Medical Care

Rating the Symptom Checkers

Online software programs known as “symptom checkers” are the go-to solution for people trying to self-diagnose symptoms and to decide whether they should go to the doctor. But how good are they? Harvard researchers decided to find out.

Their discovery: the symptom checkers are about as good to telephone “triage” lines commonly used in primary care practices. And they are better than general internet searchers.

However, they’re often wrong.

“These tools may be useful in patients who are trying to decide whether they should get to a doctor quickly, but in many cases, users should be cautious and not take the information they receive from online symptom checkers as gospel,” said senior author Ateev Mehrotra, associate professor of health care policy and medicine at HMS and Beth Israel Deaconess Medical Center.

According to a news release from Harvard, symptom checkers are hosted by medical schools (including Harvard Medical School), hospital systems, insurance companies and government agencies. This type of software asks users to list their symptoms, using methods such as multiple choice checklists and free text entry.

Once a program has collected the information, the computer returns a list of potential illnesses that might cause the listed symptoms and suggests whether the patient should seek care immediately, visit a doctor in the next few days or use self-care methods, such as resting at home.

In their study, the researchers created standardized lists of symptoms from 45 clinical vignettes that are used to teach and test medical students and then input those symptoms into 23 different symptom checkers. Overall, the software algorithms that the researchers studied listed the correct diagnosis first in 34 percent of cases. The correct diagnosis was included in the top 3 diagnoses in the list in 51 percent of cases and in the top 20 in 58 percent.

In many cases, getting the exact diagnosis may not be as important as getting the correct advice about whether—or how quickly—to go to the doctor.

“It’s not nearly as important for a patient with fever, headache, stiff neck and confusion to know whether they have meningitis or encephalitis as it is for them to know that they should get to an ER quickly,” Mehrotra said.

Overall the 23 symptom checkers provided correct triage advice in 58 percent of cases with the checkers performing much better in more critical cases, correctly recommending emergency care in 80 percent of urgent cases.  In comparison, other studies have found that Internet search engines for urgent symptoms only led to content that suggested emergency medical treatment 64 percent of the time.


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