The story for online symptom checker
Mrs. R had not felt well for the last 4 days. Her symptoms started gradually got worse day by day. She just did not fell well, her appetite went down and she started getting more and more nauseated. Her food and drink intake went down and she felt weaker and weaker. This morning, she got up from her bed and felt like her legs were too weak. She was still able to stand and walk but it felt like her legs were about to give up. She sat back down because she did not want to fall. She called her daughter who was very concerned and drove her to the ER.
Now, let’s use this information on traditional symptom checker websites and see what diagnosis they give her. We will compare this to the actual diagnosis we had and how we analyzed her symptoms.
We will use the online symptom checker found on these 5 popular medical sites:
- WebMD
- Isabel Symptom Checker
- Mayo Clinic
- Everyday Health
- Family Doctor
WebMD online symptom checker
WebMD first asks you to pick a gender and a age group to use its online symptom checker. After that, they give you an anatomical picture of the body and asks you to pick a body part where the symptoms are located.
Since the symptoms in our patient was not located on any specific body part, we could not use that part of the online symptom checker. The next step is to pick symptoms from a list that comes out after you click the “more symptoms here” tab located at the bottom of the picture. It gives you a list named general symptoms.
We could not find nausea on this list but we were able to find the other two symptoms. We checked “decreased appetite” ,”difficulty walking” and “generalized weakness” which were the items on the list closely matching the main symptoms of our patient. The online symptom checker did not require any further information on “decreased appetite” and “difficulty walking” but it required some answers for the symptom generalized weakness. It asked if anything brought it on and none of the options were close to what happened to our patient. We checked “none of the above” for that question. The next question was what made it better and since our patient sat down to avoid falls, we checked “improved by rest” as the closest option. Now, let’s look at the results.
This online symptom checker lists 69 conditions as possible diagnoses for our patient and states that they are listed in the order of how closely the symptoms match these conditions. We will list the top ten diagnoses here:
- Congestive heart failure
- Constipation
- Depression
- Diabetes, type 2
- Emphysema
- Gastroenteritis
- Heart rhythm disorder
- Heat exhaustion
- Hyperthyroidism
- Hypothyroidism
Isabel online symptom checker
Compared to the online symptom checker by WebMD, Isabel’s interface seems to relatively simple and easy to use. You just select your age, your gender and region. The online symptom checker just lets you enter your symptoms.
In our care, since we entered female, it had us choose pregnant vs non-pregnant and we selected non-pregnant. After that you just type in your symptoms and it gives you auto suggestions. We typed “nausea” as the first symptom. It had nausea in its database and we selected it. We typed “loss of appetite” and it also had it in its database. We then typed “generalized weakness” and it had it too. So, it was easy getting all symptoms into the system.
To get the results, we just had to hit the search button and it even gave us the top 10 list we wanted.
- Pernicious Anemia
- Diabetic Neuropathy
- Hyperparathyroidism
- Pancreatic Cancer
- Addison’s Disease
- Traumatic Brain Injury
- Wilson’s Disease
- Iron Deficiency Anemia Common
- Cirrhosis
- Environmental / Work Exposure
To see more diagnoses, we had to click “show all” and it listed about 30 more diagnoses. It also had little icons on each diagnosis to let you know which ones were common and which ones were serious.
Mayo clinic online symptom checker
Mayo clinic had a whole different approach. Its online symptom checker started with a list of symptoms and wanted us to pick a main symptom. It then asked more questions about that main symptom. It was, so far, the closest approach to how doctors actually ask about symptoms in real practice. We picked nausea and vomiting as our first symptom because it did not have just nausea in the list. It then asked us some very important questions about the symptom that none of the two other online symptom checkers had asked.
The first question was “triggered or worsened by” and we did not check any of the boxes because none of the choices applied to us. The second question was very important. It asked about the onset of symptom and we selected “recent (hours to days)”. The next question was “what other symptoms it was accompanied by?” We were impressed by the question but, unfortunately, it did not have any of the other symptoms of our patient in the answer choices. We had to leave that question blank.
We liked this approach by Mayo clinic very much. However, we were disappointed when we clicked the “find causes” button because it did not give us any answer and forced us to use at least one of the answer choices on the first question. It had four choices. We had to select at least something that triggered it or worsened it and the choices were “drinking alcohol”, “stress”, “certain food” and “travel or motion”. The closest we could think of if we had to choose one was “certain food” because our patient did have decreased appetite. We selected that knowing it was not really what happened and clicked the “find causes” button again. It gave us our list. We were happy to see that it did not have a long list of everything. It only had the following 5 diagnoses listed:
- Gastritis
- Viral gastroenteritis (stomach flu)
- Food poisoning
- Intestinal obstruction
- Peptic ulcer
Everyday Health Online Symptom Checker
This particular online symptom checker also looks simple. It lists several symptoms there to click form but it also has the option to type your symptom. Just like mayo clinic online symptom checker, it starts with one symptom and asks you more questions about that system. This online symptom checker says that it was designed by an ER doctor.
We decided to pick leg weakness as the first symptom just to see where it would take us.
We typed “leg weakness” and it gave a nice option of “leg weakness (both legs)” and we selected that. Next it asked us the exact age and gender of the patient. We entered those and it started asking more specific questions.
