How doctors can benefit from symptom checkers

Not long ago, the dialogue between a patient and doctor would only begin during the first appointment. Knowing precisely which were the first symptoms and when they began relied entirely on patient reporting. By the time the doctor could consult the patient, the symptoms would have changed and important details might have been overlooked. What if there was a way of collecting and organizing this information earlier? What if there were tools that helped humanize care and enrich the discussion during a medical consultation? Symptom checkers allow for this and much more.

As doctors, being able to know and measure what the patient is feeling and how much he or she is feeling as soon as disease starts is essential. Having standardized and agnostic tools that collect and organize this information allows us to have more insights during the appointments. This in turn, enriches the discussion that we have with patients and humanizes healthcare by giving us the opportunity to focus on what is most important. Aside from relieving pressure on healthcare workers, particularly doctors, symptom checkers might also become critical in enabling value-based healthcare systems.

Up until recently, patients were usually alone at the very beginning of their healthcare journey. A quick browse over the internet or a call to friends or family were the most sought sources to provide more insight into what could be happening or to give some reassurance. Then, we entered the era of new technologies, with solutions that are also reshaping healthcare journeys.

Symptom checkers are tools that, when given a number of symptoms, are able to calculate the probability of having a certain condition. This means that when the patient shares how they are feeling, they get feedback on potential causes and what they should do next. And just like with a real doctor - the more details the patient gives, the more accurate the answer will be.

This is done using an interface that asks the patient several questions, from demographics and risk factors to clinical signs and perceived symptoms. The apparent simplicity of the survey hides the robust medical knowledge base and AI algorithms that recalculate probabilities with each answered question. Once all questions have been answered, the patient receives a probability score of each condition, trustworthy information on the respective results and advice on whether to immediately seek medical care or to wait it out.

During the COVID pandemic, symptom checkers asserted themselves as excellent partners for various health organizations, as well as individuals. In such a peculiar context, they allowed a fast assessment of symptoms, recommended the following steps in care, indirectly decreased the risk of the virus transmission and helped to ease and manage the flow of patients into over-burdened emergency departments.

There are multiple studies on symptom checking tools and their impact on patients, yet the doctor's perspective is seldom reported. In a recent publication, doctors found the following benefits in using symptom checkers (Kujala et al. 2020):

• access to useful information before meeting a patient,

• more time for meeting with patients,

• reduction in the amount of routine work in usual tasks.

The use of online symptom checking tools was supported by most doctors and they found them especially useful in regards to referring the correct healthcare professional (such as a nurse, physiotherapist, or doctor) and the fact that patients could get quick help and standardized management instructions. (Kujala et al. 2020)

Let’s explore each of these in detail.

When a patient arrives, the doctor might know nothing about them, and will need to catch up on their previous medical history, conditions or allergies. Gathering data before the visit helps save time and, most importantly, improves patient safety, as patients with complex medical histories might be forgetful of their multiple treatments.

Patients can play an active role in their care by sharing their data in electronic health records (EHR). Symptom checkers can be integrated with EHR and provide the doctor with a global view of which symptoms the patient is experiencing that are associated with past conditions or current medication. This improves the way patients and doctors share information, reinforcing mutual trust.

Eventually, doctors can even contribute to a feedback loop by feeding the symptom checker with their diagnostics and asking the patient to report the evolution of their symptoms in the following days. As Angela Coulter and her team wrote “Careful observation, measurement, recording, interpretation, and analysis of patients’ subjective experiences are essential to appreciating what is working well in healthcare, what needs to change, and how to go about making improvements.”

Symptom checkers are fantastic data gatherers. Using information given by the patient, and adding in data from wearables and other medical devices, they are in a unique position to reflect what is happening.

Data can then be organized and presented using a simple interface which allows doctors, in a glimpse, to assess the situation. The consultation becomes less about “What are you feeling?” and more about “How much are you feeling?”, allowing both physicians and patients to use their time differently. This impactfully redefines healthcare as we know it and is more aligned with value-based healthcare, as posited by Michael Porter and Elizabeth Teisberg.

Moreover, access to data gathered by symptom checkers helps doctors spot conditions early on, aids in the prevention of chronic illnesses and can be useful in detecting epidemics, especially seasonal diseases, enabling doctors to prepare accordingly. In the long run, symptom checkers allow doctors to spend more time in prevention, and less time in helping patients manage their chronic day-to-day conditions, and thus have an economical result on healthcare systems.

Given that being with patients in the beginning of their journey is presently close to impossible, doctors appreciate the fact that symptom checkers can perform a first triage and referral role.

Symptom checkers can assist patients in knowing how to deal with their condition. Is it something that can be managed at home, perhaps with a remote consultation, or is it serious and requiring emergency care? If the condition is self resolving, doctors can improve symptom checkers and make them more robust by adding advice and strategies that will be shared with patients to help them right away.

For healthcare organizations, this means that care pathways can be redesigned. By being able to forecast patient flow at any given day, human resources can be organized and allocated accordingly. As a result, patient-reported experience measures (PREMs) can be improved.

Symptom checkers are tools that enable doctors to engage sooner in the patient journey. By collecting and measuring symptom data earlier, doctors can have reliable information on what happened right from the beginning. Furthermore, by having a myriad of information presented in a clear and concise fashion, doctors become even more accurate in diagnosing conditions.

Symptom checkers empower patients by sharing with them the likelihood of having certain conditions. Moreover, they share thorough information on the suggested course of action and the urgency of taking the next steps.

In the future, aside from relieving pressure from struggling healthcare systems, symptom checkers could help measure not only symptoms but also patient outcomes. This would be the closing of a feedback loop that is still open. Having this data available can motivate doctors and stakeholders to compare and improve performance, help identify what works and what doesn’t, and fulfill the goal of value-based healthcare: to enable patients to get the best care possible.

References

1. Kujala S, Hörhammer I, Hänninen-Ervasti R, Heponiemi T. Health Professionals' Experiences of the Benefits and Challenges of Online Symptom Checkers. Stud Health Technol Inform. 2020 Jun 16;270:966-970. doi: 10.3233/SHTI200305. PMID: 32570525.

2. Morse KE, Ostberg NP, Jones VG, Chan AS. Use Characteristics and Triage Acuity of a Digital Symptom Checker in a Large Integrated Health System: Population-Based Descriptive Study. J Med Internet Res. 2020 Nov 30;22(11):e20549.

3. Meyer AND, Giardina TD, Spitzmueller C, Shahid U, Scott TMT, Singh H. Patient Perspectives on the Usefulness of an Artificial Intelligence–Assisted Symptom Checker: Cross-Sectional Survey Study. J Med Internet Res. 2020 Jan 30;22(1):e14679.

4. Coulter Angela, Locock Louise, Ziebland Sue, Calabrese Joe. Collecting data on patient experience is not enough: they must be used to improve care BMJ 2014; 348 :g2225

5. Porter ME, Teisberg EO. Redefining health care: creating value-based competition on results. Boston: Harvard Business School Press; 2006.

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