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Diagnosis Without Physician Input: Russian Roulette Online

I realize how incredibly tempting it is to reduce medicine to a series of algorithms. Wouldn’t it be nice if we didn’t need to see a doctor to diagnose our ills? Wouldn’t it be great if our computer could tell us what’s wrong, and prescribe next steps for us? Wouldn’t it save money if we could triage peoples’ medical needs without human intervention?

Unfortunately, we’re not there yet. A friend of mine posted a link (on Twitter) to an online triage tool called “FreeMD.” The tool describes itself this way:

FreeMD® is an electronic doctor that conducts an interview, analyzes symptoms, and provides expert advice — for free.

So I decided to try it out. I imagined that I was a hypothetical patient – a woman in her mid thirties who had had abdominal surgery in the past and was now experiencing mild to moderate abdominal pain. My imaginary patient has abdominal adhesions from the surgery, which is causing her to have bowel pain – which could become an obstruction and surgical emergency.

I answered all the questions posed by the free MD and he responded that he had determined the most likely cause of my pain: tubal pregnancy or threatened abortion.

This response was offered even after I indicated that I was not pregnant. What would the average consumer think of seeing “threatened abortion” as a potential diagnosis for their abdominal pain? Would they know that this was the medical term for miscarriage or would their mind race to abortion clinics and ominous threats?

The problem with this tool is that it cannot take into account all the subtle co-morbidities and nuanced historical information necessary to return an accurate result. In fact, no online tool can replace a healthcare provider’s evaluation of a patient. Attempting to do so is like playing Russian Roulette with your health. Maybe you’ll get lucky and happen upon the correct diagnosis and treatment, but maybe you’ll be horribly misled and suffer irreperable harm.

Of course, companies like freeMD contain disclaimers about the service not being a substitute for a physician’s oversight. But the reality is that people are using the service to make decisions about when and if to see a professional for further evaluation. As a concerned physician, I worry about patients being misled about their health. I want patients to be empowered and to learn all they can about their disease or condition – but self-diagnosis, even with the aid of an algorithm, is fraught with danger.

My bottom line: computers will replace physicians when robots replace spouses. Similar satisfaction rates will come from either replacement option. People know instinctively that a good doctor is critical in managing their health – why else would there be so many physician rating tools, including the one here at Revolution Health? Why would Castle Connolly bother to publish their yearly “America’s Top Doctors” reports? This is not about paternalism – it’s an acknowledgement of the incredible complexity of human beings. And in this case my friends, it takes one (doctor) to know one (patient).This post originally appeared on Dr. Val’s blog at

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5 Responses to “Diagnosis Without Physician Input: Russian Roulette Online”

  1. says:

    FreeMD can be a useful triage tool just like telephone triage

    that is already being done by nurses. If we didn’t have a primary care physician shortage then maybe we would not need these triage systems. Algorithms will never be perfect but they can be improved.

    I would prefer that computer based triage systems would be a government run service (just like the 811 telephone triage system Info Santé

    in Quebec).

  2. Motivation says:

    I agree that self diagnosis as well as computer diagnosis is dangerous.  There is a lot of information that needs to be exchanged between a patient and a real live doctor.  The other side of the real live doctor deal is that all doctors need to listen carefully to their patients and of course ask questions when the information supplied is vague.  Recently I have encountered a few specialists who grunted three words at me and that was the end of the visit.  Several tests were scheduled and when I tried to ask about these procedures I was shut down by the attending physician assistant.  Needless to say the doctors who have grunted at me are no longer my physicians.

    I read a recent article about medical schools placing more emphasis on patient interaction and communications skills in their medical curriculum.  I know that when I have a good dialogue with my doctor, the outcome is traditionally a positive and productive one.

    Thanks for this thought provoking article.

  3. Motivation says:

    One last thought that is not meant to be anything but realistic: I hope Dr. Schueler has outstanding malpractice and liability insurance to cover himself and FreeMD, because that will possibly be the next issue to surface with this “triage software.”  Just another component to keep in mind.  This is still a litigious society.

  4. Motivation says:

    OK, as a psychologist I just had to try FreeMD.  Honestly, I must have answered over 40 questions for the condition I described and the outcome did not even come close to the made up but very realistic scenario I proposed.  I just had to experiment.  I think that most non-medical individuals trying to use and understand FreeMD would not recognize a large portion of the terminology that is utilized to pose questions in an effort to ascertain relevant information.  The medical scenario I used was a panic attack and each time I answered a question we went farther and farther from that scenario.  I am not sold.  I wonder how the AMA would view this tool?  Has it been evaluated for its realiability and validity?  Are there any solid write ups in JAMA or a related journal?

  5. Motivation says:

    My apologies for the duplication.  I am done.  Have a good discussion. 

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