Your Phone May Be Smart, But Your Doctor Still Knows More

Your Phone May Be Smart, But Your Doctor Still Knows More

 If you're feeling sick and you want to know what's wrong with you, there's an app for that. But the diagnosis won't be as accurate as the one you'd get from a doctor -- not by a long shot. 

In a head-to-head comparison, real human physicians outperformed a collection of 23 symptom-checker apps and websites by a margin of more than 2 to 1, according to a report published Monday in the journal JAMA Internal Medicine.

Even when the contestants got three chances to figure out what ailed a hypothetical patient, the diagnostic software lagged far behind actual doctors. Indeed, the apps and websites suggested the right diagnosis only slightly more than half of the time, the report says. 

The research team -- from Harvard Medical School, Brigham & Women's Hospital in Boston and the Human Diagnosis Project in Washington, D.C. -- asked 234 physicians to read through a selection of 45 "clinical vignettes" to see how they would handle these hypothetical patients. Each vignette included the medical history of the "patient" but no results from a physical exam, blood test or other kind of lab work. 

Most of the doctors were trained in internal medicine, though the group included some pediatricians and family practice physicians too. About half of them were in residency or fellowship, so their training was not yet complete. 

Even so, of the 1,105 vignettes they considered, they listed the correct diagnosis first 72% of the time, according to the study. 

The 23 symptom checkers evaluated a total of 770 vignettes in an earlier study by some of the same researchers. The apps and websites (including several from professional medical organizations, such as the American Academy of Physicians, the American Academy of Pediatrics and the Dutch College of General Practitioners) listed the correct diagnosis first just 34% of the time. 

Both the doctors and the computer programs were able to include more than one ailment in their differential diagnosis. So the researchers also compared how often the correct diagnosis was among the top three responses. 

For the doctors, that happened 84% of the time. For the symptom checkers, it was 51% of the time. 

Though the humans trounced the computers across the board, there were situations in which did a particularly good job of naming the correct diagnosis first. For instance, their margin in cases with common conditions was 70% to 38%. In cases with uncommon conditions, it grew to 76% to 28%. 

The seriousness of the malady made a difference too. In cases with low acuity, doctors bested software by 65% to 41%. But in cases with high acuity, that gap widened to 79% to 24%. 

"Physicians vastly outperformed computer algorithms in diagnostic accuracy," the researchers concluded. Full disclosure: Three of the study authors are doctors, and none are apps.

Should You Take Multivitamins ?

Multivitamins: Should You Take One?

Food is the best source of most nutrients, but a multivitamin can help provide what your diet doesn't. Find out what to look for in a daily multivitamin.

Our bodies need many different vitamins and minerals to function properly.
Vitamins and minerals also offer us protection against a host of ailments, including heart disease and some cancers, such as colon and cervical cancer.
The good news is that we can get most of the vitamins and minerals our bodies need daily by choosing the right foods and eating a wide variety of them.
Still, many people take a multivitamin daily as an insurance policy — just to be sure they are getting all the vitamins and minerals that their bodies require.
“A multivitamin is a good idea for the trace elements,” says Donald Novey, MD, an integrative medicine physician with the Advocate Medical Group in Park Ridge, Ill.

“You want a multivitamin for all those little things at the bottom of the ingredients list. The ones at the top of the list are familiar and the ones we can’t avoid if we're eating enriched foods. It’s the trace elements at the bottom that are the ones often missing.”

Trace elements include chromium, folic acid, potassium, iron, manganese, selenium, and zinc.

Daily Vitamin: Our Needs Change With Age

Vitamin supplements can be particularly important during certain stages of our lives, Dr. Novey says. For example, women in their childbearing years can benefit from folic acid, which decreases the risk of some birth defects. A pregnant woman needs a multivitamin, starting in the first trimester, to ensure that the baby receives proper nutrition. Active and older women can benefit from increased calcium, which can help prevent bone loss and fractures. Vegetarians also can benefit from taking extra calcium, iron, zinc, and vitamins B12 and D.
Does it matter what time of day you take a multivitamin? Not really, says Stephen Bickston, MD, AGAF, professor of internal medicine and director of the Inflammatory Bowel Disease Center at Virginia Commonwealth University Health Center in Richmond. However, he says, some people find it helpful to take vitamins at the same time every day. If it becomes part of their routine, they are less likely to forget. Also, he says, some people feel that if they take their vitamin with food, it is less likely to cause stomach upset. “I often recommend that people take a chewable vitamin,” Dr. Bickston says, “because they seem to be well tolerated, even in people who have serious digestive conditions, which is what I deal with in my practice.”


