Clinical Cases

Final Diagnosis

Disposition

1. A 56-year-old male presents with chest pain for 6 hours. It is retrosternal, sharp, and rated 5/10 in intensity. The patient also complained of shortness of breath. Upon further questioning, the patient reported experiencing shortness of breath when lying flat and needing three pillows to sleep comfortably in the recent past. The patient further complained of lower extremity edema. Upon presentation, blood pressure was 125/89, heart rate 103, and pulse oximetry 92% on room air. The patient denied any other complaints.

Congestive Heart Failure
Doctor Ai: Correct.
Babylon: Not disclosed/critical. Physicians: 2 out of 3 correct

Hospital/Emergency Room Doctor Ai: Agree Babylon: Agree Physicians: 2 out of 3 agree

2. A 66-year-old female presents with a fever for 7 days. Her temperature was 100.4°F. The patient complained of chest pain and cough. She stated that her chest pain worsens when she takes a deep breath. The patient mentioned that she does not bring up any sputum while coughing and coughs all day long. She also reported worsening shortness of breath on walking or minor exertion for the last 4 days. Additionally, the patient complained of chills, nausea, and vomiting but denied any nasal congestion, headache, sore throat, or problems related to the throat, neck, ear, or face. Upon presentation, her blood pressure was 89/65, heart rate 110, and pulse oximetry 88% on room air. The patient denied any other complaints.

Pneumonia
Doctor Ai: Correct.
Babylon: Not disclosed/critical. Physicians: All correct

Hospital/Emergency Room
Doctor Ai: Agree Babylon: Agree Physicians: All agree

3. A 45-year-old female presents with worsening shortness of breath for 12 hours while walking normally. The patient also complained of having stabbing chest pain on the left side of the chest when taking a deep breath, rated 3/10 in intensity. The chest pain started suddenly and was not radiating. She denied any cough, sore throat, nasal congestion, or headache. The patient had a heart rate of 110 and complained of palpitations. Upon further questioning, it was found that she had traveled a long distance and was in the hospital for 4 days prior to this event. The patient has right lower extremity swelling and a positive history of DVT in the past. Upon presentation, her blood pressure was 155/95, heart rate 110, and pulse oximetry 85% on room air. The patient denied any smoking, alcohol, or drug abuse.

Pulmonary Embolism
Doctor Ai: Correct.
Babylon: Not disclosed/critical Physicians: Allcorrect

Hospital/Emergency Room Doctor Ai: Agree Babylon: Agree Physicians: All agree

4. A 45-year-old female presents with chest tightness

Chronic Obstructive Pulmonary Disease Doctor Ai: Correct. Babylon: Correct.
Physicians: All correct

General Practitioner Doctor Ai: Agree Babylon: Agree
Physicians: 2 out of 3 disagree

and shortness of breath during normal walking or at

rest for the last 4 days, accompanied by a cough. She

stated that she has had a nonproductive cough for

more than 8 weeks, with symptoms persisting day

and night. The shortness of breath is not associated

with any allergens. Additionally, she noted having

audible wheezes while exhaling. The patient denied

any fever, chills, chest pain, palpitations, abdominal

pain, heartburn, nasal congestion, headache, sore

throat, leg pain, leg edema, anxiety or panic attacks,

and weight loss. She usually smokes one pack per

day but has not smoked in the past two days and

complained of fatigue and tiredness. Furthermore,

her pulse oximetry is 85% on room air. The patient

denied any other complaints. Upon presentation,

her blood pressure was 129/89, heart rate 87, and

pulse oximetry 88% on room air.

5. A 35-year-old female presents with pain in her

right wrist for the last 4 weeks. She also complained

of right hand weakness. The patient has no history

of wrist, hand, or elbow injuries, and her wrist is not

swollen. She experiences pain in the hand,

numbness, and a tingling sensation in the thumb,

index, and middle fingers. There is no pain in any

other part of the arm. Her symptoms worsen at night but are not associated with cold weather. Frequently, the patient finds it difficult to hold objects or turn keys and doorknobs. She works as a
secretary where she mainly types all day. She denied

Carpal Tunnel Doctor Ai: Correct. Babylon: Correct. Physicians: All correct

General Practitioner Doctor Ai: Agree Babylon: Agree Physicians: All agree

having a fever, chills, joint pain, nausea, vomiting,

chest pain, shortness of breath, palpitations, night

sweats, dizziness, or lightheadedness, and she did

not pass out. She has no past medical history of

hypertension, hyperlipidemia, diabetes, no history

of heart attack or stroke, and does not smoke. Upon

presentation, her blood pressure was 155/95, heart

rate 100, and pulse oximetry 98% on room air.

