soul...

Here, we have a 24 hour medical helpline.  The phones are manned by volunteer (I believe) doctors and nurses and you have the comfort of 'a second, and professional, opinion.   As far as I know, the helpline has eased non emergency cases in hospital EM rooms and it also gives us, the consumer, a sense of comfort..  I would always be questioning a 'diagnosis' from a computer, but from the soft voice of a person at 3am...   

« Last Edit: 05/04/2013 01:15:38 by JnA »
 

Offline CliffordK

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I agree that there are many things that one can gain from internet surveys as it can collect data that might otherwise go unnoticed.  However, there are also risks.

An anecdote is not the same as a rigorous scientific study. 

Consider cold remedies.  Pretty much anything a person does, within a week or so, the cold will be mostly resolved.  One can come up with many unique "cures", all curing the cold.  A well designed double blinded study would be required to determine whether symptoms were alleviated, or the duration was shortened, or transmission was reduced. 

Another thing is that there are many biases in self-reported internet studies.  The people finding the studies may have an agenda, or may represent extremes of either "believed cures", or "no cures".  thus the statistics may be horribly skewed. 

There are some websites that provide excellent information resources such as the Mayo Clinic website.  But, physicians should seek a more thorough understanding of the disease processes than the lay public. and they may have a better background to understand interdependent health issues.  Whether they do, in fact, put in the same effort as individuals suffering from chronic conditions is another question.
 

Offline RD

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Quote
Topic: Why doesn't the medical profession make better use of the internet?

Or to put it another way :
Why don't a profession wish to adopt technology which could to some extent replace them at a tiny fraction of the current cost ?, making their job less secure and applying a downward pressure on their salary.

If diagnosis is a decision tree , rather than a black-art, then software can perform that task quicker cheaper and more reliably.

Re: UK (NHS). Bear in mind the function of the NHS is to minimize the cost of illness to the state, that does not necessary mean to diagnose it correctly, or at all. Software which diagnosed people accurately , rather than leaving them in zero-cost-limbo, or with a cheap false-diagnosis, would not be welcome in the "wonderful" NHS.
« Last Edit: 05/04/2013 09:29:48 by RD »
 

Offline graham.d

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I used the self diagnosis web-sites as an example of how the internet is currently used by individuals and how it could be expanded to provide more data. I understand that data gathered from such a site is not perfect but there are now some very good techniques available to sift data to give reliable results. These techniques are used widely by the reputable market and political survey professional organisations - these are not to be confused by the many poorly designed surveys knocked up by people who don't know what they are doing.

JnA points out the problems of describing pain. This is an area that badly needs addressing and could be helped by developing a more universal language for descriptions of the various types of pain. It is very ad hoc at the moment and would benefit from input from people with a wide range of known ailments correlating their experiences with more normal language descriptions and then getting these into specific categories of pain types.

Correlation of between ailments that are simply not recorded at present would be another area of use. A personal experience I had was that following hernia surgery I had an outbreak of shingles centred over the operation scar. This within two weeks of the surgery. This may have been coincidence (though seems unlikely) but there was/is no way to find out if this has occurred with others. It would seem to me that this would be useful information in looking how the Shingles virus behaves but I, at least, found nobody interested in this. If there ahd, on the other hand, been a few hundred such experiences it would, or should, spur interest in research.

The use of multiple drugs and their interactions could be studied in a much broader way and, with modern data management systems, mostly automatically with data presented in a digestable form.

The possibilities are very wide indeed; it is all within the realms of existing technology and with a large resource of people more than willing participate. The cost of this need not be high (certainly not by NHS or drug company standards). It really could be started on a very low budget indeed but needs some multidisciplinary talent to spend time in its development.
 

Offline RD

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... I had an outbreak of shingles centred over the operation scar. This within two weeks of the surgery. This may have been coincidence (though seems unlikely) but there was/is no way to find out if this has occurred with others.

Possibly Köbner phenomenon ...
Quote
isomorphic response
a response to trauma at sites of injury in previously uninvolved areas of patients with skin diseases such as psoriasis and lichen planus, typically with linear lesions at sites of scratching or a scar.
Synonym(s): Köbner phenomenon
http://medical-dictionary.thefreedictionary.com/isomorphic+response
 

Offline graham.d

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My GP diagnosed it as Shingles and put me on anti-virals. It looked nothing like lichen planus (I've never heard of that - looks unpleasant) or Psoriasis and the rash followed a nerve line, but then there was no other tests done. I had a lot of pain but then I guess I would have had this as a result of the operation. Anyway, this is just an example; if there were no other similar cases then it probably was a coincidence. The point is that a database would be very useful in determining this.
 

Offline RD

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Köbner phenomenon occurs with a wide range of skin conditions,
 not just the "such as" examples listed in the above definition.
 

Offline graham.d

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Maybe RD, but this personal example is only to illustrate one point in the suggestion. It is not especially important in itself and I was not intending to elaborate. But FYI there was no itching and the rash extended from the scar along the likely nerve track around my side and towards my spine. I think the GP who examined me probably got it right. The point is, if it was right, was it is an interesting and unfortunate coincidence or is it possible that the occurrence of shingles as a result of traumatic nerve damage (during an operation for example and in the same localized region) is indicative of some process in the resurgence of the dormant virus that would be of interest to research. Maybe it is already known, though my GP regarded it as a coincidence having not come across it before.
 

Offline majorminor

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With alot of those who have the internet also having webcams, is it not feasible for this to be used in diagnosis or at least  an  online  guide could suggest going to their local doctor if it looks serious. I know such a format would be susceptible to hypochondriacs and occasionally trolls but I think it certainly would reduce workload at cheap cost.
In 2004 my father went to doctor about rash type thing on his skin... told everything was okay .. went back a few times over the next year and half... finally there was a vistiting doctor at the practice and he sent him to hospital. Turns out he had the most aggressive form of skin cancer. Made me angry that a thing we are meant to be able to recognise ourselves was missed by trained professional. But as mentioned before they are not gods and for this reason an easy access second opinion seems like a great idea. I would not know if its financially feasible but seems like  could even be setup from back office in any practice and linked online. With rotating shifts for time periods dictated by the doctors.
 

Offline RD

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... With alot of those who have the internet also having webcams, is it not feasible for this to be used in diagnosis or at least  an  online  guide could suggest going to their local doctor if it looks serious.

There is teledermatology, but I don't think a low-resolution web camera would be up to the job.
 

Offline cheryl j

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I have often misdiagnosed myself, but even doctors don't rely on signs and symptoms for a diagnosis.  It may give them a direction to start with, but a lot depends on laboratory tests and imaging, which the internet cannot provide. But tele-medicine is a benefit in rural areas, where specialist appointments may mean hours and days of travel for sick, weak people with no access to transportation. I've also seen doctors check the internet or programs on their phones or ipads for quick information, drug interactions, side effects, etc.
 

Offline graham.d

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The subject has drifted on to self-diagnosis. I only mention about the websites that do that to show how much public interest there is and how much medical science could benefit from capitalising on the vast amounts of data that could be available freely from the many people willing to contribute, for example, in correlating symptoms with diagnosed ailments. There are also many other areas where the statistical weight of such data would be a huge, and as yet untapped, resource.
 

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