For many years, the Internet was expected to help consumers manage their health. A Pew Foundation survey documents effectiveness by the 35% of consumers who used the Internet for medical self-diagnosis and follow up. After self-diagnosis, 38% of “diagnosers” felt they could handle the condition at home, but 46% were felt they needed to talk with a physician and 51% actually did so. It seems that a few did not decide what to do.
Almost 80% of those who spoke with a physician had their diagnosis affirmed (41% out of 51%), but, 18% (of 51%) said the physician at least partly disagreed. Thus the resulting “error rate” for online self-diagnosis is 20% to 35% – as judged by physicians. It’s not very accurate. On the other hand, neither are the diagnoses done by physicians.
The incidence of misdiagnosis by physicians varies by context. In Emergency Room situations misdiagnosis runs 20% to 40%. In Intensive Care Units, the rate is 20%, and in general hospital wards it’s 15.5%. Consumers’ self-diagnosis accuracy needs improvement, but it’s comparable to these physicians’ results. The potential value from a professional “consult” is evident: if the physicians are independent, then the risk of both producing the same misdiagnosis is just 15% of 15% or 2.25%. When the diagnoses disagree, the attending physician has to reconcile the disagreement – producing a better diagnosis in many cases.
The consequences of misdiagnosis can be large. If 15% of physician-conducted diagnoses are inappropriate then a matching 15% of treatment plans are based on faulty diagnoses. A misdiagnosis that calls for “no treatment” may produce a short-run cost savings, but patient health and lives may be at risk, and it may add to the 98,000 preventable deaths each year due to medical errors. Misdiagnoses and the derived inappropriate treatment plans may waste as much as 15% of the 2 trillion per year spent on healthcare. Misdiagnosis errors could cost $1,000 per US citizen per year and patient health and lives would be put at risk.
Advances in diagnostic accuracy are needed. Many US states have enacted legislation on continuing medical education (CME) to include courses on error prevention. These courses tend to focus on improving diagnosis for the most commonly misdiagnosed maladies. Unfortunately the courses make little impact on physician practices. Perhaps a consumer’s online self-diagnosis can play a homespun version of the consult’s role by providing a perspective that the physician must work to dismiss or confirm. Consumers’ self-diagnoses are clearly worth something.
Alan Daley is a retired businessman living in Florida and following public policy issues from a consumer’s perspective.