The Doctor of the Future

By: Chuck SalterFri May 1, 2009 at 2:00 PM

Photograph by Jamie Chung | Prop Styling by Bryan Byrn

Cost, access, quality -- the prognosis for American health care may look grim, but innovation is the cure. The medicine of tomorrow is being born today.

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Photograph by Tanit Sakakini

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In theory, the more doctors learn about the body, the better basis they have for figuring out what's wrong with you. In reality, they can't keep up with the flood of new information. In neurology alone, the number of identified disorders has more than doubled in 10 years, to more than 1,800, the majority extremely rare. True, doctors as a community know more, but what any individual knows constitutes a smaller portion of medical information overall. What if physicians could use technology to tap their peers' expertise to make quicker, more accurate diagnoses?

Dr. Michael Segal, 54, a renowned pediatric neurologist in Chestnut Hill, Massachusetts, has been working on this problem off and on for 20 years. The result: SimulConsult, a sophisticated online crowd-sourcing tool for identifying neurological disorders that demonstrates the potential of the Web to transform the way all kinds of diseases are diagnosed. Doctors enter a patient's symptoms and test results, and the software produces likely diagnoses and the probability for each.

"It's like having a group of more- experienced physicians helping with every diagnosis," says Dr. Viveck Baluja, a resident in pediatric neurology and developmental medicine and a fellow at Baltimore's Kennedy Krieger Institute. "The people inputting data about the diseases are experts in this field."

Segal recognized the need for such a tool as a resident in the 1980s, when he spent hours poring through books and looking at every possible unusual disease for one particularly perplexing patient. "The problem is that textbooks are arranged so if you know the disease, they tell you the symptoms or lab results," he says. "But patients come to us in the opposite way, with findings that we need to put together in a story to reach a diagnosis."

SimulConsult works the way a physician does. It produces an initial diagnosis based on information from experts with a wealth of experience, then prompts the doctor to consider other pertinent tests and findings. For example, if a physician enters information about a teenager with a history of attention-deficit-hyperactivity disorder, an abnormal electrocardiogram, and bouts of weakness, SimulConsult asks about recent salt intake. "Most clinicians would not flag such information as relevant," says Segal, but sodium has been known to trigger those symptoms in patients with a neurological syndrome known as hypokalemic periodic paralysis. Says Baluja: "There are thousands of outliers. The problem isn't in the disease itself. It's in the subtle variations of disease. The details matter."

In 1997, Segal went part-time at Harvard Medical School, where he had been an award-winning researcher, to found SimulConsult. The firm didn't begin generating revenue until this year; the tool was more of a puzzle he wanted to solve than a way to make money. Last year, in hopes of expanding, he hired a CEO, got his first ads, and secured an initial round of funding from an angel investor; eventually, he plans to charge a subscription fee for access to more detailed information. "This is typical of a lot of medical innovations," says David Williams, a health-care consultant in Boston and informal adviser to Segal. "There's a long incubation from basic R&D to commercialized product."

Segal began by offering the database free to pediatric neurologists. Now primary-care physicians make up 20% of users, a development that should increase its impact. If SimulConsult helps generalists make correct diagnoses early on, that means fewer visits to the wrong specialists and unnecessary tests, greatly reducing costs and accelerating appropriate treatment.

Most significantly, more users would lead to more findings and a richer, more valuable diagnostic tool. "I think we will discover that many diseases that we thought were rare," says Segal, "will turn out to have been just rarely recognized."

It's this ability to expand and harness knowledge that makes cutting-edge information technology such a powerful driver of the emerging health-care revolution. Professional tools like SimulConsult, Isabel, and Diagnosaurus can improve care and control costs. Sites such as PatientsLikeMe, which connects people with similar conditions, help them understand their health and may promote compliance with treatment. Physicians, not surprisingly, complain about patients who try to diagnose themselves after logging onto the symptom search engine Medgle. But the end result is to deepen communication, both among doctors and between physicians and their patients. Everyone will be smarter for it.