A snapshot of modern medicine in 100 cases
This is what it looks like when you connect one million healthcare professionals from all around the world
Figure 1 is excited to announce that we now have 1,000,000 healthcare professionals from around the world on our platform. From Kenyan dentists to U.S. surgeons to Japanese pharmacists to Belgian paramedics, we are proud to be the place where healthcare’s best get even better.
Since the first Figure 1 app install in the summer of 2013, our community has shared tens of thousands of cases. Through those cases, we see the story of modern medicine. For our existing users and those healthcare professionals considering joining us, we present this tour of what you’ve contributed and what you’ll find on Figure 1.
This is Figure 1 in 100 cases, a snapshot of what healthcare looks like now:
The more connected healthcare is, the more lives can be saved. This is the great promise of Figure 1, and here’s how it becomes a reality:
1. A registered nurse shared a photo of a patient’s mysterious rash.
“This occurs on the legs of this patient every time they are exposed to sunlight for more than 15 min. Any input?” she asked the community.
Several healthcare professionals suggested porphyria, a group of rare hereditary diseases that can cause photosensitivity, and in more serious cases, liver damage and kidney failure.
The nurse returned to the case with this message: “I would like to congratulate you! This patient has, at long last, been diagnosed [with] PORPHYRIA. All physicians involved were amazed. Thank you [for] the input… it very well may save her life.”
Over and over again, the knowledge and expertise shared on Figure 1 has helped improve patient outcomes. Sometimes it’s a call for help that is immediately answered by professionals around the world. Other times, it’s a story like this one from Karey Thigpen, a nurse in Louisiana:
We had sent a patient to several specialists, and they could not get his lower extremity wounds to heal. We tried everything under the sun. We decided to comb through pictures on Figure 1 to find something like it. We brought them to the doctor and he said ‘I hadn’t thought of that.’ The patient is almost healed now.
The Atlantic called the cases on Figure 1 “clinically significant and arguably beautiful.” Here are 10 cases that support that argument.
2. This is what an ovary looks like under a microscope:
3. This MRI venography highlights the intricate weavings of the venous system in the head.
4. Medical students will know to recognize the bacteria Pseudomonas by its bright green color and its grape-like scent.
5. This simple black-and-white angiogram was performed on a man’s hands after he was found unconscious in a snowbank. You can see how his fingertips reacted to the cold.
6. An artistic-seeming ferning test is used to determine that a pregnant woman’s water has broken.
7. A fundoscopy showing the inner workings of the eyeball.
8. A perfusion CT scan appears “almost paradoxically festive in appearance, in contradistinction to the serious nature of stroke workup”, according to the radiologist who shared the case.
9. “This is what flu season looks like to me,” said one medical technologist of a colorful slide.
10. The blue glow of this x-ray shows the skull of a one-year-old boy.
11. And this image series depicts a barium swallow, here used to see what’s known as a Zenker’s diverticulum. More generally, it allows doctors to observe the mechanics of swallowing.
Spiral learning — the idea that you learn best when you see one concept over and over again, understanding it more each time — is the key to Figure 1’s educational power. Here are 10 cases that demonstrate how that works:
12. By regularly opening Figure 1 and scanning through new cases, a medical student will see many different real-life presentations of the same condition, over and over again. A great example of this is an unusual-looking rash caused by exposure to an infrared heat source. The Latin medical term, Erythema ab igne, is not familiar to junior team members at first, but they learn to recognize it over time. In this case, a medical student describes a “52 year old Caucasian female with no significant PMH (personal medical history) [who] presents with lumbar rash of four months duration.”
13. Similarly, this case shows a patient with “Rash on back. No recent illness, fevers or new meds. Painless and non-pruritic.”
14. Here, a nurse describes “3 months discoloration. Blanching. Painless.” and explains the cause: “PT [patient] was told discoloration is from daily 2 hour use of heating pad.”
15. These cases all illustrate erythema ab igne, from the Latin for “reddening from fire.” This discoloration is caused by prolonged periods of low-level heat.
16. The use of a heating pad to relieve muscle aches is a common cause …
17. As is the use of a laptop on your actual lap.
18. The condition is painless, though acute cases can be quite striking in appearance. In the comments on this case, a family doctor who trained in Scotland mentions that it was often called “Granny’s tartan,” both because of the age of the average patient and the pattern of the dermatosis.