6. A 55-year-old female presents with a burning and stinging sensation during urination. The patient reports increased frequency of urination at night

Urinary Tract Infection
Doctor Ai: Correct.

General Practitioner
Doctor Ai: Agree

Babylon: Correct.

Babylon: Agree

and foul-smelling urine. She also complains of pain

on the right side of her abdomen. She mentions a
low-grade fever of 100.4°F for the last 2 days. She

Physicians: All correct

Physicians: All agree

could not remember anything during the event. She

denied any other complaints. Upon presentation,

her blood pressure was 136/76, heart rate 78, and

pulse oximetry 93% on room air.

7. A 75-year-old male has had a cough for the last 6 weeks accompanied by a low-grade fever. He decided to see a physician when he noticed blood in his sputum, predominantly at night. Recently, the patient traveled to Africa for a medical mission. He complained of night sweats and a persistent low- grade fever. Additionally, he has been losing weight, with a total loss of 20 pounds, and has complained of fatigue. He denied having coronary artery disease, hypertension, or heart failure. The patient also denied any smoking, secondary smoke exposure, and asbestos exposure. Upon presentation, his blood pressure was 125/85, heart rate 77, and pulse oximetry 98% on room air. He denied any other complaints.

Tuberculosis Doctor Ai: Correct. Babylon: Correct.
Physicians: All correct

General Practitioner Doctor Ai: Agree Babylon: Agree.
Physicians: 2 out of 3 agree

8. A 67-year-old male presents with chest pain and associated shortness of breath on exertion. The patient complained of retrosternal chest pain, rated 7/10 in intensity, radiating to the neck or jaw, and relieved with nitroglycerin. He stated that he has been progressively experiencing shortness of breath upon minor exertion for the last month. On presentation, his blood pressure was 187/95, pulse 115, respiratory rate 20, and temperature 98°F. He denied having any fever or cough but complained of nausea and vomiting. He denied any other complaints.

Myocardial Ischemia (MI)
Doctor Ai: Correct.
Babylon: Not disclosed/critical.
Physicians: All correct

Hospital/Emergency Room Doctor Ai: Agree Babylon: Agree Physicians: All agree

9. A 24-year-old male presents with a fever of 101°F, chills, and a nonproductive cough for 3 days. He reports coughing both day and night, accompanied by a headache and sore throat. His headache started gradually, mainly in the forehead, and is rated 4/10 in intensity; it is constant and not associated with light sensitivity. The patient also complained of muscle aches, joint pain, fatigue, and lethargy. He has some skin rashes (petechiae) that become lighter when pressed. The patient denied experiencing nasal congestion, shortness of breath, chest pain, abdominal pain, nausea, vomiting, dysuria, diarrhea, and constipation. He also denied taking any medication that could cause immune deficiency. On presentation, his blood pressure was 120/65, heart rate 85, and pulse oximetry 95% on room air. He denied any other complaints.

Influenza/COVID-19 DoctorAi: Correct. Babylon: Correct.
Physicians: 2 out of 3 correct

General Practitioner Doctor Ai: Agree Babylon: Agree Physicians: All agree

10. A 59-year-old female presents with a fever of 101°F. She complained of intractable vomiting since this morning and also mentioned having left lower quadrant abdominal pain. The patient reported constipation in the recent past. On presentation, her blood pressure was 135/65, heart rate 55, and pulse oximetry 94% on room air. All other findings and complaints were negative.

Diverticulitis Doctor Ai: Correct. Babylon: Correct.
Physicians: All correct

General Practitioner Doctor Ai: Agree Babylon: Agree
Physicians: 2 out of 3 agree

11. A 35-year-old female presents with extreme fatigue. She also complained of having heavy menstrual periods and constipation. She has experienced significant weight gain, cold intolerance, and hoarseness of voice. Additionally, she is losing hair, and her skin feels dry, thin, and brittle. She denied having any headaches, palpitations, shortness of breath, drowsiness, or tremors. The patient does not have any known heart or kidney diseases. She denied any other complaints. On presentation, her blood pressure was 145/85, heart rate 105, and pulse oximetry 98% on room air.

Hypothyroidism
Doctor Ai: Correct.
Babylon: Unable to determine.
Physicians: All correct

General Practitioner Doctor Ai: Agree Babylon: Agree Physicians: All agree

12. A 55-year-old male presents with increased thirst and appetite for the past 6 weeks. He has also experienced an increased frequency of urination and has been passing more urine recently. He needs to wake up several times at night and has reported recent weight loss. The patient also feels tired and unwell but denied any confusion. He has a significant family history of type 2 diabetes mellitus but has never been diagnosed with diabetes. He denied any complaints of nausea and vomiting, numbness or loss of feeling, any skin lesions or rash, lightheadedness, dizziness, and has no history of immune deficiency. The patient has never been diagnosed with any autoimmune disease. On presentation, his blood pressure was 135/85, heart rate 102, and pulse oximetry 98% on room air.

