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 Symptom checkers are all over the web, often using algorithms to
deliver diagnoses even as they post disclaimers advising against
using these tools for medical advice. While some studies have
already documented many ways that symptom checkers can mislead
patients, less is known about how well they work specifically for
eye conditions, researchers note in JAMA Ophthalmology.
For the current study, researchers tested how often an online
symptom checker offered by WebMD generated the correct diagnosis for
42 clinical vignettes similar to situations that patients might
describe to doctors in person. They wanted to see how often the
symptom checker got the correct diagnosis or at least generated the
right diagnosis as one of the top three possible answers. The tests
were conducted in late 2017.
Overall, the symptom checker nailed the diagnosis for just 11 of the
42 cases, or only 26 percent of the time. And the correct diagnosis
was among the top three possible diagnosis in just 16 cases, or 40
percent of the time.
"Ultimately, what's at stake here is the patient's vision and peace
of mind," said lead study author Dr. Carl Shen of McMaster
University in Hamilton, Canada.
"If patients receive the wrong diagnosis or are told to not urgently
seek medical care when they otherwise should have, they may run the
risk of losing their eyesight, sometimes permanently," Shen said by
email.
Out of the 42 vignettes in the study, 18 were "emergent" conditions
that needed immediate care and 24 were "nonemergent." On average,
the vignettes included three to four symptoms, and many had at least
one symptom that didn't directly involve the eye.
The symptom checker got the urgency level of the situation right in
just seven of the emergency cases, or only 39 percent of the time.
It correctly categorized most of the non-emergency cases as
situations that didn't need immediate care.
When the symptom checker generated a long list of possible
diagnoses, the correct one was usually 4 or 5 places down the list,
on average, not in the top three.
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The most common diagnosis made by the symptom checker was
nearsightedness, which was given in nine cases.
It's unclear how closely the vignettes used in the study might match
what patients would enter in an online symptom checker in real life.
The study also wasn't designed to determine whether or how these
online tools might influence patients' decisions about seeking
medical care.
"The version of the WebMD Symptom Checker used in this study
represents the older version of the online tool, which did not use
the latest algorithm and technology that drives the current
version," Dr. Michael Smith, chief medical director for WebMD, said
in an emailed statement.
"Symptom checkers are intended for informational purposes only,"
Smith said. "They do not provide medical advice, and they are not a
substitute for professional medical diagnosis."
Still, the study highlights that patients need to proceed with
caution when consulting "Dr. Google," said the author of an
accompanying editorial, Dr. Rahul Khurana of Northern California
Retina Vitreous Associates in Mountain View, California.
"This is the first study to look at ocular online symptom checkers,
and it clearly shows that they are not accurate," Khurana said by
email.
"The correct diagnosis is a combination of clinical history,
physical exam, and physician input to generate the correct
diagnosis," Khurana added. Online symptom checkers "could be a
starting point, but they are very inaccurate so I would be cautious
about them."
SOURCE: https://bit.ly/2Juj3km and https://bit.ly/2VUqgkr JAMA
Ophthalmology, online April 11, 2019.
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