參考譯文：54Doctor 周鵬遠(yuǎn)

　　讓我們試試：發(fā)燒、頭痛和頭暈

　　大家在自己頭痛、頭暈、咽喉疼痛的時候，有沒有想過通過google或者webMD這樣的在線癥狀檢查系統(tǒng)進(jìn)行自我判斷呢？我們想知道：在線癥狀檢查真的準(zhǔn)確嗎？事實(shí)上，成千上萬的人正在通過這種糟糕的在線癥狀檢查系統(tǒng)來幫助他們自己做健康判斷。
　　研究人員對23家（主要是美國和英國的）在線癥狀檢查系統(tǒng)進(jìn)行測試發(fā)現(xiàn)這些系統(tǒng)給出與該癥狀關(guān)聯(lián)正確的潛在疾病信息的準(zhǔn)確率只有1/3,也就是說由這些在線系統(tǒng)給出的有2/3的信息是錯誤的。
　　哈弗大學(xué)醫(yī)學(xué)院主持healthcare政策研究的教授Ateev Mehrotra博士認(rèn)為：人們在選擇這類在線癥狀檢查工具時應(yīng)該意識到它們是不準(zhǔn)確的，更不應(yīng)該把這類系統(tǒng)給出的信息作為自我診斷的結(jié)論。他們甚至完全沒有必要相信這些在線癥狀檢查系統(tǒng)所提供的信息。這份刊載在《英國醫(yī)學(xué)期刊（BMJ）》2015年7月8日的研究，考察了包括全球最的在線癥狀檢查系統(tǒng)，包括：Ask MD, 英國的iTriage和梅奧診所提供的互聯(lián)網(wǎng)門戶服務(wù)等等。每一家網(wǎng)站都輸入統(tǒng)一的45個標(biāo)準(zhǔn)化患者的疾病癥狀，從復(fù)雜的肝臟衰竭、腦膜炎到簡單的蜜蜂蟄傷。各系統(tǒng)提供的最終結(jié)果則大相徑庭，有的系統(tǒng)給出了臨床診斷，有的只是給出了一些建議，比如：待在家里或者去看醫(yī)生，還有的讓盡快去看急診。
　　在線系統(tǒng)給出的這些處理意見作為提高診斷準(zhǔn)確率的參考意見無疑是有益的，至少在緊急情況下是這樣。當(dāng)患者的病情非常危急時，80%以上的系統(tǒng)給出的意見是盡快去看急診。
　　Mehrotra教授指出，在線癥狀檢查系統(tǒng)能夠及時給出處理意見比向患者提供診斷意見更為重要。對患者來說，當(dāng)他們感覺自身不適時他們最需要知道的是：“我究竟該馬上對這些身體不適做出處理還是呆在家里繼續(xù)等待？”Mehrotra教授認(rèn)為，相對于要搞清楚身體不適究竟是為什么，不如盡快去醫(yī)院就診更為重要。
　　另一方面，這項(xiàng)研究還發(fā)現(xiàn)這些在線癥狀檢查系統(tǒng)對一些輕微的癥狀信息給出了過度的處理意見，比如有些情況讓病人呆在家里多喝點(diǎn)雞湯比建議患者去就醫(yī)更適合。
　　“通過計(jì)算機(jī)給出診斷意見或治療建議目前是一個比較前沿的課題”，Mehrotra教授說，“目前我們測試的是代在線癥狀檢查系統(tǒng)，我希望我們的研究結(jié)果可以幫助他們進(jìn)行技術(shù)提升”。
　　iMedicalApps的創(chuàng)始人Iltifat Husain博士對哈佛的這項(xiàng)研究結(jié)果并不表示驚奇，他認(rèn)為移動醫(yī)療應(yīng)用是一個全新的技術(shù)領(lǐng)域，尚未成熟，有待進(jìn)一步提高。“你所看到的絕大多數(shù)與醫(yī)療相關(guān)的App都是這樣”，他解釋道，“越來越多的研究發(fā)現(xiàn)這些App并不符合循證醫(yī)學(xué)的要求也沒有充分參考醫(yī)學(xué)的專業(yè)信息”。
　　然而，這并不妨礙威克福瑞斯特浸禮會醫(yī)療中心（Wake Forest Baptist Medical Center）的急診科醫(yī)生Husain支持這類App應(yīng)用。他認(rèn)為，“如果使用得當(dāng)，這些App可以幫助患者更加積極主動地尋求及時就診，判斷是否需要到醫(yī)院就診比通過癥狀信息獲得準(zhǔn)確的診斷更為重要。特別要注意的是，臨床診斷必須由醫(yī)生來做。在線癥狀檢查系統(tǒng)不可能也不應(yīng)該給出最終的診斷，要知道，我們醫(yī)生花了7年時間在醫(yī)學(xué)院學(xué)習(xí)如何進(jìn)行臨床診斷，這是App無論如何也無法取代的。

