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Evaluation of symptom checkers for self diagnosis and triage: audit study

BMJ 2015; 351 doi: (Published 08 July 2015) Cite this as: BMJ 2015;351:h3480

Re: Evaluation of symptom checkers for self diagnosis and triage: audit study

The authors are to be congratulated for carrying out the first large study of symptom checkers designed for use by patients.

However, this study, like most discussions on this topic is framed in the wrong way. These tools are designed primarily to help the patient become better informed and be able to ask their doctor the right questions. They are not intended to encourage the patient to diagnose themselves and avoid a discussion with a clinician. This is about the patient and doctor working as partners to get to the right diagnosis and receive appropriate care and treatment as soon as possible.

The study also has some serious limitations.

The test cases were very medical and very different from the way real patients enter their symptoms. Many, for example, included negatives which patients would very rarely enter. From our experience at Isabel, over 90% of the cases entered by patients include 4-6 symptoms expressed in normal everyday language.

The study did not compare the ease and speed of use. Many symptom checkers require the patient to go through over 20 screens answering questions before they are finally shown the results.

The study also did not look at knowledge provided to users when they were presented with the results to help the patients learn more. This is an important aspect as many of the diagnoses will not mean much to most patients and they need to be shown trustworthy reference resources to encourage them to understand their symptoms better.

Competing interests: Founder of Isabel

09 July 2015
Jason R Maude
Company director