Although I tend to focus much of my time evaluating and using smartphone apps aimed at medical professionals, a much larger and likely more lucrative market is for smartphone apps aimed at patients. In mid-2014, the iOS and Google Play stores included over 100,000 medical apps. A subcategory of these apps includes self-diagnosis apps. The authors (Lupton D, Jutel A) of a recent article published in Social Science and Medicine evaluated the potential social consequences of a “digitized” diagnosis on patients and the physician-patient relationship (Soc Sci Med. 2015 May;133:128-35. doi: 10.1016/j.socscimed.2015.04.004. Epub 2015 Apr 3).
The authors searched the iOS and Google Play app stores using the words “medical diagnosis” and “symptom checker”. They limited the search to apps in English and those that included a broad differential diagnosis and were not limited to a specific disease diagnosis. They found a total of 35 apps (16 only in Google Play, 12 only in iOS, 7 in both) aimed towards the lay person regarding self-diagnosis. Some of the apps they found included WebMD, Isabel Symptom Tracker, iTriage Health, Symptom Check, Virtual Doctor, Dr Android MD, etc. Surprisingly, some of these apps had been downloaded over 1 million times.
The article was not geared towards evaluating the apps’ accuracy; though the authors cite other articles that have done this. We here on iMedicalApps have also examined self-diagnosis apps including WebMD, Zipnosis, NHS Direct, and a recent article that evaluated their accuracy. Instead, the authors examined how the information obtained/exchanged could affect the patient and the physician patient relationship. Some of their results were surprising, others just disappointing.
The authors noted that many of the apps were either not written by medical professionals at all or at least that was only one of many tangentially related apps they authored. Some app’s authors also wrote apps on children’s books and ancient Rome. Frequently, there were no specifics given about the expertise of the “team of doctors” who authored the app. No references were included for the content listed in many of the apps. Furthermore, the titles, symbols, colors, etc. all gave the apps an air of authority. However, this was contradicted by the disclaimers most used stating that their apps were for entertainment purposes only or were not meant to diagnose or treat any medical condition. Obviously, some of this is for legal protection as well as to avoid FDA regulation. But it likely will give some patients a mixed message.
Many apps seem to empower patients to take charge of their health. This isn’t new and has exploded over the years with the internet and now appears poised to go even further with health trackers, watches, etc. This likely may be very good for patients and providers, but per the authors, is too soon to tell. They found that many patients were left with confusing results from these self-diagnosis apps. What was the patient to do next? Still seek the advice of their doctor?
The biggest concern raised by the article regarded the lack of security of patient information. Nearly all of the apps they reviewed stated that the information entered by patients became the property of the app creators and could be sold to 3rd parties. We have reported on this previously in iMedicalApps that providers in some apps, such as Epocrates and Medscape, share their information. This seems even more widespread for these apps for patients. This data includes very personal information, contact lists, geolocation data, etc.
The authors conclude with a rather pessimistic view of these self-diagnosis apps. I am not sure I completely agree on all points, but I am concerned about the variance found in the quality of the apps reviewed. The article tends to raise more questions than it answers on the possible benefits of self-diagnosis apps. What is the role of the physician-patient relationship in the age of the digitized diagnosis? What should patients do with the information they get from these apps? How valid are the diagnoses generated by these apps?
Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.
