Can an Advanced Computer Program Replace a Doctor at

the Diagnostic Stage of Patient Treatment?

Sudeep Sunthankar

Spring Valley High School

Past Research

Computers help doctors with diagnosis as early as 1969 (Waxman & Worley, 1990) .

1970: William Schwartz felt that computers could be used to replace doctors completely (Waxman & Worley, 1990).

Schwartz did not produce a program that was strong enough to support his idea (Waxman & Worley, 1990).

Current Day Programs

Doctors utilize software to diagnose patients (Scott and Purves, 1998).

Meditel and the Quick Medical Reference (QMR) are two types examples (Federhofer, 2005).

Designed for doctors use (Federhofer, 2005).

Influenza C

Most common of the three types of Influenza (AMA, 2004).

Only affects humans and animals (AMA, 2004).

Known as the flu to most people, usually contracted annually (C Health, 2005).

Non Lethal unless infects an already weakened immune system such as the elderly, young children, or people already fighting a disease (AMA, 2004).

Influenza C

Fever Shaking Chills Sneezing Headaches

Weakness Chest pains Muscle aches Sore throats Dry coughs

(AMA, 2004) (CDC, 2004).

Coronary Artery Disease

Almost 1 out of every 2 males over the age of 40 contract the disease (49%). This is the most vulnerable group (Medline plus, 2005) .

Coronary Artery Disease Discomfort Heaviness Pressure Aching Burning Short breath Irregular heartbeats Dizziness Nausea Sweating Weakness

Pain in the: • Chest

• Left shoulder

• Arms

• Neck

• Throat

• Jaw

• Back (WebMD, 2004)

Hypertension

Strongly tied to high blood pressure and high cholesterol.

120/80 Hg is normal blood pressure Blood pressure over 140/90 Hg is considered

hypertension (Crews, 2005). Blood pressure at 139/89 Hg is considered

prehypertension (Crews, 2005).

Hypertension

Obesity Glucose intolerance Stress High alcohol intake High sodium intake High blood pressure (Crews, 2005).

40% of hypertension victims display obesity, which is an easier symptoms of hypertension to identify (Neutel and Smith, 1998).

Purpose

Discover whether a computer can correctly diagnose certain types of patients better than a doctor.

Microsoft Clip Art 2005

Materials

Human Subjects

Computer

Microsoft Access

Microsoft Visual

Basic

Surveys

Picture taken by Sudeep Sunthankar

Hypothesis

The computer program, the “Virtual Doctor”, will be able to produce an overall higher percentage of correctly diagnosed patients than the human doctor in the three disorders, influenza C, coronary artery disease, and hypertension.

Methods: The PatientVirtual Doctor created in Microsoft Access

with a combination of Visual Basic Code.

Patient Survey Forms created

The surveys contained a place for the symptoms

for the disease and a section for the disease that the patient had suffered from.

Once the surveys had been completed, the

section that contained the symptoms of the

disease was sent to the doctor for diagnosis.

Patient/Doctor Survey

Methods: The Doctor

The doctor’s decision had to be made strictly from the symptoms the patient had listed on the survey.

The diagnosis was recorded on the survey in a section that was designated for the doctor’s diagnosis

Once the doctor’s diagnosis had been made for that survey, the survey was ready to be sent back to the researcher

Methods: The ComputerAn unbiased party then entered the symptoms into the computer. The unbiased party was an individual who did not have access to information about the research such as the purpose of the research.

The symptoms could then be entered without any bias or favoritism during this process.

The individual entered the patient’s symptoms by selecting the symptoms listed on the computer screen.

Once all the symptoms on a form had been entered, the database informed the individual whether it could make a diagnosis from the information entered.

Computer Program In Use

Pictures taken by Sudeep Sunthankar

Experimental Design Diagram

Dependent Variable: The number of correctly diagnosed patients by the computer and doctor respectively.

Constants:• Area from which patients are collected• Program used to diagnose symptoms• Creator of program• All subjects over the age of 18.

IV: Type of Disease

Influenza Coronary Artery Disease

Hypertension

45 75 36

Descriptive Statistics-Correctly Diagnosed Patients

Groups N Mean Median Min Max Variance

Doctor 138 46 40 28 70 467.85

Computer 113 37.66 36 26 51 158.26

Total 251 41.83 38 26 70 313.055

Descriptive Statistics-Incorrectly Diagnosed Patients

Group N STDV Mean Median Min Max Variance

Doctor 18 1.73 6 5 5 8 2.99

Computer 43 8.39 14.33 15 9 24 70.39

Total 61 7.67 10.17 8.5 5 24 36.96

Results

Influenza C

01020304050

Doctor Correct ComputerCorrect

DoctorInocorrect

ComputerIncorrect

Type of Diagnosis

Num

ber o

f Pat

ient

s

•The doctor had 40 correct and 5 incorrect. •The computer had 36 correct and 9 incorrect.