The first question was, “Have you become unable to walk?” and we answered “no”. The online symptom checker then asked, “Did your leg weakness start suddenly?” We really liked that question and answered “no” as our patient’s symptoms started gradually over 3 days. The next question was “Is your leg weakness worsening?” and we answered “yes”. Then it asked, “Have you been unable to control your bladder?” We answered, “no”. It then asked if the patient had a disease that caused muscle weakness and we answered in the negative.
After these questions, it gave us some possible causes of the symptoms and also recommended some actions. It also did not have a long list. The only four possible causes listed were these:
- Small Risk for Neuromuscular Disease
- Small Risk for Drug Side Effect
- Viral Syndrome
- Small Risk for Blood Electrolyte Imbalance
Family Doctor online symptom checker
The last online symptom checker by familydoctor.org did not have any of the symptoms of our patient on its list and it did not have a search function for symptoms. We were unable to test this particular online symptom checker for this patient but we will test it again with another patient.
Our human analysis of the symptoms
The onset of symptom is very important. When and how the symptoms started can be more important that the actual symptom. The main advantage of being a human when analyzing symptoms is that you can first listen to the whole story and then ask questions based on the big picture. Some of the online symptom analyzers did ask the right questions but they did not have the ability to listen to the whole story and see the big picture.
The diagnosis always lives in the story of the illness. When you get the story right, you can get the correct diagnosis. The whole story lets us see what happened chronologically. The online symptom checkers that accepted multiple symptoms did not have the whole picture to put each symptom in its right moment in time.
As a human, you can see that our patient first had nausea and she lost her appetite. By simply using common sense, you can tell that these two things are related. When you feel nauseated, you don’t want to eat. This was followed by weakness. You can infer that our patient became weak because she was not eating. When you are nauseated and have lost your appetite, you are probably not drinking enough water. When you are not eating and drinking, you get weak and dehydrated. When you do not eat and drink for 2-3 days, your whole body gets weak. When your body gets weak, you lose muscle strength. Your leg muscles have to support your body. When you try to walk, you notice the weakness of your leg muscles as they struggle to support your weight.
As you can see, as a human, you can simply look at the whole story and see how each symptom fits in its place. This is the main difference between you and the online symptom checkers. Even without much medical knowledge you can simply use common sense to arrive at the big picture and see what is happening.
The next step requires some knowledge about how your body organs work in health and sickness. This kind of knowledge is relatively easy to learn when you start with the story and look for the missing pieces of knowledge. That is exactly the goal of this book Symptoms and Diagnosis. It gives you detailed medical knowledge by inserting them inside the stories of patients with different medical problems.
In this case, it is relatively easy to proceed forward after you have the big picture in your mind. You are looking for a condition that starts slowly, makes you nauseated. You slowly lose your appetite and become weaker and weaker. Before looking for any specific diagnosis that does it, you need to know that there are several types of disease processes in our body. Different types of disease processes work in different ways and with different speeds. Metabolic problems, electrolyte abnormalities, certain infections can have this pattern of relatively slow and steady progression over 3-4 days. In fact, these things are related and they can lead to one another. In our patient, this is the most important and accurate statement you can make based on the story. It is not possible to make specific diagnoses just based on the reported symptom but you can guess the kind of disease process at play and proceed with subsequent steps to get to the diagnosis.
The story is useful in giving you the right diagnostic path. If you do not see the big picture, you can be thrown off by individual symptom and end up being lost in myriad of diagnostic possibilities. You saw that happen with the online symptom checkers from WebMD and Isabelle. These 2 online symptom checkers focused too much on individual symptoms and did not analyze their details. Mayo clinic had some good questions but the answer choices were limited. Mayo clinic online symptom checker had a good algorithm but it was very restrictive. So, far the best online symptom checker seemed to be Everyday Health. It focused on the timing and progression of symptoms and arrived at a conclusion that was closest to the one we arrived at. In this case, Everyday Health seems to be the best online symptom checker so far but we will analyze many more real cases and see if it can hold that ranking.
The real diagnosis
I know you have been very curious to know the real diagnosis but coming at the conclusion we arrived earlier is the hardest part. From there, it is just a routine process. After the story, we look at the physical exam where patient is actually examined by the doctor. On exam, she had a slightly higher than normal heart rate. She had a slightly elevated temperature of 99 degrees Fahrenheit. Her blood pressure was on the lower side of normal at 100/45. Her mucous membranes and her skin looked dry.
The exam just confirmed that she was dehydrated and raised the possibility of infection. After that, routine blood tests were ordered. It showed a somewhat elevated count of white blood cells in the blood. While blood cells fight infection. This made infection more likely. She did not have any specific symptom to point toward a particular type of infection. We, therefore, looked at the two most common sites of infection in these types of situation: lungs and urine. Chest x-ray was normal. The urine test result came back. The urine sample was packed with white blood cells, a definitive evidence of urine infection.
A test of good medical diagnosis is that you can tell the story using your diagnosis and it all makes sense. It fits in like missing pieces of a puzzle. Our patient had an infection of her urine that started a few days ago. The infection grew and her body tried to fight it. This immune response created a kind of inflammation in her body and she felt nauseated, her appetite went down. She did not eat and drink enough and became dehydrated. The inflammation and dehydration made her weaker and she was almost septic. She was diagnosed with UTI(urinary tract infection), dehydration and early sepsis (sepsis is just a term to describe inflammation and other bodily response to overwhelming infection). She was given IV fluids, antibiotics and was observed in the hospital overnight. She felt better and was discharged home next day.
Please check back for our next case analysis using the online symptom checkers and see how it compares with our human analysis.