NYTimes: Her Various Symptoms Seemed Unrelated. Then One Doctor Put It All Together.

Tom Benzoni benzonit at GMAIL.COM
Mon Feb 19 18:07:03 UTC 2018


The logic error we tend to commit is to run the case backwards.
With a retrospectoscope, I am right 100%.

This was not a case of Schnitzler's, it was a case of a patient with a rash
and fever.
That it took a few years to sort out is likely a sing of a system working
correctly.
(OK, maybe a bit slowly.)

You will note that the 11 page summary had the benefit of all the things
which this case wasn't.
That type of hindsight bias is a good thing, but it does not in any way
mean the patient should have been diagnosed sooner.

Febrile rashes have a huge differential.
But they come in only 2 types: good and bad.
Bad you can't miss: meningococcemia, etc.
"Good" is a relative term, but time will sort out most of these.
Only then do you have "the rest."
These are the ones that need careful parsing.

What I'm suggesting is development of AI that watches over my shoulder,
silent most of the time.
Point out when I'm down a blind alley or what I/others have ruled out and
the degree probability of that rule-out.
Then suggest options with degree probabilities, not cheating by having the
answer.

tom


On Sun, Feb 18, 2018 at 5:39 PM, Edward Hoffer <ehoffer at gmail.com> wrote:

> This story makes a very good case for the use of computer-based
> diagnostic decision support systems. I entered the findings into the one
> with which I work, DXplain, and Schnitzler's came in ranked #1 I did not
> try Isabel, but would not be surprised if it also had the correct diagnosis
> near the top. Much easier than spending the reported "hours" in PubMed that
> the hero expended to arrive at the correct diagnosis.
> Ed
> Edward P Hoffer MD, FACC, FACP
>
> On Sun, Feb 18, 2018 at 9:16 AM, Joe Graedon <jgraedon at gmail.com> wrote:
>
>> https://www.nytimes.com/2018/02/14/magazine/her-various-symp
>> toms-seemed-unrelated-then-one-doctor-put-it-all-together
>> .html?smprod=nytcore-ipad&smid=nytcore-ipad-share
>>
>> Chills, sweats, hives, achey bones — the older woman was sick for years
>> before someone figured out the unusual disease that ailed her.
>>
>>
>> Sent from my iPad
>>
>>
>>
>>
>>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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