Let's see: fever, headache and dizziness.

 iStockphoto

We've all been there before: headache, dizziness, sore throat. Uh-oh! Better Google the symptoms or maybe try WebMD's online symptom checker to see what's wrong.
But how accurate are these online symptoms checkers, anyway?
Turns out, millions of people are entrusting their health to some pretty lousy diagnostic systems.
Researchers tested 23 online symptom checkers and found that the correct diagnosis was provided first on a list of potential illnesses only about a third of the time. That means symptom checkers are spitting out wrong diagnoses two-thirds of the time.
"People who use these tools should be aware of their inaccuracy and not see them as gospel," says Dr. Ateev Mehrotra, who led the research and is a professor of health care policy at Harvard Medical School. "They shouldn't think that whatever the symptom checker says is what they have."
The study, published Wednesday in The BMJ, examined some of the most popular online symptoms checkers, including Ask MD, iTriage, one from the U.K.'s National Health Service and another from the Mayo Clinic.
Each website was fed 45 standard patient vignettes with symptoms consistent with medical conditions ranging from acute liver failure and meningitis to mononucleosis and a simple bee sting.
The final information provided by the symptom checkers varied. Some provided a diagnosis, while others offered recommendations for care, such as stay at home, go to a doctor or head to the ER right away.
These treatment recommendations were right on compared to diagnosis accuracy, the research team says — at least when it came to emergency situations. In cases where the patients were seriously ill, the systems accurately urged them to head to the ER 80 percent of the time.
Timely treatment, Mehrotra says, is more important than getting the diagnosis exactly right. "If a patient isn't feeling well, they're thinking, 'Is this something I have to take care of right away or can I stay home?'" he says. "We do not think distinguishing the exact problem is as important as getting to the hospital right away."
On the other hand, the researchers found that the symptom checkers were overly cautious when it came to patients who had little cause for concern, suggesting they head to a clinic when staying home and having chicken soup was appropriate.
"Using computers to help diagnose and manage care is a new frontier," Mehrotra says. "This is just the first generation [of symptoms checkers], and I'm hopeful that this research can help them improve."
iMedicalApps founder Dr. Iltifat Husain agrees and is hopeful that the mobile health world will "mature and grow up" with time. Because current symptom checkers are so new, Husain, says he wasn't surprised by the results.
"This is pretty consistent with what you see with medical-related apps out there now," he says. "More and more studies are finding that apps are not using evidence-based techniques and that they don't adequately reference medical content."
However, that doesn't stop Husain — an ER doctor at Wake Forest Baptist Medical Center — from recommending online systems and apps like symptom checkers.
"If used appropriately, these apps can help raise red flags so a patient is more proactive and seeks care in a timely fashion," he says. "Nailing the specific diagnosis right away isn't necessarily as important as nailing down, 'Do I need a health care provider?'"
Besides, Husain adds, diagnosis is what doctors are made for.
"Symptoms checkers shouldn't be for getting that final diagnosis," he says. "We spend upwards of seven years in medical school and residency to figure out how to diagnosis effectively and an application isn't going to replace that."

（摘自：美國國家公共廣播電臺官方網(wǎng)站 NPR.org，7月9日，http://www.npr.org/sections/health-shots/2015/07/09/421460415/online-symptom-checkers-can-t-replace-the-good-ol-doc ）