Background Patients are increasingly seeking Web-based symptom checkers to obtain diagnoses. However, little is known about the characteristics of the patients who use these resources, their rationale for use, and whether they find them accurate and useful. Objective The study aimed to examine patients’ experiences using an artificial intelligence (AI)–assisted online symptom checker. Methods An online survey was administered between March 2, 2018, through March 15, 2018, to US users of the Isabel Symptom Checker within 6 months of their use. User characteristics, experiences of symptom checker use, experiences discussing results with physicians, and prior personal history of experiencing a diagnostic error were collected. Results A total of 329 usable responses was obtained. The mean respondent age was 48.0 (SD 16.7) years; most were women (230/304, 75.7%) and white (271/304, 89.1%). Patients most commonly used the symptom checker to better understand the causes of their symptoms (232/304, 76.3%), followed by for deciding whether to seek care (101/304, 33.2%) or where (eg, primary or urgent care: 63/304, 20.7%), obtaining medical advice without going to a doctor (48/304, 15.8%), and understanding their diagnoses better (39/304, 12.8%). Most patients reported receiving useful information for their health problems (274/304, 90.1%), with half reporting positive health effects (154/302, 51.0%). Most patients perceived it to be useful as a diagnostic tool (253/301, 84.1%), as a tool providing insights leading them closer to correct diagnoses (231/303, 76.2%), and reported they would use it again (278/304, 91.4%). Patients who discussed findings with their physicians (103/213, 48.4%) more often felt physicians were interested (42/103, 40.8%) than not interested in learning about the tool’s results (24/103, 23.3%) and more often felt physicians were open (62/103, 60.2%) than not open (21/103, 20.4%) to discussing the results. Compared with patients who had not previously experienced diagnostic errors (missed or delayed diagnoses: 123/304, 40.5%), patients who had previously experienced diagnostic errors (181/304, 59.5%) were more likely to use the symptom checker to determine where they should seek care (15/123, 12.2% vs 48/181, 26.5%; P=.002), but they less often felt that physicians were interested in discussing the tool’s results (20/34, 59% vs 22/69, 32%; P=.04). Conclusions Despite ongoing concerns about symptom checker accuracy, a large patient-user group perceived an AI-assisted symptom checker as useful for diagnosis. Formal validation studies evaluating symptom checker accuracy and effectiveness in real-world practice could provide additional useful information about their benefit.

While infertility is a global challenge for millions of couples, low income countries have particularly high rates, of up to 30%. Infertility in these contexts is not limited to its clinical definition but is a socially constructed notion with varying definitions. In highly pronatalistic and patriarchal societies like Pakistan, women bear the brunt of the social, emotional and physical consequences of childlessness. While the often harsh consequences of childlessness for Pakistani women have been widely documented, there is a dearth of exploration into the ways in which prescribed gender roles inform the experiences of childlessness among Pakistani women and men. The aim of this study was to explore and compare how gender ideologies, values and expectations shape women’s and men’s experiences of infertility in Pakistan. Using an interpretive descriptive approach, in-depth interviews were conducted with 12 women and 8 men experiencing childlessness in Punjab, Pakistan from April to May 2008. Data analysis was thematic and inductive based on the principles of content analysis. The experience of infertility for men and women is largely determined by their prescribed gender roles. Childlessness weakened marital bonds with gendered consequences. For women, motherhood is not only a source of status and power, it is the only avenue for women to ensure their marital security. Weak marital ties did not affect men’s social identity, security or power. Women also face harsher psychosocial, social, emotional and physical consequences of childlessness than men. They experienced abuse, exclusion and stigmatization at the couple, household and societal level, while men only experienced minor taunting from friends. Women unceasingly sought invasive infertility treatments, while most men assumed there was nothing wrong with themselves. This study highlights the ways in which gender roles and norms shape the experiences associated with involuntary childlessness for men and women in Punjab, Pakistan. The insight obtained into the range of experiences can potentially contribute to deeper understanding of the social construction of infertility and childlessness in pronatalistic and patriarchal societies as well as the ways in which gender ideologies operationalise to marginalise women.

BackgroundPatient complaints are associated with adverse events and malpractice claims but underused in patient safety improvement.ObjectiveTo systematically evaluate the use of patient complaint data to identify safety concerns related to diagnosis as an initial step to using this information to facilitate learning and improvement.MethodsWe reviewed patient complaints submitted to Geisinger, a large healthcare organisation in the USA, from August to December 2017 (cohort 1) and January to June 2018 (cohort 2). We selected complaints more likely to be associated with diagnostic concerns in Geisinger’s existing complaint taxonomy. Investigators reviewed all complaint summaries and identified cases as ‘concerning’ for diagnostic error using the National Academy of Medicine’s definition of diagnostic error. For all ‘concerning’ cases, a clinician-reviewer evaluated the associated investigation report and the patient’s medical record to identify any missed opportunities in making a correct or timely diagnosis. In cohort 2, we selected a 10% sample of ‘concerning’ cases to test this smaller pragmatic sample as a proof of concept for future organisational monitoring.ResultsIn cohort 1, we reviewed 1865 complaint summaries and identified 177 (9.5%) concerning reports. Review and analysis identified 39 diagnostic errors. Most were categorised as ‘Clinical Care issues’ (27, 69.2%), defined as concerns/questions related to the care that is provided by clinicians in any setting. In cohort 2, we reviewed 2423 patient complaint summaries and identified 310 (12.8%) concerning reports. The 10% sample (n=31 cases) contained five diagnostic errors. Qualitative analysis of cohort 1 cases identified concerns about return visits for persistent and/or worsening symptoms, interpersonal issues and diagnostic testing.ConclusionsAnalysis of patient complaint data and corresponding medical record review identifies patterns of failures in the diagnostic process reported by patients and families. Health systems could systematically analyse available data on patient complaints to monitor diagnostic safety concerns and identify opportunities for learning and improvement.