Make the diagnosis

One of my favorite things to do (because I'm weird or watched too many House reruns) is to play MedPage's weekly game of "What's the Diagnosis."

Each week, the editors publish an image and brief description of a medical condition, like a wound, swelling, rash or X-ray. They then present you with a list of possible diagnoses to choose from. 

So I begin by doing a quick Google search on each possible diagnosis. I look at sample images from across the web, look for similarities and differences to the MedPage image. I sleuth out clues about age and gender, onset, symptoms, co-morbidities. I dutifully search and research and then, I make my best guess and log my answer.

And guess what? Every single time, over the past few years, I've been wrong. Every. Single. Time!

Today's quiz, which I got wrong, again, made me think of a conversation I'd had with a friend, freshly back from Health 2.0. She came away excited about telemedicine as a way to streamline the experience of going to the doctor. As she put it, "I know I need antibiotics. The doctor knows I need antibiotics. So why can't we just skip the visit and get me the thing I know I need?" 

There are so many reason why I disagree. First, I hate pills. Second, she doesn't know she needs antibiotics. She knows that she's had similar symptoms and taken antibiotics. Maybe this is the same thing, maybe not. Maybe it's bacterial, maybe not. None of those things are knowable, only guessable. Third, she isn't qualified to evaluate the risk/benefits of Z-Paks and their repeated use. Finally, a conversation about other diagnoses won't happen, if she doesn't talk to her doctor. Multiple infections over a short period of time...that's doctor worthy, not layperson guesswork material. 

I'm not saying that telemedicine doesn't hold great promise. I believe it does. But what it should do is strengthen the doctor/patient relationship, not undermine it. Much of what happens with our health happens over long periods of time. And skipping around from doctor to doctor via telemedicine could threaten the formation of long term relationships rather than nurture them.