He opened a new tab on his computer and went to a new website that he helps design and run: the Human Diagnosis Project, or Human Dx. The project allows primary-care doctors to ask for assistance on difficult cases from an online network of physicians all over the world.
He clicked “get help on a case” and, on a checklist-style page, input that she was “43f”—a 43-year-old female—with episodic dizziness for the past two months. He then submitted the case to a doctor at another Mary’s Center clinic, as well as to Human Dx’s entire database of nearly 7,000 doctors.
Trained in internal medicine, Nundy now leads the nonprofit arm of Human Dx, but he spends Fridays at the clinic as its only provider for adults. (Other doctors and nurses see children there the other days of the week.)
Mary’s Center is a safety-net clinic, so its patients pay according to their income. At just after 8:30, the waiting room was bustling. The staff issued each patient a number and called them back in English and Spanish—“Twenty-six ... veintiseis!”
Nundy says about 80 percent of his patients are uninsured, in some cases because of their immigration status. Even for those with insurance, a specialist might be out of reach because of high deductibles and co-pays or long wait times.
“For you and me, someone who has insurance, the standard of care is that you see an expert who lives and breathes ... your diagnosis,” Nundy says. But for the 28 million uninsured Americans, seeing, say, a dermatologist or a neurologist usually means getting on long waiting lists for a doctor who is willing to volunteer his or her time.
Human Dx might help doctors confirm their suspected diagnoses or think of things to rule out. At Mary’s Center, one man came in complaining of headaches and nausea, and the Human Dx physicians suggested a blood test called an ESR. Another time, Nundy used it to confirm a suspected case of rheumatoid arthritis before putting a low-income patient on a heavy-duty course of medications.
Experienced doctors use Human Dx for their most difficult cases, and newer providers use it to hone their skills. Johns Hopkins Hospital and other teaching hospitals are now using it to train medical residents. Georgia Lewis, a nurse practitioner who works with Nundy, used Human Dx when, two months into her stint at Mary’s Center, all the other providers went on vacation. Rashes can be confounding, so she’ll upload them to Human Dx along with a photo.
The contributors to the project are vetted based on how accurately they’ve solved past cases. Human Dx uses machine learning, which means that eventually the algorithms powering the diagnosis suggestions will become “smarter” based on the input of the doctors using it. The hope is that, over time, Human Dx can help reduce misdiagnoses, which according to studies happen up to 20 percent of the time.