To any Doctors, medical researchers or biologist out there.
I’m working on a little medical db app for patients to record and communicate the apparent location of symptoms in three-dimensional space. I’ve code named the app “Hypochondria.”
I was inspired by my own experiences having trouble communicating with doctors. One time my spouse almost got a gall bladder infection missed by a doctor who interpreted her description of the pain as superficial back pain instead of being deeper in the abdominal cavity itself. I think such miscommunications occurs often, especially across language and cultural barriers.
I’ve been trying to find both images and a coordinate system that naive patients can use to map and log the apparent internal location of pain or other symptoms. I expected that there would be some public domain images because I’m pretty sure I’ve seen them before on either medical forms or back in college.
I just need simple related outlines, that show:
- Coronal (right-to-left or x-z plane),
- Sagittal (front-to-back or y-z plane )
- Transverse sections (left-to-right and front-to-back cross section or x-y plane ).
The outlines need to share scale and coordinate system such that by marking all three linked images a patient could accurately mark the apparent location of a symptom in three-dimensional space within the body. E.g. For gall bladder pain, the patient would mark the right-side coronal in the upper abdominal, the sagittal about in the same z-axis but inside the abdominal cavity about halfway along the y-axis and then the transverse to narrow it down further.
I can find anything on the internet if I know what it is called, so I am assuming my inability to find these specific type of images is owing to my not knowing the proper nomenclature. I suppose it’s thinly possible that I’m misremembering and that no one has tried to do this before, but I don’t think I’m that original.
I also dimly remember that someone had come up with a graph like coordinate system for anatomy keyed of invariant major features, but I could be wrong about that.
I could generate the outline graphics myself, but doing so makes me nervous. Making a mistake could in a medical app could kill somebody so I would like to use a more professional and known system if such exist.
If you know of something put it in the comments or email me at the address at the upper right of the page.
P.S. In passing I would note that this is the kind of thing that makes “evidence based clinical medicine” so difficult. Trying to convert patient descriptions of pain or other symptoms into some standardized coordinate or symbolic system that a computer can process will prove very difficult. Without careful planning followed by ruthless testing, the “evidence” one gathers can easily be gibberish that if acted upon, can kill.
Here is a patent app for something that resembles what you describe: I offer no endorsement…PDF
Here is a review paper on the subject of Geometric Morphometrics – basic background stuff on methods, with a good list of references: PDF
The problem with such a system would be the possibility of misleading. Pain, for example, is felt according to the nerve distribution. Doctors learn this but patients don’t. Pain under the diaphragm is felt by the patient on top of the shoulder. This related to embryology where the lungs develop from the gut and push the diaphragm down. The under side of the diaphragm is in the neck or shoulder according to nerves.
Appendicitis, for another example, starts with pain in the middle of the abdomen because the gut cannot localize pain. It is felt in the middle of the abdomen. Once the inflamed appendix starts to irritate the peritoneum in the right lower quadrant, the pain shifts down there.
Kidney stone pain is often felt in the testicle or groin.
“Trying to convert patient descriptions of pain…”
My big gripe is with the current “on a scale of 1 to 10, how bad is your pain” nonsense? Really??? My pain-o-meter is supposed to be calibrated? This just seems like a (pointless at best, if not dangerous) exercise in fake precision.
“My pain-o-meter is supposed to be calibrated? This just seems like a (pointless at best, if not dangerous) exercise in fake precision.”
Students are taught to try to calibrate pain by asking, in addition to your example, for an estimation such as, “ten being labor pain (if it is a woman) or the worst pain you could imagine. One being mild discomfort.” Pain alone is a very crude term. It has been my observation as a surgeon that more sever pain completely cancels less severe pain. For example, patients to have abdominal surgery would sometimes ask if I would do their hemorrhoids at the same time. It would seem masochistic to want two places to hurt at the same time but they would never notice any pain from the hemorrhoids. The more sever pain just cancelled out the less severe although post-hemorhhoid surgery alone the pain seemed maximal.
There is lots of psychology to pain. This was studied in WWII when soldiers wounded in battle often felt little pain in the exhilaration at being removed from battle. The same injury from a truck accident would result in terrible pain.
I recall no pain associated with multiple compound fractures of my ulna and radius. I actually tried to raise my self from the nurses bed at school and return to class because nothing was wrong. I attribute this to shock. On the other hand I recall countless evenings spent in agony over what are probably miniscule amounts of fluid creating excruciating pain in my ear. Oh for shock then.
Joe Citizen,
Thanks, Geometric Morphometrics was the magic words I was looking. That paper looks real familiar so I think I’ve read it or read about in the past.
Mike K,
The problem with such a system would be the possibility of misleading. Pain, for example, is felt according to the nerve distribution.
Yes, referred pain is tricky for ordinary people to wrap their head. That’s why I used the phrase “apparent location” of pain. I had a bit about Kern’s sign in the parent but I took it out for brevity.
I think it’s important though, to make sure that the patient and doctor communicate clearly. The patient doesn’t have to understand what is causing the pain or whether the pain is proximate or distal to the actual injury/lesion but because pain is so subjective, they do need a means of accurately communicating its location. That is particular important if the pain is episodic and considerable time may pass between the episodes and doctor visits.
I think having a way to mark and log the apparent position of pain would help.