ResultsCoronary Artery Disease

01020304050607080

Doctor Correct ComputerCorrect

Doctor Incorrect ComputerIncorrect

Type of Diagnosis

Num

ber o

f Pat

ient

s

•The doctor had 70 correct and 5 incorrect. •The computer had 51 correct and 24 incorrect.

ResultsHypertension

05

1015202530

Doctor Correct ComputerCorrect

Doctor Incorrect ComputerIncorrect

Type of Diagnosis

Num

ber o

f Pat

ient

s

•The doctor had 28 correct and 8 incorrect. •The computer had 26 correct and 10 incorrect.

X² Summary Table-Doctor Diagnosed

Group Influenza CoronaryArtery

Disease

Hypertension n

Observed 40 70 28 138

Expected (45) (75) (36)

DF=2, Critical value=5.991, Chi Square Test Value= 2.67, α= 0.05, P-Value: 0.2636

X² Summary Table-Computer Diagnosed

Group Influenza CoronaryArteryDisease

Hypertension n

Observed 36 51 26 113

Expected (45) (75) (36)

DF=2, Critical value=5.991, Chi Square Test Value= 12.25, α= 0.05 P-value: 0.0022

Conclusions

Variation between patient and doctor diagnosis: No significant difference between the doctor and

patient’s diagnosis. This means that the doctor’s diagnosis and the

patient’s diagnosis agreed.

Variation between patient and computer diagnosis: Significant difference between the computer’s

diagnosis and the patient’s diagnosis. This means that the computer did not produce enough

correctly diagnosed patients to statistically match the doctor.

Conclusions

The experimental hypothesis, the computer would produce a higher amount of correctly diagnosed patients than the doctor and therefore would be able to replace a doctor at the diagnostic stage of patient treatment, was not statistically proven after conducting a chi square goodness of fit test.

Conclusion

The main reason the program was not statistically proven was the fall-off in the coronary artery disease group.

The computer and doctor diagnosis were very close in both the influenza and hypertension groups.

Sources of Error

Lack of diversity in disorders Localized study Time restraints Lack of symptoms

Future Research Preference of Doctor or Computer

• Test to see if patients prefer the doctor instead of the computer or vice versa. This could have added an extra dimension to the project

Patients able to enter their own data

Producing the program and making it available on the internet

Future Research Larger database

• more diseases/ symptoms • more useful and relevant program.

More complex program • treat adults, young children, and the elderly.

Store and monitor patients’ data and medical history• such as blood pressure, weight, and other

medical information• when a patient uses the program repeatedly, the

program could use previous symptoms and medical history to better diagnose an illness

Acknowledgements

I Would like to thank: Mr. Dale Soblo and Ms. Michelle Sutton for their

advice, supervision, and advice throughout the study. Dr. Kalpana Sulhyan for her tremendous assistance to

organize and collect subjects for this project. Nitin Uplekar for his help in creating the database. All of the human subjects for their participation and

cooperation in this research My friends and family

Literature CitedAmerican Medical Association. (2004). Family medical guide (4th ed.). New

Jersey: John Wiley and Sons, Inc.C Health. (2005). Flu and Cold. Retrieved September 1, 2005, from

http://chealth.canoe.ca/channel_health_features_details.asp?health_feature_id=69&article_id=147&channel_id=39&relation_id=2114.

Center for Disease Control and Prevention. (2004). Clinical Description and Diagnosis. Retrieved July 12, 2005, from http://www.cdc.gov/flu/professionals/diagnosis/.

Crews, Leigh. (2005). Designing a yoga program for active seniors: how a simple yoga practice can alleviate symptoms of arthritis, hypertension and osteoporosis, three health conditions that typically affect older adults. IDEA Health & Fitness, 2 (4), 56. Retrieved July 22, 2005, from Info Trac OneFile.

Medline Plus. (2005). Coronary Heart Disease. Retrieved July 12, 2005, from http://www.nlm.nih.gov/medlineplus/ency/article/007115.htm.

Literature CitedScott, D. and Purves, I.N. (1996). Triadic relationship between doctor, computer

and patient [Electronic version]. Interacting with Computers 8, 347-363. Federhofer, Judith. (ND). Medical Expert Systems. Retrieved July 13, 2005, from

http://www.computer.privateweb.at/judith/name_3.htm#qmr_name.Neutel, J.M. & Smith, D.H.G. (1998). Hypertension: Where have we gone wrong

and how can we fix it? [Electronic Version]. American Journal of Hypertension 10, 150S-157S.

Waxman H. S. & Worley W.E. (1990). Computer-assisted adult medical diagnosis: subject review and evaluation of a new microcomputer-based system. Medicine, 69(3), 125-137. Retrieved May 2, 2005, from Info Trac OneFile.

WebMDHealth. (2004). Heart disease: coronary artery disease. Retrieved May 1, 2005, from http://my.webmd.com/content/pages/9/1675_57851.htm

Can an Advanced Computer Program Replace a Doctor at

the Diagnostic Stage of Patient Treatment?

Sudeep Sunthankar

Spring Valley High School