Last winter, my friend’s husband sent me a text with a list of symptoms he was having. Mild fever, headache and a rash on his hands. I knew he had a preexisting condition that at times required him to take certain medications. After getting a few more details, I told him I thought it might be a medication reaction. He then clarified that the whole family had experienced some version of these symptoms during the week. I was stumped and encouraged him to call his doctor.
About an hour later, he sent another text saying it was hand, foot, and mouth disease (not to be confused with foot-and-mouth disease). I asked if that was what his doctor said when he called. No, he replied, that is what Wikipedia said when he typed in the symptoms. With that I sighed and responded, “I guess we won’t need doctors and nurses anymore now that we have Wikipedia.”
At the time, I was just trying to be funny, but after looking at the iTriage application (which can be used via a desktop or mobile device) my comment doesn’t seem to have been so far-fetched.
Developed by two emergency medicine physicians, iTriage, according to its website, “empowers people to make better healthcare decisions and improves healthcare delivery for providers and payers.” As someone who is a proponent of informed patients, I thought this sounded like a great benefit. The website’s user comments support this claim. There are even comments from RNs who said they use it to check clinical guidelines and brush up on medications.
It sounded promising so I decided to give it a test drive. The homepage is clean and easy to navigate which is a plus. But is this an edgy and new idea? Not really. It’s very similar to WebMD’s “Symptom Checker” feature. I’ve never been wild about that function because it gives such a broad range of possible causes of symptoms. Have a headache? Could be a brain tumor or you could just be stressed out from a bad day at work. I was hoping iTriage would be better. It’s not.
A few years ago, my dad experienced a sudden left-sided facial droop. Being a neuro nurse and knowing how strokes present, I encouraged him to call his doctor and go to the emergency room. He refused. I did my own neuro check on him and noticed he could only raise his right eyebrow. This helps to distinguish between a stroke and Bell’s Palsy, a non-life threatening damage to cranial nerve 7 that often resolves with no residual damage. I still thought it would be wise for him to at least call his doctor. He still refused but did end up going to his physician’s office next day. Sure enough he was diagnosed with Bell’s Palsy.
I used his symptoms to see if iTriage would give a more specific diagnosis. I typed “facial droop” into the “search your symptoms” box and got a list of seven causes of facial droop. Bell’s Palsy was on there but so was stroke, brain tumor and ear infection. How a lay person is supposed to decide which problem is the cause of the symptoms I don’t know. I thought maybe if I clicked on Bell’s Palsy it would give me some prompts asking for more details (how long were the symptoms going on, were any other body parts affected) to help determine if that was really the problem. Instead, I got a synopsis of the disease, symptoms, tests and places nearby to get medical care. At least the healthcare provider list would be helpful if someone was traveling and uncertain about where to find help. Though good old Google can do that as well.
I noticed providers could be sorted via distance or “featured.” Not quite sure what featured meant, I typed in my internal medicine physician’s name (my father goes to the same practice). He didn’t appear on either list. Neither did his partner. So I tried my obstetrician’s name and his name popped up on both the distance and featured list. Strange since all three practice out of the same hospital and office park.
Trying to figure out what that meant, I ended up on the physicians link under the “healthcare solutions section.” The first sentence on the page read, “Growing your practice with lucrative patients is quicker and easier with iTriage.” Lucrative patients? I’ve never heard this term before but for some reason the words cash and cow sprung to mind. It leads me to believe that providers must pay to be listed on the site. If this is indeed the case, I have concern that patients will think they are getting provider suggestions based on quality and location when in fact the list is based on which providers paid for the service.
In addition to these issues, I also wondered how a healthcare provider would react if a patient called and said they think they either have a brain tumor because the iTriage symptom finder suggested it. And, in my opinion, access to care isn’t increased with this app. If a patient has a problem like a facial droop, they still have to call their physician, wait for him or her to call back and will likely be told told to either make an office appointment or go to urgent care or the emergency room. I’m already subject to that system without even using an app.
I don’t think the concept of iTriage is totally worthless. If patients could be prompted to submit more specific symptoms via the app to an actual triage nurse, who would then call the patient to get more information and decide the course of action ie office visit, urgent care, emergency department, that would be extremely helpful and cost effective.
I’d love to hear opinions on iTriage and other apps like it. E-patients and providers tinker around on iTriage and tell us about your experience. Did you find it helpful? What could be better? What would your dream app look like?
In the meantime, I’m going to see what some of these symptom checkers think might be causing my recent fatigue. Cancer, hypothyroidism and anemia will probably be suggested though I’m pretty certain what I suspect to be the cause, having a one-year-old with unpredictable sleep habits, isn’t going to be on the list
Jennifer Thew, RN, MSJ
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