AMA: Symptom-Checking Health App Often Wrong in Diagnosing Eye Problems

Source: American Medical Association

Some estimate six of 10 patients enter the exam room having tried to self-diagnose by entering information into an online symptom checker, but there is room for improvement for these tools in the ophthalmic setting, new research shows, according to the American Medical Association.

The online symptom checker WebMD got the primary diagnosis correct for 26% of the 42 vignettes that study authors plugged into the website, according to the brief report, “Accuracy of a Popular Online Symptom Checker for Ophthalmic Diagnoses,” published in JAMA Ophthalmology. The correct diagnosis was in the online symptom checker’s top three diagnoses list 38% of the time.

To test how accurate online symptom checkers are, researchers picked 18 emergent and 24 nonemergent conditions that represented the most common ophthalmic diagnoses in clinical practice. One person with a medical background and one person without a medical background entered an average of 3.6 symptoms for each of the conditions into WebMD.

The study shows that triage urgency based on the top diagnosis was appropriate 39% of the time in the 18 emergent cases and 88% of time in the 24 nonemergent cases. In 11 of the 14 cases where the triage urgency of the primary diagnosis was incorrect, an urgent case would have been triaged as nonurgent.

If patients use an online symptom checker to help decide whether they should seek medical attention, it is concerning that urgent cases—for example, acute angle-closure glaucoma and retinal detachment—may not be diagnosed correctly through the online tool and could lead to a patient failing to get care quickly, wrote the study’s authors, Carl Shen, MD, Michael Nguyen, MD, and Alexander Gregor, MD.

“Until the accuracy and information provided by [online symptom checkers] are improved, there is a risk of unnecessary use of health care services and, conversely, missed opportunities for appropriate intervention when seeking care is delayed,” the physicians wrote. Drs. Shen and Nguyen are from the McMaster University Division of Ophthalmology, while Dr. Gregor is affiliated with the University of Toronto Department of Surgery.

Ophthalmic office visits crucial

Online symptom checkers appear to have less accuracy for ophthalmic conditions than for symptoms entered for conditions involving otolaryngology, orthopedics and plastic surgery, the authors wrote.

Among the previous studies they point to is a 2015 study published in BMJ, “Evaluation of symptom checkers for self-diagnosis and triage: audit study.” That study found that overall, the correct diagnosis was listed first in 34% of the 45 clinical vignettes those researchers tested representing several general medical conditions. It was in the first three diagnoses 51% of the time.

“This difference may be because of the nature of ophthalmology, in which a spectrum of diseases share similar clinical manifestations, often necessitating reliance on physical examination and ancillary testing,” the JAMA Ophthalmology study authors wrote.

“Googlers beware”

One big takeaway from the study is that while the internet may be easy for patients to access, it isn’t a substitute for an ophthalmologist when seeking an accurate diagnosis, California ophthalmologist Rahul N. Khurana, MD, wrote in an invited commentary that accompanies the study.

“It is concerning that 79% of the urgent ophthalmic cases were diagnosed incorrectly and would have led to an urgent case being triaged as nonurgent. Even though the clinical history is important, the ocular examination is necessary in the diagnostic process,” he wrote in “The Inaccuracy of Ocular Online Symptom Checkers—Googlers Beware.”

He noted that as advances in augmented intelligence—often called artificial intelligence—are made, the accuracy of online symptom checkers are likely to improve. Yet, he wrote, physicians and patients need to be vigilant in ensuring patient safety isn’t sacrificed.

“Empowering patients with more information leads to greater engagement and better health outcomes,” Dr. Khurana writes. “However, the accuracy must be validated before trusting these online resources. Incorrect diagnosis can create unnecessary anxiety for the patient and inappropriate triage advice, which can compromise care.”

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