Posts Tagged second opinion

DIY Digital Diagnosis — better with some human input

man and algorithm

On 7/23/13 Laura Landro of the Wall Street Journal published an article about “A Better Digital Diagnosis”.  The essence of the story is on-line symptom checkers are available and may be useful to patients.   Just input your symptoms, get your diagnosis, call for an appointment, and get your treatment.  Sounds good; possibly too good.

Below are listed some good sources for information, some symptom checkers and some software to download to a smart phone.  The software is actually intended for health care providers and may have too much jargon for the average person.

However, before you jump in to get a diagnosis for what ails you try a test run.  OK, this is not a double blind experiment but worth your time.  The idea is to look up the details of a known disease then enter the published symptoms in the symptom checker and see what comes out.  You will find a huge variation, often the expected diagnosis does not even show up at all!

For example:  plantar faciitis.  This is a common disease of the foot caused by inflammation of the connective tissue in the sole of the foot especially causing pain just in front of the heel bone.  The striking and often diagnostic symptom is heel pain on first getting out of bed and walking.  The pain gets better after a few minutes of walking.  It is common in runners and people who spend lots of time standing.  Being overweight or wearing hard-sole shoes contributes.  As people get older the natural padding of the sole thins which is probably why the problem is common after age 50.

footpain

The symptoms were entered into several of the symptom checkers.  Esagil seemed to give every diagnosis know to medical science and nothing would narrow down the possibilities — every symptom could be due to syphilis.  The Mayo Clinic site required some human thinking.  Foot pain showed several areas to read about: after reading the material the diagnosis of plantar faciitis seems to fit.

The diagnosis of plantar faciitis can usually be made by a primary care provider in a flash — it is a common problem.  Worrying about whether you have syphilis is a waste of time and a real source of anxiety — if you ask the primary care provider whether you could have syphilis, you can almost count on some testing.

Once you have tested any symptom-checker and understand the limitations they can be helpful.  It’s almost like a second opinion about a problem.  Discuss the findings with the health care provider early in an office visitdon’t spring the information after the provider makes a plan.  Be a team player to prevent being at odds with the provider.


Good sources for medical information:

Evaluate symptoms / differential diagnosis

Smart Phone Apps

  • Android
    • Differential Daignosis by mHealth Labs, LLC
    • Differential Diagmosis by  Borm Bruckmeier Publishing LLC
    • Your Rapid Diagnosis for Android by  WWW Machealth
  • iPhone
    • Differential Diagnosis from the BMJ Group
    • Your Rapid Diagnosis by  WWW Machealth
    • VisualDx by Logical Images
    • Common Symptom Guide by Mobile Systems:

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X-Ray Images — lost in space

chest CT

Laura Landro of the Wall Street Journal published the article:  “Image Sharing Seeks to Reduce Repeat Scans” on April 1, 2013.  Ms. Landro reported on an academic project to store x-ray pictures on the Internet called the “Imaging Sharing Project” (image share news release).  The idea is to have patients own a secure copy of their personal x-rays.  By having this storehouse of x-rays in the “cloud” they can be given to any health care provider or hospital as needed.

Any patient who has had to take x-ray images from one provider to another understands the problem.   The provider handed the disk of images may or may not be able to look at them because of incompatible ways of recording the material.  Of course, this means another visit to the provider (or worse, a repeat x-ray and unnecessary x-ray exposure).

Storage of images is nothing new.  But, the concept of the patient owning the images is indeed  something new.  It allows a patient to seek a second opinion without all the hassle of getting the disk.  This is a real asset to a patient who keeps copies of their own medical information.  The typed radiologist report is usually very brief and does not allow for alternate interpretations.

The difficulty transmitting images is partly intentional.   Radiologists fear someone else far away could be a business competitor.   It would be very bad for local radiologists if patients always wanted their brain CT evaluated by some expert in Boston or London.

Cancer patients will find this service very helpful.  If a woman has an abnormal mammogram she can pick the oncologist or surgeon and then share the images with them.  If she has a mammogram at a different facility she can share the older image for the purpose of comparison.

People who move from city to city would still retain easy access to x-ray images.  The US population is much more mobile than in the past so this is very important.

The Image Share project is not available everywhere.  There is a commercial product called LifeIMAGE.  It is a great idea so hopefully the idea will spread.  It would be a step forward if all insurance programs and x-ray offices were required to provide this as a benefit.  If you know of other similar products please leave a reply.

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Second Opinion — really?

marcus welby 2nd opinion

Dr. Kiley asks Dr. Welby for a second opinion (circa 1970).  What was the story?  A crusty patient does not believe Dr. Kiley’s diagnosis and demands a second opinion from Dr. Welby.  Oh, the drama, the crushed feelings of Dr. Kiley, the wisdom of Dr. Welby, and the horror that neither knows how to use a microscope!

Holly Finn wrote an article today in the Wall Street Journal “First of All, Get a Second Opinion” (WSJ March 23, 2013).  She is strongly in favor of second opinions for two basic reasons:  there are now more successful companies that specialize in second opinions and 60% of people who seek a second opinion obtain recommendations which are less invasive and less costly.  But, she is taking the statistics out of context.  99% of people do not get a second opinion but the 1% who find a problem with the first opinion are often correct another solution is better.  The take-home lesson, like many things in life,  if something does not sound right,  it’s probably not.

Contrary to popular belief most physicians are very happy to help a patient get a second opinion.  Why?  Because a patient who feels uneasy with a situation will not follow directions, will not take prescribed medications, and will be hyper-critical if the outcome of treatment or surgery does not meet their expectations.  So, all a patient has to do to get a second opinion is to ask the provider (“do you think a second opinion would help us?”).

It is important to keep the primary care provider “in the loop”.  The best consultations or second opinions happen when there is a good exchange of information — what has been done, what tests show and what medications have been tried.

When should a person ask for a second opinion?

  • When a provider is unable or unwilling to discuss your questions or the information you have found in books or the Internet.  An unending barrage of questions is counterproductive — be prepared by doing your homework and ask a few good questions.
  • When you simply do not understand the diagnosis.
  • Give your provider an opportunity to adjust medications if side effects happen or if medications are not working as expected.  A second opinion is a good idea if the treatments and modifications are not working.
  • When the provider is unable to make a diagnosis of a problem.
  • When you have been diagnosed with a life threatening condition — you may not get a second chance for a second opinion so don’t wait.  Sometimes a bad situation can not be cured — at least you will have some comfort that what can be done is being done.
  • When your doctor is not giving you more than one option for treatment — there is always an option (perhaps not a good one, but there is always a choice)
  • When you are uneasy about the need for any surgery.  A CNN report  lists 5 surgeries that should trigger a second opinion:
    • Heart bypass surgery (get a second cardiologist opinion)
    • Hysterectomy (often not needed)
    • Pregnancy termination for fetal abnormality (because the diagnosis can be difficult)
    • Surgery for varicose veins (often not needed)
    • Treatments for brain tumors (a really big step)
  •  Sometimes insurance companies require a second opinion for certain problems.  Listen carefully to that second opinion even if you were happy with the first opinion.  There is indeed a lot of unnecessary testing and surgery which can be  dangerous for you and expensive for the insurance company.

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