Correspondence

. . . And a Diagnostic Test Was Performed

N Engl J Med 2005; 353:2089-2090November 10, 2005

Article

To the Editor:

At a recent case conference with a distinguished visiting professor, a fellow in allergy and immunology presented the case of an infant with diarrhea; an unusual rash (“alligator skin”); multiple immunologic abnormalities, including low T-cell function; tissue eosinophilia (of the gastric mucosa) as well as peripheral eosinophilia; and an apparent X-linked genetic pattern (several male relatives died in infancy). The attending physicians and house staff discussed several diagnostic possibilities, but no consensus was reached. Finally, the visiting professor asked the fellow if she had made a diagnosis, and she reported that she had indeed and mentioned a rare syndrome known as IPEX (immunodeficiency, polyendocrinopathy, enteropathy, X-linked). It appeared to fit the case, and everyone seemed satisfied. (Several weeks later, genetic testing on the baby revealed a mutation in the FOXP3 gene, confirming the diagnosis.)

“How did you make that diagnosis?” asked the professor. Came the reply, “Well, I had the skin-biopsy report, and I had a chart of the immunologic tests. So I entered the salient features into Google, and it popped right up.”

“William Osler,” I offered, “must be turning over in his grave. You googled the diagnosis?”

Where does this lead us? Are we physicians no longer needed? Is an observer who can accurately select the findings to be entered in a Google search all we need for a diagnosis to appear, as if by magic? The cases presented at clinicopathological conferences can be solved easily; no longer must the discussant talk at length about the differential diagnosis of fever with bradycardia. Even worse, the Google diagnostician might be linked to an evidence-based medicine database, so a computer could e-mail the prescription to the e-druggist with no human involvement needed. The education of house staff is morphing into computer-search techniques. Surely this is a trend to watch.

Robert Greenwald, M.D.
North Shore–Long Island Jewish Health System, Lake Success, NY 11042
rgreenwald@lij.edu

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