Crowd Wisdom for Diagnosis?

Perlis, Roy H., M.D. RPERLIS at PARTNERS.ORG
Wed Jul 24 21:59:08 UTC 2013


another way to describe Kurt's work would be that in a substantial proportion of these patients, symptoms are attributable to brain disorders without focal lesions. Remember, these are nothing more or less than illnesses without well-validated biological markers. The heritability of some of these ranges from 30-70%, similar to RA, type 2 diabetes, breast cancer, and so on.

an interesting question in this context is when a workup should be considered sufficient. The cost-effectiveness of working up every depressed patient for cancer (or even hypothyroidism) is low - but the case reports we celebrate in NEJM are the pancreatic cancer where the dumb shrink, or PCP, treated with fluoxetine for 6 months first.
________________________________
From: Eric S. Holmboe, M.D. [EHolmboe at ABIM.ORG]
Sent: Wednesday, July 24, 2013 2:59 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: Crowd Wisdom for Diagnosis?

There has been a lot of work on symptoms, including unexplained symptoms, and their outcomes. Kurt Kroenke of Indiana University has been a leader in this field. It is true that depending on the symptom and population studied no significant problem is often found. Of this group, a fair proportion appear to suffer from anxiety, somatoform disorders, etc.

Eric

From: Robert Bell [mailto:rmsbell at ESEDONA.NET]
Sent: Wednesday, July 17, 2013 11:39 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: Crowd Wisdom for Diagnosis?

I remember reading that a large percentage of those patients, who seemed to live in a doctor's office, often women, had been sexually abused when younger. Whether that was in any way causally related I am not sure.

Have not seen any confirmation of that hypothesis in recent years, but this group of patients could well be studied to find out more exactly what is going on, and perhaps better clarify the diagnoses for this group of patients. "What am I missing," might become less of a question for us!

Rob Bell, MD

Sent from my iPad

On Jul 16, 2013, at 6:22 PM, Ehud Zamir <ezamir at UNIMELB.EDU.AU<mailto:ezamir at UNIMELB.EDU.AU>> wrote:
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<mailto:dm0015 at ICLOUD.COM>]
Sent: Wednesday, 17 July 2013 5:10 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto: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://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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