Diabetes Mellitus (DM)
Doctor Ai: Correct. Babylon: Correct. Physicians: All correct

General Practitioner Doctor Ai: Agree Babylon: Agree Physicians: All agree

13. A 51-year-old male presents with a constant headache on both sides of the head for 6 hours, which is precipitated by light and sounds. The headache started gradually, and he has sensitivity to light and sounds but denied any eye pain or changes in vision. He also complained of associated nausea and vomiting, though no blood was observed in the vomit. The patient reported seeing zig-zag lines and spots. Additionally, he mentioned that the headaches are precipitated by hunger and fatigue. He denied any head or neck injuries, neck pain, traffic accidents, nasal congestion, or fever. The patient also denied any numbness, weakness in any part of the body, or scalp tenderness. On presentation, his blood pressure was 136/85, heart rate 90, and pulse oximetry 96% on room air.

Migraine
Doctor Ai: Correct. Babylon: Correct. Physicians: All correct

General Practitioner Doctor Ai: Agree Babylon: Agree Physicians: All agree

14. A 31-year-old female presents with abnormal vaginal bleeding. She complained of painful sexual intercourse and lower abdominal pain for the last 10 days. The patient is also experiencing constipation. In addition, she reports urinary frequency and dysuria. She denied any other complaints. On presentation, her blood pressure was 125/75, heart rate 110, and pulse oximetry 98% on room air.

Endometriosis
Doctor Ai: Correct.
Babylon: Unable to determine.
Physicians: 1 out of 3 correct

General Practitioner Doctor Ai: Agree Babylon: Agree Physicians: All agree

15. A 35-year-old female presents with a fever of

Strep Throat
Doctor Ai: Correct
Babylon: Not disclosed/critical
Physicians: 2 out of 3 correct

102°F for 3 days. She complained of fatigue and a

sore throat but denied any chills and shivering. The

patient reported difficulty swallowing and speaking.

She denied any cough, nasal congestion, and
earache, but mentioned drooling, although she

Hospital/Emergency Room

denied any difficulty breathing. She has a rash that

Doctor Ai: General

resembles sandpaper. Her neck was found to have

Practitioner

some tender, enlarged lymph nodes. She denied chest pain, abdominal pain, shortness of breath,
abdominal discomfort, diarrhea, constipation,

Babylon: Agree
Physicians: 2 out of 3 agree

nausea, vomiting, dysuria, frequency, muscle ache,

joint pain, and lethargy. The patient is not taking

any medication that would suppress the immune

system. On presentation, her blood pressure was

136/85, heart rate 90, and pulse oximetry 96% on

room air.

Surrogate measure for time needed to complete

DoctorAi

Babylon

P Value
<br>(two sided)

(n=15)

(n=15)

Number of symptoms collected using open-endedquestions to generate differential diagnosis:Number of symptoms collected using open-endedquestions to generate differential diagnosis:

2.8
(±0.86)

1.0
(±0)

<0.001

Number of screens used to collect history with open- ended questions (from the start to differentialdiagnosis):

5.3
(±1.75)

2.0
(±0)

<0.001

Number of screens used to find the final diagnosis (from the start to end):

7.8
(±2.08)

21.5
(±9.63)

<0.001

Number of screens to determine final disposition (from the start to end):

10.0
(±2.33)

21.5
(±9.63)

<0.001

Number of Yes/No events to find the final diagnosis (from the point of differential diagnosis to end):

13.9
(±6.54)

62.3
(±31.55)

<0.001

Did the Ai system provide a final diagnosis?

100.0%
(±0)

53.3%
(±0.13)

<0.001

Disposition decision to hospital (versus general practitioner)

26.7%
(±0.11)

33.3%
(±0.12)

<0.08

Combined Ai Decision

Physicians Decision

Correct Diagnosis

Wrong Diagnosis

Chi-Square

Correct Diagnosis

7 (46.7%)

4 (26.7%)

Wrong Diagnosis

1 (6.7%)

3 (20.0%)

<0.185

Total

8 (53.3%)

7 (46.7%)

Correct Disposition Wrong Disposition

Correct Disposition

8 (53.3%)

0 (0%)

Wrong Disposition

6 (40.0%)

1 (6.7%)

<0.268

Total

14 (93.3%)

1 (6.7%)