Why a doctor reviews your results, and what a health score can tell you

What an automated score does well

A good score turns several measurements into one estimate, the same way every time, in seconds. The best are built from large data sets and tested on people they were not built from. NICE recommends one of them, the QRISK3 tool, to estimate the risk of heart disease and stroke over the next 10 years for people aged 25 to 84 who do not already have cardiovascular disease [1].

Apps and symptom checkers can also help you notice a pattern, decide what to ask, and arrive at an appointment with your questions ready. Used that way they make a consultation better.

Where scores and apps fall short

Symptom checkers are less accurate than many people expect. An audit of 23 online symptom checkers found the correct diagnosis listed first in 34% of test cases and within the first 20 suggestions in 58%, with appropriate triage advice in 57% [2]. Their advice was generally cautious, sending people to care for problems they could have managed themselves [2].

A later systematic review of 10 studies found the accuracy of the main diagnosis ranged from 19% to 37.9%, and triage accuracy from 48.8% to 90.1%, varying between tools given the same symptoms [3]. The authors called for larger studies based on real patients [3].

A result outside its range is a question

Most apps flag a result in red when it falls outside the reference range. Reference ranges are drawn from the results of large groups of healthy people, and it is common for a healthy person to have a result outside the range at times [4]. A result within the range is no guarantee of good health either [4].

A doctor reads a result beside the others, your symptoms, your medicines and how the sample was taken, and decides whether it needs repeating, explaining or acting on. With us, every result arrives into one record and is interpreted together, so nothing is read in isolation [5].

Knowing when a score does not apply

A score is only as good as its fit to the person in front of it. NICE advises against using a risk tool at all for people already at high risk, such as people with type 1 diabetes, reduced kidney function, familial hypercholesterolaemia or another inherited disorder of blood fats [1].

NICE also warns that risk tools may underestimate risk in some groups, including people treated for HIV, people already taking medicines for cardiovascular risk factors, people who have recently stopped smoking and people taking medicines that can disturb blood fats, and that clinical judgement should inform how a score is read [1]. An app working from a form cannot always know these things about you.

How health software is regulated

In the UK, many software and AI products used in health care are regulated as medical devices by the MHRA, which works to make sure they meet a clinical need and are safe [6]. If you have a problem with health software, you can report it through the MHRA Yellow Card scheme [6].

Who a doctor’s review suits, and when to act sooner

A doctor’s review suits anyone with a result flagged as abnormal, a score that worries or reassures them more than they expected, or a symptom an app has struggled to place. If you feel well and are tracking one marker that a doctor has already discussed with you, an app may be all you need between reviews.

A doctor’s review has limits as well, since it can lead to repeat or further tests, and a normal result today is no reason to ignore a new symptom later. For chest pain, difficulty breathing, severe bleeding or a head injury, do not wait for an app or an appointment, and call 999 in the UK or the local emergency number [7].

Questions to ask about any score or app

Use these questions to judge a score before you act on it.

• What does the score estimate, and over what period?
• Was it tested in people like me, of my age, sex and background?
• Does anything about me mean the score does not apply?
• Which reference range does the app use, and from which laboratory?
• Is the software regulated as a medical device?
• Who will read the result with me, and what would change my plan?

How The Wellness can help

A telephone consultation of 15 minutes is £59, time for a GMC registered doctor to go through a result or a score with you the same day. If you would like a fresh baseline, Core Wellness bloods are £350, covering a full blood count, liver function, lipids, HbA1c, thyroid stimulating hormone, hs-CRP, ferritin and vitamin D, and a doctor explains every result.