Physicians beat symptom checkers in test of diagnostic accuracy
hmepstein at GMAIL.COM
Tue Oct 11 20:06:10 UTC 2016
Thank you so much for your analysis of the study. I agree that the closer we can get to real world measurement of diagnostic successes and errors, the better off we will be. It's interesting that the physicians were given the same data that the symptom checkers were given and that they were measurably more successful. Is that a problem with the symptom checkers or the nature of a standardized patient case study?
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On Oct 11, 2016, at 10:02 AM, Follansbee, William <follansbeewp at upmc.edu> wrote:
Thank you for sharing this article and I understand you concern. The members following this listserv recognize the serious issue of diagnostic error and are committed to the challenge of improving diagnostic accuracy. At the same time, we need to remain objective in our interpretation of data. The process of reaching a diagnosis is typically a longitudinal one as patient symptoms evolve and as data are gathered over time. This study measured diagnostic accuracy in a first impression type of scenario, with no physical examination information nor any diagnostic testing information such as laboratory data or radiologic studies. In that context, having the correct diagnosis in the top three approximately 85% of the time may not be as discouraging as it initially appears. Presumably as more information is provided, clinical accuracy would improve. On the other hand, this study might also be overestimating diagnostic accuracy. Standardized cases, as were used in this study, is one approach which is attractive in the research environment because it can be controlled and defined, but it is less clear how well a study like this reflects real world experience. Developing reliable methods to measure diagnostic error in the real world is one of the major challenges we all face as we work to reduce its frequency.
William P. Follansbee, M.D., FACC, FACP, FASNC, FAHA
The Master Clinician Professor of Cardiovascular Medicine
Director, The UPMC Clinical Center for Medical Decision Making
Suite A429 UPMC Presbyterian
200 Lothrop Street
Pittsburgh, PA 15213
Email: follansbeewp at upmc.edu
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From: HM Epstein [mailto:hmepstein at GMAIL.COM]
Sent: Tuesday, October 11, 2016 12:18 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [IMPROVEDX] Physicians beat symptom checkers in test of diagnostic accuracy
Modern Healthcare's analysis of today's research letter in JAMA Internal Medicine states that while participating physicians beat the symptom checkers in identifying the correct Dx (which includes listing it in the top three possible diagnoses), they were still off too often.
"The physicians listed the correct diagnosis first across all cases 72.1% of the time, while symptom checkers listed the correct diagnosis first only 34% of the time, according to the research letter.
Physicians also listed the correct diagnosis in their top three diagnoses 84.3% of the time, while symptom checkers included the correct condition in the top three 51.2% of the time."
As a patient, I'm depressed that physicians got the correct Dx less than 3/4 of the time. It's more significant to me than the higher results achieved for naming it in the top three possibilities, because patients rarely hear the alternatives unless they specifically ask "What else could it be?" To be fair, the lack of physical exams is a noteworthy element.
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