Diagnosing medical conditions online, a notion sure to make malpractice lawyers salivate, is very much on the mind of a Chicago dentist who believes his computerized questionnaire will revolutionize the practice of medicine.
In the back of his dental office in the basement of Chicago's soaring Sears Tower, Allen Moses tinkers with his recently launched Web site, headachesearch.com, which he said can accomplish what others have only attempted.
His 13-page survey aims to find diagnoses for the causes of chronic headaches that affect 40 million Americans, most of whom suffer without knowing exactly why. A diagnosis is generated by matching answers from the exhaustive questionnaire with thousands of references drawn from standard medical texts and leading professional journals.
Moses set up complex algorithms and statistical formulas to sort through the 250 or more potential causes of headaches and match up symptoms with the likely source of a patient's pain. The site also uses a series of what he calls "if-then rules."
For example, low-pitched ringing in the ears combined with a throbbing or pulsating headache will trigger the computer to warn of a possible aneurysm, a dangerous widening of an artery. But if the ringing is high-pitched, constant and accompanied by ear pain, especially while chewing, that could signal an acoustic neuroma - a tumor involving the acoustic nerve that connects the inner ear to the brain.
"A doctor can't remember everything and a computer can't forget. This allows the computer to analyze what's really important and it will consider the obscure," Moses said. "Let the computer do the busy work. Then the doctor can focus on the humanistic aspect of treatment."
The 200-question survey, which takes about half an hour, first gauges if the headache is acute, which could point to a life-threatening problem. Severe symptoms trigger the computer to halt the survey and direct the patient to see a doctor.
GETTING AT THE CAUSE OF HEADACHES
Patients judged to suffer from chronic headaches then answer questions about the intensity, frequency and site of the pain and provide their medical history. The survey also seeks to determine the patient's stress level by asking about career, debts, relationships, sleep and dietary habits, alcohol or drug use, and sexual issues.
Over time, Moses intends to incorporate information gathered by the surveys themselves into the database. While patients remain anonymous - each is assigned a number - a compilation of real answers will render better virtual diagnoses, he said. Surveys containing inconsistent answers are tossed out.
Moses, 58, hopes to profit by selling advertising on the site and also by publishing the findings or even licensing the computer software. And he wants to expand the Web site's diagnostic reach into other ailments such as sleep disturbances, nausea, dizziness, and depression.
"These are symptoms, not causes. We're trying to get to the cause of a problem," said the gray-bearded, bespectacled dentist. "I stood on my head trying to avoid the word 'diagnosis,' but that's the word everyone understands."
The Web site domain name, headachesearch.com, is a unit of his umbrella Internet-based company whathaveigot.com. Moses emphasized that computer diagnoses are based on existing medical literature and cannot be considered a "clinical" diagnosis, which requires a doctor's physical exam.
Moses, who sits on a Food and Drug Administration panel that evaluates dental devices and publishes articles in medical journals, said some doctors have warned him his Web site could pose risks to his medical license. Authorities might consider it an illegal practice of medicine or accuse him of violating laws against practicing medicine across state lines, he was told.
"I'm scared. They could shut me down and I'd lose everything. But I don't think the objections are valid," said Moses, who has invested two years and $100,000 in the venture. "Medicine by computer is going to happen and if I don't do this someone with deep pockets will," he added.
To be sure, there is already a wealth of medical information on the Internet and a huge collection of textbooks, scientific reports and medical journals can be accessed with the click of a mouse. Medical advice also can be obtained online from Medical Advisory Systems Inc. (www.mas1.com and www.doctalk.com) and AmericasDoctor (www.americasdoctor.com), to name two.
The difference is that a user of Moses' site actually interacts with the computer program.
EXPERTS WONDER ABOUT SELF-REPORTING SYMPTOMSBut neurologist Michael Schwartz, who runs the Hyde Park Headache Clinic in Tampa Bay, Florida, was concerned about the quality and credibility of the patients' self-reporting and the computer's inability to ask follow-up questions.
"This questionnaire certainly covers a lot of things I'd want to know during a visit with a patient, but there's no substitute for an actual person doing the interviewing because a good doctor can elicit information that the patient doesn't even know is significant," Schwartz said.
Another neurologist, who asked for anonymity, said he found the survey to be too long and unwieldy.
"The number of questions is so long that the number of people who would actually work through it is small. Because there are so many questions, I think it's unlikely that people would attend to all of the response options, so I question how accurate the information (is) that this data-collecting machine would gather," he said.
"I think there might be substantial inaccuracies caused by waning attention. In general, I think this is too complicated to be usable," he added.
Some patients are also wary of diagnosis by computer.
Chicago attorney Dimitri Christopolous, who has suffered from severe headaches for years, took the survey but was skeptical of the result.
"This completely eliminates the art of medicine," he said. "I wouldn't trust any diagnosis I got from a computer survey."
Moses said the survey should not be used as a substitute for visiting a doctor. "It should be used as a tool to help get the patient to the right doctor and help the doctor narrow the possibilities. It gives the doctor a short list."