Digital Differential Diagnosis

Now you think I’m going to blog about something medical for patients, right? Well — I will in a minute — but let me tell you where the idea came from for this morning’s post…

At 2:30 this morning, I was awakened to a beeeep…… beeeep….. beeeeep….. It took me almost 10 minutes of searching to find the source (no, it wasn’t the smoke alarm!) Finally I checked in the basement and sure enough — it was the Verizon FiOs box on the wall. The box was telling me I had no internet access. Right next to it was the Time Warner cable/phone box and it, too, was flashing. I pushed a button that said “silence alarm” and went back to bed.

This morning I called Verizon (using my cell, of course!), explained the problem, and the gentleman on the phone (you know — Tom Smith with a heavy Indian accent?) walked me through the diagnosis of the problem. He was really very good. Push this button, unplug that cord, check the circuit breaker, try plugging a lamp into the wall plug, and voila — turns out the problem was not Verizon or Time Warner. Instead, the problem was the electrical supply into the plug. So I rigged an extension cord from another plug, attached the phone and internet boxes and — woo hoo! I’m online and have phone access! Thanks Tom.

It occurred to me that this is exactly what doctors are supposed to do when we are sick and present with symptoms. The beeping, like a fever (for example) signals a problem. The doctor checks our temperature and blood pressure, listens to our heartbeats (checks our circuit breakers), runs a test (plugs in a lamp to see if it will work), and whatever else to figure out what’s wrong with us.

The concept of differential diagnosis (DD or DD2) is used when there is more than one possibility of what’s wrong. The doctor uses all the evidence to eliminate one possibility after the next, just like Tom did with me on the phone. Tom performed a digital differential diagnosis, right?

For the great majority of patients, the doctor accurately chooses the right diagnosis, or at least something close enough that the recommended treatment works — as did Tom. I still have to call an electrician to find out why that plug isn’t working correctly (nor are the other plugs nearby) — and why the circuit breaker didn’t trip to indicate a problem. So while Tom’s suggested treatment (running an extension cord) has provided me with symptom relief, it’s not the long term cure I need.

I expect an electrician will be able to provide me with a cure. Not all patients are so lucky. Sometimes their symptoms never get translated correctly (failure to diagnose) so their treatment is never correct. Sometimes they are accurately diagnosed, but no cure is available. Then they may choose from among various treatments that are more or less problematic for their lifestyles. In effect, they just have to cope. My coping will be limited to the times I have to step over the ugly orange extension cord until the electrician gets here.

Sticking with my digital metaphor, there are tools that can be used by doctors and patients alike to hone in the right diagnosis. In the old days, doctors just trusted what they learned in med school, or through experience, or what they could look up in books or professional journals. Now they have access to the internet, and dozens of digital diagnostic tools to help them through the DD process. There is almost no excuse any longer for someone to go undiagnosed, or to be given the wrong diagnosis.

As patients, we have access to some of those tools. I am NOT a fan of “symptom solvers” for most of us because I’m a firm believer that we need to partner with our medical professionals to arrive at the right conclusions about diagnoses. Besides, most of the time we can’t prescribe our own treatments anyway.

However, I fully recognize that we don’t always get the information or help we need from our doctors. Failure to diagnose happens way too often because some doctors, feeling insurance and profitability constraints, are in too much of a hurry and miss too many signs. Patients must fend for themselves, trying to second guess their doctors, trying to figure out on their own what questions to ask when they return, yet again, to the professionals who should be helping them.

In those cases, the tools available digitally to patients — on the internet — can be invaluable. If you and your doctor aren’t arriving at diagnosis conclusions that help you get the right treatment, you may want to check them out. Find a list here:

Like health care, electrical work will be expensive! And of course, we have no insurance for electrical repairs. Further, I called the electrician and made an appointment. He will fit me in…. does all this sound familiar?

But I thank heavens for this digital age and access to information. Tom became my digital diagnosis partner this morning. And now the electrician will provide me with a cure for what ails my electrical system.

All will be right with my digital health once again. I wish the same for you.

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Trisha Torrey
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