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Diagnosing Medical Cases Online: Threat to Traditional Medicine?

Doctor-to-be Neil Dubey ponders healthcare innovation, internet-empowered patients, and what it all means for the future of medicine.

As long as the Internet exists, patients will utilize it. Doctors have a unique opportunity to embrace and help shape the future of health, while engaging with patients who now have access to a world of open information and diverse input.

The 2013 Pew Report Health Fact Sheet reveals that 87% of people use the Internet, and 72% of them seek health information online. We now live in an era where the Internet plays a significant role in both individual health and the doctor-patient relationship. As such, healthcare providers must learn how to understand the various ways in which patients are learning about and addressing their own health concerns.

Recently, the ability to “crowdsource” one’s own health – from initial consultation, test and image analysis, diagnosis and treatment, to medical research and clinical trials – has all become possible with the help of a rapidly expanding universe of new health and technology ventures including MDLive, CrowdMed, MedXT, and PatientsLikeMe, and large online communities including Reddit, WebMD Exchange and Mayo Clinic Connect.

Specifically related to crowdsourced diagnosis, one of these companies – CrowdMed – is focused on helping a significant segment of the patient population with longstanding medical illnesses who haven’t received satisfactory answers or treatment from more traditional medical channels. As a medical student and an active member of the CrowdMed “medical detective” community, I am in a unique position to understand both the excitement and hesitation any new innovation seems to evoke in both patients and doctors.

There are definitely those within the medical community who are skeptical about, or resistant to, change. At the same time, patients are overwhelmingly demanding change. Patients want a healthcare system that adequately addresses their needs. No longer content with the status quo, they’re demanding change in a space that historically resists it.

So, allow me to outline some reasons why change is good, and how crowdsourced patient services like CrowdMed offer tremendous opportunity and value in the doctor-patient relationship.

Crowdsourced medical cases draw perspectives from dozens of disciplines.

On CrowdMed, medical students, residents, MD’s, RN’s, PT’s and PA’s are all contributing diagnostic suggestions to real patient cases. This ability to leverage so many perspectives (from both the medical community and others) significantly increases the likelihood that a low incidence diagnosis or mis-categorized pathology can be properly recognized.

The average “patient” on CrowdMed is someone who has already gone through more than six years, eight different doctors and specialists, and incurred more than $50,000 US in medical expenses, with no definitive answers. For an interesting reference, see this write-up on the CrowdMed blog regarding their “Top 20 Most Common Uncommon Health Issues.” Not only has this crowdsourced paradigm helped solved rare diseases in weeks that otherwise would take years to identify, but the “wisdom of crowds” also appears to be more quickly resolving more common issues that often begin with vague or general symptoms.

The case of “Florencio,” a 17 year-old boy from California:

Florencio’s mother told CrowdMed “My son feels like an old man. He suffers from constant, debilitating fatigue, painful body aches… he feels ‘like I’m dying.'” His symptoms came on suddenly a few years ago, and after $75,000 in medical expenses and 14 different doctors, his medical mystery remained unsolved. On CrowdMed, 40 “medical detectives” collaborated on his case and the company’s underlying patented technology helped determine the strongest signals from the noise to present Florencio with a short list of the top diagnostic suggestions, including Lyme disease. Florencio’s doctors ultimately confirmed the diagnosis of Lyme disease, leading to his successful treatment and cure. Florencio feels better than he has in years, and his mother credits CrowdMed.

Countless other examples like Florencio’s case can be found on CrowdMed today. The process has already helped solve hundreds of difficult cases that had baffled doctors and frustrated patients for years.

Primum non nocere (“First, do no harm”).

Crowdsourced health and diagnostic suggestions pose no apparent threat to a patients’ health. Patients with longstanding chronic illnesses often use findings from services like CrowdMed to enable more dialogue between them and their providers about possible causes. Ultimately, patients are looking for the right answer from any source possible – not the wrong answer from the same source that has already failed to yield any conclusive answer.

When patients receive their report from CrowdMed, it can’t be used as a substitute for going to the doctor’s office, as the possible diagnoses and treatment plans are not actionable without consultation from an actual healthcare provider. CrowdMed does no harm and actually has tremendous potential to call attention to some aspect of diagnosis or treatment that was not previously considered.

CrowdMed can strengthen the provider’s assessment and plan.

If, in the end, a patient’s CrowdMed report is congruent with previous diagnoses and treatment plans, the assessment and plan for the patient can move forward with much more confidence from both the provider and patient’s perspectives. As the medical community develops better understanding of how to use crowdsourced medical information as a diagnostic tool, both doctors and patients stand to benefit.

As a doctor-in-training, I thoroughly enjoy working with patients who are passionate about understanding more about their health. I like that CrowdMed has both experts and novices chiming in with their perspectives and ideas about my patients’ treatment. Ultimately, (or eventually) I will be the main person to work with my patient and come up with a treatment plan. I’m also keenly aware that if I can work with dozens of other peers to benefit my patients’ health, that makes my treatment plan stronger – and my work even more interesting!

Health innovation and technology, crowdsourced health and other new patient services all have potential to upset and established processes – but the ultimate goal is to empower both patients and doctors, giving them access to the world’s information and input from any source that can help solve each case. CrowdMed happens to be my favorite new service out there today, but I urge patients and my colleagues in medicine to take a closer look at all of the latest developments happening in healthcare and medicine. Whether we feel comfortable about these changes or not, interactive and globally connected healthcare is the future of medicine. There are great opportunities for those of us who are part of healthcare system and medical community to not only help shape that future, but also benefit from these services today.

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Neil Dubey is a member of CrowdMed’s medical expert community and one of the company’s select Medical School Ambassadors. He is a current third-year medical student in the Health Policy Track at George Washington University School of Medicine and Health Sciences. Prior, Neil studied Political Communication and Health Economics at the University of Pennsylvania and has worked in epidemiology research at the NIH, public health interventions on his college campus, and global medical volunteer projects in Latin America and India. You can read his blog at http://neildubey.weebly.com/.