Medical diagnosis – can anyone do it?

Not sure if the New York Times and Netflix quite intended that to be the message of their recently launched documentary series “Diagnosis” but a less exaggerated version of that question did bother me after watching the first episode last night. Dr Lisa Saunders is a clinician who has been writing a monthly column in the New York Times for the past decade or so. She decided to test out her suspicion that diagnostic failures could often be overcome via improved internet communication around the globe. This documentary series traces a dozen cases which she has featured in her NYT column and how they have led to diagnostic breakthroughs as a result of reaching parts of the medical research world which previous efforts had not. Dr Saunders talks about “crowd-sourcing” contributions to resolving the diagnostic puzzle.

In this first episode, a young athletic woman in Las Vegas facing the permanent prospect of crippling, agonising and seriously life-curtailing muscular pain throughout her body was rescued by a young medical researcher in Turin who read the NYT piece online and recognised symptoms similar to those observed by the research team for which she was working. Cue a conveniently scenic shift from the desert plains of Nevada to the streets of Turin and bunches of blood tests carried out by suspiciously camera-friendly and charming Italian professors and medics, followed by a tense two-month hiatus ending in diagnosis of a rare metabolic disorder for which a drastic diet change provided the route back to normal life, if not actual cure.

Much of the scene-setting came straight out of the documentary film maker’s manual of how to stretch five minutes of hard data into forty-five minutes of compelling drama. Several of the earnest conversations amongst medical staff and the empathetic Skype exchanges between the young woman in Las Vegas and the many fellow sufferers and researchers who had responded to the NYT article carried the unmistakable feel of stage management. And the young woman’s execrable parents had clearly been shoe-horned into a more central role than they merited in the medical context for their contribution to the melodrama. At times, I wondered whether De Niro or Pacino in full Godfather mode had been persuaded to play the father’s part in heavy make-up. It was a tough call whether to feel sorrier for the young woman over her excruciating pain or over her disastrous choice of parents. There was a moment, when the genetic angle raised its head, of pure paternal self-absorption for which Scorsese would have paid a fortune to have portrayed so brilliantly in a fictional drama.

Yet the core message was serious and to the point. The simple act of putting the young woman’s story and symptoms out on the web via the NYT article succeeded in finding a diagnosis and effective treatment where the might of the US medical system had so far failed. But can it really be that simple? And if this route of “crowd-sourcing” diagnoses (Dr Saunders’ words, not mine) takes off, are we heading for the unintended consequence of more populism than professionalism in medical practice?