Crowd Wisdom for Diagnosis?

Swerlick, Robert A rswerli at EMORY.EDU
Wed Jul 17 15:53:51 UTC 2013


I also found this intriguing. I read a number of scenarios and they seem to fall into the category of chronic diseases that were subjective heavy and objective light in terms of findings. The SIDM meeting I attending last year highlighted misdiagnosis in an acute care environment where the outcomes are not so subtle and can be measured in time frames of hours to days. In the chronic disease world, the concept of diagnosis is more subtle and in many respects, each patient has their own disease. The concept of missed diagnosis is a bit fuzzy.



Dr. Zamir's comments belie a very physician focused perspective. A patient who presents with a headache may view it in itself is a significant problem. To conclude that if  they do not have anything life threatening, they do not have anything serious is a problem and potentially a form of misdiagnosis. If our goals as physicians do not align with the goals of our patients, we need to be very careful about concluding that our patient's goals need to change.



CrowdMed is a testimonial to a sea of patients whose needs are not being met through conventional channels. I am not sure that using physicians as filters as to what should be posted would give us the same information or population of patients.



Also just my two cents...





Robert A. Swerlick, MD
Alicia Leizman Stonecipher Chair of Dermatology
Professor and Chairman, Department of Dermatology
Emory University School of Medicine
404-727-3669
________________________________
From: Ehud Zamir [ezamir at UNIMELB.EDU.AU]
Sent: Tuesday, July 16, 2013 9:22 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: Crowd Wisdom for Diagnosis?

Interesting idea. However, one has to remember that in primary care, most patients with unresolved symptoms (after medical assessment) have no serious or significant underlying problem. Not sure anyone has ever counted them, but I think one may safely assume that a competent GP is often required to conclude, correctly, "I don't know what the reason for your chronic headache is, Mrs Smith, but I can tell you it is unlikely to be anything serious". The risk of such a project, is that, statistically, in the majority of patients who believe they are a "diagnostic mystery", none of the ideas raised by the "detectives" will really help reach a significant diagnosis (simply because there is none). There will possibly be an occasional misdiagnosis needle in the haystack, but that will be diluted by a lot of background noise. That is the one of the challenges of primary care in the first place, isn't it?
I think it would be more likely to help if the cases were ones where doctors  posted their unresolved cases where they felt the unease of a truly unresolved, and potentially serious, problem. Statistically, it would increase the utility of second opinions.
Just my two cents
Ehud

Ehud Zamir, MD, FRANZCO
Centre for Eye Research
Melbourne Australia
________________________________
From: David Meyers [dm0015 at ICLOUD.COM]
Sent: Wednesday, 17 July 2013 5:10 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: Crowd Wisdom for Diagnosis?

Dr Lisa Sanders, the NY Times medical correspondent, has been doing this for quite a while in the Sunday magazine.  See link:  http://topics.nytimes.com/topics/news/health/columns/diagnosis/index.html.  There are also Twitter resources in emergency medicine like this.  One has to be careful to use the wisdom of crowds  (see James Surowiecki, 2004) and not the madness of crowds (Charles Mackay, 1841), if we can tell the difference.

David

David L Meyers, MD, FACEP
dm0015 at icloud.com<mailto:dm0015 at icloud.com>
Mobile: 410-952-8782
Fax: 410-367-0449




On Jul 16, 2013, at 1:59 PM, Bill Thatcher <BillThatcher at MINDSPRING.COM<mailto:BillThatcher at MINDSPRING.COM>> wrote:

Yesterday I posted a short piece from Mark Graber, MD about an intriguing new website:

CrowdMed.com <http://www.crowdmed.com/> is a new online startup that uses the 'wisdom of the crowd' to suggest the correct diagnosis for patients with unresolved symptoms. The project is the brainchild of Jared Heyman, an internet-entrepreneur, who thought of the idea after his sister suffered through an undiagnosed illness for over three years. Cases are submitted by patients for a small fee, and anyone can register as an "MD" (medical detective - cute, eh? No license required) to suggest a diagnosis or vote on the suggestions already made.

You can read the rest of the post from Mark Graber here:

http://improvediagnosis.site-ym.com/blogpost/950784/Latest-News

Bill Thatcher

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