For doctors, diagnosing gets a technological boost

Sept. 6, 2007 — -- Pediatrician Stephen Borowitz was walking the floors of the University of Virginia Children's Hospital with his residents when he was presented with an unusual case.The patient was a boy who was very ill with a severe childhood disease called hemorrhagic shock and encephalopathy syndrome. Borowitz says the boy had significant neurological damage and was fed through an intravenous feeding tube.

The immediate problem was that he had a fever. But he was showing other symptoms that didn't match his condition. "He had developed diarrhea, which is extremely unusual for him, and he seemed uncomfortable," Borowitz says.

Borowitz worried that the culprit was a bloodstream infection, a typical problem with patients with intravenous feeding tubes. But something still didn't seem right.

So Borowitz and his residents consulted Isabel, a Web-based medical technology that generates a list of possible diagnoses based on the patients' symptoms.

"I put all his symptoms into Isabel and it came up with a number of ideas," he says. "One of them was gallbladder disease, which I probably should have thought of, but I didn't."

An ultrasound was ordered, and gallbladder disease was indeed the problem, and it may not have been related to the boy's pre-existing condition or his feeding tube.

According to a 2003 Journal of the American Medical Association review of autopsy studies, doctors misdiagnose 8% to 24% of the time. Cognitive errors, such as latching onto a diagnosis that seems the most likely without considering other possibilities — which experts call "anchoring" — are among many root causes, according to Jerome Groopman, chairman of experimental medicine at Harvard University and author of the book How Doctors Think.

The solution for some is technology. Doctors are increasingly using the Internet, even search programs as basic as Google, when they're stumped, according to "Googling for a Diagnosis," a British Medical Journal study last year.

Although Isabel is used in only 18 hospitals, interest in similar decision-support systems is growing in the medical community, according to the American Medical Informatics Association. Priced at around $50,000 a year for a typical 300 bed hospital, Isabel is considered a robust tool, highly rated by the Healthcare Information and Management Systems Society.