Dr Val over at Revolution Health pointed me out to a new service called FreeMD. It represents itself as a triage service for the masses. Type in signs or symptoms and the program will take you through its own triage process, validated by millions of interactions over 8 years. It will spit out answers like, you should see a doctor now, or see a doctor within 8 hours or see a doctor within 3 days. I plugged in a whole bunch of diagnoses, things I as an internist see on a regular basis.
Just scanning the program, it appears that the triage is based on numerous "red flag" questions that we as physicians ask in working through our differential diagnosis. It appears to me that the "red flag" answers you give determine how quickly the program feels you should see a doctor. It also gives you answers for diagnoses that it believes you have.
I typed in "weakness all over" in a 70 year old man as a general complaint and then answered no to all of the following questions as the system prompted me through its questions review of systems. I answered yes only to "Do you feel very weak and tired?". I created my self proclaimed diagnosis as digoxin toxicity induced severe bradycardia secondary to acute renal failure from volume depletion due to excess sweating and decreased oral intake due to a heat wave. I expected the program to triage me appropriately. Instead by answering all the questions appropriately, I got my diagnosis as
Mild Weakness or Fatigue
Treatment recommendation? Based on your responses, you may care for yourself at home.
In this one specific patient with one specific complaint of generalized weakness with medication induced bradycardia from acute renal failure, it tells the patient to stay home. Not even to visit their doc in a week. We could go around and around with games like this finding examples of faults within the triage system. Hell, there are faults in regular physician triage as well. Medicine is not an exact science and because I know nothing is 100% in the real world, nothing will be 100% in the virtual world as well. Which leaves you back to square one. How much do you as a patient trust FreeMD to triage you? You need to answer only one question.
Does the founder of FreeMD, emergency physician Stephen Schueler, have enough faith in his product to institute it at his own ER as its triage program of choice. Fire his triage nurse. Set up a computer in his lobby and have all prospective patients triage themselves. And if the program says you don't need to see a doctor NOW, would he feel comfortable sending that patient home from the lobby without ever seeing them? If the answer is yes, then you, the patient, should trust FreeMD. If the answer is no, then you should delete your bookmark.
As always, you get what you pay for.
"Does the founder of FreeMD, emergency physician Stephen Schueler, have enough faith in his product..."
ReplyDeleteOr more simply, would he tell his mother/daughter to use it as their triage system of choice? I hope for sanity's sake that's a rhetorical question.
Good comment and I posted about it as well. By the way, with all those neat dog pictures you have on the site, have you heard about Dogster? Check it out, for dog lovers:)
ReplyDeleteSomethings still need the human touch in healthcare and will for quite some time if not forever.
Perfect example of getting what you pay for.
ReplyDeleteIn the near future, look for insurance companies to require mandatory use of this web site before any care is rendered.
I gave it all the symptoms that a 15 year old patient of mine reported not long ago. FreeMD told me that I had "muscle tension headache" and that I could care for myself at home.
ReplyDeleteI'm quite pleased that in the case of the real patient, the mother kept telling us that this 15 year old with a mild headache for less than a day, without hx of recent trauma or vomiting, was "not acting like my son." The patient, who looked totally fine to us sans headache got a CT scan because of mom's persistance. (FreeMD never asked behavioral questions.) Spontaneous, nontraumatic head bleed. Good thing they didn't use FreeMD, huh?
Perhaps for fun, my next slow shift in triage I'll pull this up after each patient and see what it says.
I put in my symptoms for what was diagnosed as gastritis/possible peptic ulcer and all I got from this was pancreatitis, possible appendicitis, kidney stone, and gallbladder problems. I went back and tried modifying my answers to the questions a few times and could never get it to suggest PUD. I don't think I'll be using this for any real problems.
ReplyDeleteYeah - this guy is putting himself at serious medical-legal risk.
ReplyDeleteI have thoracic outlet syndrome.
ReplyDeleteI entered arm pain, then did neck pain associated with arm weakness.
Neither came up with the correct diagonsis. Arm pain resulted in a dx of cellulitis. Neck pain w/ arm weakness suggested cervical fx.
Every health portal on the Internet has a "Symptom Checker". Why dont you go use one or all of these products and tell me how accurate or informative they seem to be? As someone who has used them in the past I can tell you they are 100% useless. I have not yet used FreeMD (I will) but to be fair to this product it must be compared to its peers, which seem to be the symptom checking products at major portals like WebMD and NOT to live doctors. After all, I dont think the product is positioned as a substitite for a human intervention, is it?
ReplyDeleteI don't really think there are that many people out there wondering whether or not they are sick and need to see a doctor. The problem is, people know they're sick and they only doctor they have is the ER.
ReplyDelete