Daily Vitamin: Tips for Shopping for the Right Multivitamin 

Do you need to buy brand name vitamins? Novey says vitamins are like any other consumer product: “You get what you pay for.” He suggests shopping for vitamins in health food or natural food stores. Read the label and make sure its expiration date is at least a few months away. The U.S. Food and Drug Administration’s advice on how much to take — or the Recommended Daily Allowance (RDA) — is often written as “% DV” for percentage of daily value on the label. However, be careful because the DVs on the label may not take into consideration the different requirements for age and gender as RDAs do.
Multivitamins can be beneficial, but doctors warn not to be suckered by “mega” vitamins. The amount of vitamins in a standard multi is generally what you need for health benefits. Rarely do people need more than the RDA of any vitamin. When it comes to vitamins, the too-much-of-a-good-thing rule can apply, Bickston says.


Daily Vitamin: Ensuring Good Health

Clearly, eating a variety of fresh fruits and vegetables, whole grains, fish, lean meats and poultry, and low-fat dairy products is the best way to get your daily dose of vitamins and nutrients to keep your body functioning properly and to ward off illnesses. But taking a multivitamin daily is a good backup plan, and an easy way to fill in any gaps in your diet.

 

How to Eat a Healthy Diet

How to Eat a Healthy Diet 

 In order to keep yourself in the best shape possible, it's essential to eat a healthy diet. Find out exactly what you should be eating on a regular basis.

 

If you are what you eat, it follows that you want to stick to a healthy diet that’s well balanced. “You want to eat a variety of foods,” says Stephen Bickston, MD, AGAF, professor of internal medicine and director of the Inflammatory Bowel Disease Center at Virginia Commonwealth University Health Center in Richmond. “You don’t want to be overly restrictive of any one food group or eat too much of another.”

Healthy Diet: The Building Blocks
The best source of meal planning for most Americans is the U.S. Department of Agriculture (USDA) and U.S. Department of Health and Human Services Food Pyramid. The pyramid, updated in 2005, suggests that for a healthy diet each day you should eat:

• 6 to 8 servings of grains. These include bread, cereal, rice, and pasta, and at least 3 servings should be from whole grains. A serving of bread is one slice while a serving of cereal is 1/2 (cooked) to 1 cup (ready-to-eat). A serving of rice or pasta is 1/2 cup cooked (1 ounce dry). Save fat-laden baked goods such as croissants, muffins, and donuts for an occasional treat.
• 2 to 4 servings of fruits and 4 to 6 servings of vegetables. Most fruits and vegetables are naturally low in fat, making them a great addition to your healthy diet. Fruits and vegetables also provide the fiber, vitamins, and minerals you need for your body’s systems to function at peak performance. Fruits and vegetables also will add flavor to a healthy diet. It's best to serve them fresh, steamed, or cut up in salads. Be sure to skip the calorie-laden toppings, butter, and mayonnaise, except on occasion. A serving of raw or cooked vegetables is equal to 1/2 cup (1 cup for leafy greens); a serving of a fruit is 1/2 cup or a fresh fruit the size of a tennis ball.
• 2 to 3 servings of milk, yogurt, and cheese. Choose dairy products wisely. Go for fat-free or reduced-fat milk or cheeses. Substitute yogurt for sour cream in many recipes and no one will notice the difference. A serving of dairy is equal to 1 cup of milk or yogurt or 1.5 to 2 ounces of cheese.
• 2 to 3 servings of meat, poultry, fish, dry beans, eggs, and nuts. For a healthy diet, the best ways to prepare beef, pork, veal, lamb, poultry, and fish is to bake or broil them. Look for the words “loin” or “round” in cuts of meats because they're the leanest. Remove all visible fat or skin before cooking, and season with herbs, spices, and fat-free marinades. A serving of meat, fish, or poultry is 2 to 3 ounces. Some crossover foods such as dried beans, lentils, and peanut butter can provide protein without the animal fat and cholesterol you get from meats. A ¼ cup cooked beans or 1 tablespoon of peanut butter is equal to 1 ounce of lean meat.
• Use fats, oils, and sweets sparingly. No diet should totally eliminate any one food group, even fats, oils, and sweets. It’s fine to include them in your diet as long as it’s on occasion and in moderation, Bickston says.

Healthy Diet: Eat Right and the Right Amount
How many calories you need in a day depends on your sex, age, body type, and how active you are. Generally, active children ages 2 to 8 need between 1,400 and 2,000 calories a day. Active teenage girls and women can consume about 2,200 calories a day without gaining weight. Teenage boys and men who are very active should consume about 3,000 calories a day to maintain their weight. If you're not active, you calorie needs drop by 400 to 600 calories a day.
The best way to know how much to eat is to listen to your body, says Donald Novey, MD, an integrative medicine physician with the Advocate Medical Group in Park Ridge, Ill. “Pull away from the table when you’re comfortable but not yet full. Wait about 20 minutes,” he says. “Usually your body says, ‘That’s good.’ If you’re still hungry after that, you might want to eat a little more.”

Healthy Diet: Exercise Is Part of the Plan
At the bottom of the new USDA food pyramid is a space for exercise. Exercise is an important component of a well-balanced diet and good nutrition. You can reap "fabulous rewards," says Dr Novey, just by exercising and eating “a healthy diet of foods that nature provides.”