It’s a well-known fact that people go to the internet to ask questions about their health. In a 2012 survey by Philips North America, 49% of Americans reported feeling comfortable using online tools to understand their symptoms and decide whether to seek medical care.
Google, the world’s largest search engine, says about 1% of its search queries are related to medical symptoms — translating to millions of searches.
The Silicon Valley tech giant is currently upgrading its symptom search by reviewing individual information. The enhanced tool will match symptoms to a list of related conditions.
“We worked with a team of medical doctors to carefully review the individual symptom information, and experts and Harvard Medical School and Mayo Clinic evaluated related conditions for a representative sample of searches to help improve the lists we show,” Veronica Pinchin, a product manager on Google’s search team, wrote in a recent blog post announcing the effort.
To improve search results, Google regularly reviews and incorporates appropriate feedback into its algorithms, a spokesperson wrote in an email. “We rely on our algorithm and the data gathered from search results and our knowledge graph to reflect the most accurate information for symptom queries."
The company plans to make symptom searches available via desktop browsers and eventually extend the service to international markets in languages other than English.
WebMD Health’s stock dipped 2% immediately following the June 20 announcement.
Search it out
As symptom searches become more sophisticated, doctors are encouraging patients to use them and a growing number of hospitals are offering them on patient portals. They’re also an increasingly popular feature on a variety of health apps.
“We get an approach from somebody probably every other day asking whether they can integrate the [Isabel] Symptom Checker into their product,” says Jason Maude, CEO and founder of Ann Arbor, MI-based Isabel Healthcare.
Unlike most symptom checkers, which require people to enter one symptom at a time, Isabel allows patients to enter an unlimited number of symptoms or clinical features and get a list of possible diagnoses, says Don Bauman, CEO of Isabel Healthcare USA. The Isabel Symptom Checker, with around 3,700 diseases, gets hundreds of thousands of searches a month.
Isabel is designed to help people be better informed, not replace a doctor’s diagnosis, both men stress. “It provides information for people to learn more about possible diagnoses and be able to have a more meaningful conversation with their provider,” Bauman tell Healthcare Dive.
Based on a professional-grade tool that Isabel Healthcare began marketing in 2000, the Isabel Symptom Checker recently added a triage feature that overlays on top of results and helps patients decide whether they should go to a walk-in clinic, their family doctor or an emergency room.
Bauman sees the Google and Isabel search tools as complementary, rather than competing. For simple searches, such as a headache, Google “may be very useful,” he says, but for more complex problems where an individual is trying to also figure out a possible cause, then a more sophisticated tool like Isabel is helpful.
Symptom of an informational trend?
Children’s Hospital of Wisconsin is one of the many organizations that have begun offering symptom checkers as part of a broader interactive tool kit for customers. Parents can access Children’s On Call, made by Windsor, CO-based Self Care Decisions, through the hospital’s patient to search symptoms and get suggestions on the appropriate level of care for their child.
“We describe it as a right care, right time, right place tool,” says Neal Linkon, director of digital engagement. “It’s not meant to diagnose, but instead to give parents some direction on what to do based on the symptoms, like take your child to the ER, call your doctor within 24 hours, etc.”
The app, fueled by content from pediatrician Barton Schmitt, has an 80% user return rate.
Other hospitals with symptom checkers include Omaha Children’s Hospital & Medical Center, which uses Isabel, and Riverside Community Hospital in California, which uses an app marketed by iTriage.
Two sides to every story
Despite their growing use, symptom-checking websites can have drawbacks, some experts say.
For example, patients who would normally seek professional advice about a health concern may do so if they are reassured by what Google or another tool tells them. This is particularly true where patients don’t have an established relationship with a primary care doctor, says Michael Warner, a critical care specialist and chief medical officer of Ask the Doctor.
“Patients who rely on walk-in clinics/retail clinics may turn to Google more often since they may not have a relationship with a physician they trust,” he wrote in an email.
Online symptom checkers could also cause people to believe they have a certain condition and ignore symptoms that don’t fit that ailment, Warner says. “Patients may now be coming to doctors with a strongly held position that they have ‘x’ diagnosis, derailing the time-proven process of using the patient’s story to figure out their diagnosis.”
In the first widespread study of symptom checkers, a team of researchers looked at 23 tools and found they provided the correct diagnosis first in just 34% of standardized patient evaluations. The websites listed the correct diagnosis within the top 20 options given 58% of the time and provided the appropriate triage advice 57% of the time.
ITriage, Isabel, Symcat and Symptomate always urged users to seek care from one of the triage levels, according to the study published in The BMJ in June 2015.
The authors say such tools could be improved by incorporating local epidemiological data and individual clinical data from medical claims or electronic medical records.
Join the conversation
Despite the limitations, Isabel Healthcare’s Maude believes symptom checkers have an important role to play in healthcare. He recounts a doctor who complained that providers are being pressed to involve patients more in decisionmaking, but that patients are uninformed and don’t know how to think through their symptoms.
“All these tools can help that conversation,” he says.