The pros and cons of online symptom checkers

There are various models of triage for general practice that aim to improve access to care, including 'online symptom checkers' hosted on the practice's website. Dr Gabrielle Pendlebury from Medical Protection looks at the pros and cons of using these systems.

(Photo: iStock.com/IGphotography)
(Photo: iStock.com/IGphotography)

General practice has been faced with an average increase in workload of around 2.5% a year since 2007/8, taking account of both volume and acuity.1

Some of this demand could be dealt with by increasing the workforce, but it is also important for practices to try and moderate demand through appropriate access. The GMC’s Good Medical Practice states that: ‘You must make good use of the resources available to you.’

To manage access, some practices are considering whether an ‘online symptom checker’, hosted on the practice’s website, can aid GPs in making the best use of often limited resources.

What are symptom checkers?

Symptom checkers use computerised algorithms that ask users a series of questions about their symptoms, or require users to input details about their symptoms. They are intended to facilitate self-diagnosis by providing a range of diagnoses that might fit the patient's symptoms. They also seek to assist with triage by advising the patient whether to seek care, where they should seek it and with what level of urgency.2

This article is looking specifically at online symptom checkers that act solely as a triage tool and where, unlike online consultations, there is no input from, or contact with, a healthcare professional in the practice.

Greater use of technology in healthcare

Greater use of digital technology can enhance access, for example, apps that connect patients to their practice more easily, phone and email consultations, and webcam links with care homes.  However, care must be taken because while remote consultations can provide greater access to care and reduce waiting times, there are also inherent limitations, such as difficulties in spotting non-verbal clues and the inability to examine the patient.

Members of the public are increasingly using the internet to gain an understanding of their health needs. A study in Belgium indicated that searching the internet for health information or using ‘Dr Google’, can have a positive impact on the doctor-patient relationship, as a result of a better mutual understanding.3

A YouGov survey of over 2,000 adults in Britain, commissioned by Medical Protection, showed that 47% of the public have searched online for their symptoms and a possible diagnosis before seeing their doctor. One in five of those surveyed (21%) admitted that they had then challenged their doctor’s diagnosis.4

There is an acknowledgement that patients require access to good quality, evidence-based information so they can take an active part in decisions about their health care, but there is a concern around the veracity of such information on the internet.

A review of the evidence

Similarly, online symptom checkers can encourage patients with life-threatening symptoms to seek help quickly, and conversely, reassure patients who do not require assistance to remain at home, thus potentially reducing visits to the GP or hospital. But these outcomes are determined by the clinical performance of the symptom checker, in terms of accuracy of diagnosis and triage advice.

Unfortunately, a 2015 study suggested that symptom checkers have deficits in both diagnosis and triage, and their triage advice can be risk-averse, which could lead to an increase in unnecessary appointments, rather than a reduction.5

While online symptom checkers, hosted on practice websites, may have more value than a general internet search for symptoms, they are dependent upon the information that the patient inputs and can therefore never replace triage and assessment by a qualified professional. Harvard researchers in the United States found that ‘doctors made a correct diagnosis more than twice as often as the online symptom checkers’.6

Therefore, while symptom checkers may be useful as an adjunct to triage, they are not recommended as a substitute for triage. Medical Protection does not support claims relating to the accuracy or reliability of symptom checkers, as this amounts to product liability, which Medical Protection does not indemnify. You should check with your medical defence organisation about your own arrangements and contact them for further advice.

Principles of safe triage
  • Experienced practice nurses/nurse practitioners can assess the patient’s concerns via telephone
  • Full details of the triage call must be in the patient’s medical records
  • Receptionists may be in the preliminary triage, but they must not give clinical judgment
  • Gabrielle Pendlebury is a medicolegal adviser at Medical Protection

References

  1. General Practice Forward View https://www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf
  2. Campbell J, et al. Telephone triage for management of same-day consultation requests in general practice (the ESTEEM trial): a cluster randomised controlled trial and cost-sequence analysis. Lancet 2014;384:1859-68.
  3. Van Riel, N et al. The effect of Dr Google on doctor–patient encounters in primary care: a quantitative, observational, cross-sectional study. BJGP Open 16 May 2017 DOI: https://doi.org/10.3399/bjgpopen17X100833
  4. All figures, unless otherwise stated, are from YouGov Plc. Total sample size was 2021 British adults. Fieldwork was undertaken between 26 – 31 May 2016. The survey was carried out online. The figures have been weighted and are representative of all GB adults (aged 18+).
  5. Semigran HL, et al. Evaluation of symptom checkers for self-diagnosis and triage: audit study. BMJ 2015; 351:h3480
  6. Mehrotra A, Comparison of Physician and Computer Diagnostic Accuracy. JAMA Intern Med 2016;176(12):1860-1861.

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