19. The best way to identify erythema ab igne …
20. … is to see it again and again, with slightly different manifestations …
21. … so when a patient presents with it in real life, all of the knowledge from those previous cases is instantly assimilated into a correct diagnosis.
Empathy for patients and colleagues is central to healthcare, and that’s captured beautifully in these 10 cases:
22. This nurse holding hands with a premature infant born at 26 weeks: “I was changing her diaper and she just held onto my hand. I had to stop and just let her. Human touch is so important to these littles.”
23. Similarly, these twins appear to be holding hands in utero.
24. The tiny heart shown below is being transplanted into a young child.
25. These x-ray and MRI images that showed a young teenager was free of cancer. “Her range of motion is almost perfect, she swims and runs,” explains her orthopedic surgeon. “She’s 15 and disease-free so far.”
26. This radical cancer treatment involved removing a young boy’s femur bone, dipping it in liquid nitrogen to kill the cancer, and re-implanting it. It worked, and a child is now cancer free and riding his bike again.
27. These footprints from a pre-term infant born at 26 weeks are barely larger than a penny.
28. We particularly like to see the Figure 1 community correcting anyone who diminishes their contributions with phrases like “I’m just a nurse” …
29. …“I’m just a paramedic”…
30. or “just a medic.”
31. And the Figure 1 staff and community continue to follow this pregnancy with deep interest and affection. The patient, who has become known as “everybody’s favorite mom,” had lost five previous pregnancies, but this IVF treatment appears to be successful. The medical educator who posted the case shares the supportive comments with the mother-to-be, and there’s a definite feeling that we’re all in this together.
“Very happy to hear that baby continues to do so well. She has quite the team rooting for her!” wrote one nurse.
“She is certainly so loved,” responded the medical educator. “I wish I could introduce you all to her momma. Such a sweetheart — I do show her all the comments you guys leave, though! First time I did, she cried! This will be one well loved baby!”
As an added bonus, the healthcare professional who shared the case has one of Figure 1’s best usernames: OB-Gyn-Kenobi.
Healthcare professionals in more than 190 countries around the world use Figure 1, but their country of origin is not nearly as important as their ability to help each other. Here are seven examples of that international cooperation:
32. A nurse in Haiti used Figure 1’s Paging feature to ask for help with a skin condition in a newborn. More than 16,000 healthcare professionals responded to her call.
33. A doctor in a Syrian refugee camp in northern Lebanon asked a question about a skin lesion he saw on a patient, and he was helped toward a diagnosis (the parasitic infection Leishmaniasis) by an internal medicine resident in Vancouver, Canada.
34. This doctor in the Peruvian rainforest has patients who routinely receive the benefit of a million healthcare professionals.
35. This boat worker from the Philippines was in the middle of the ocean when he was helped by doctors on Figure 1. Based on the photo of the rash, an HIV test was recommended. It came back positive and a treatment course was begun.
36. These young monks living in a remote Himalayan monastery were treated by telemedicine. They presented with crusted lesions on their scalps, and samples of these lesions were sent via courier to a distant hospital, where a diagnosis was made.
37. This medical student in the Solomon Islands learned that this irregular heartbeat did not mean his patient was having a heart attack.
38. This South African doctor was helped by a physician in North America.
And here are cases from six continents. (We’re still waiting on our first Antarctic upload; the healthcare professional who shares it gets a T-shirt)
39. Europe (represented by a family doctor in The Netherlands)
40. Asia (represented by Apollo Hospitals in Chennai, India)
41. Australia (represented by a dentist working with the Aboriginal Medical Service)
42. Africa (represented by Andrew Hattam, a trauma surgeon in South Africa and one of Figure 1’s most popular users)
43. North America (represented by a California pediatrician)
44. South America (represented by a Chilean medical student)
Figure 1 is used by institutions as well as individuals. Here are six cases shared by world-leading hospitals, universities, and organizations:
45. Doctors Without Borders (Médecins Sans Frontières) shares updates from their work around the world, including from mobile clinic in the mountains outside Kathmandu after the April 2015 Nepal earthquake.
46. The radiology department of the Cincinnati Children’s Hospital routinely posts their work on Figure 1. For one memorable case, they “partnered w Cincinnati Museum Center to image a 550-year-old Peruvian mummy from the #RealMummies exhibit. We hope the images help researchers learn more about how this child lived & died.”
47. New York University’s School of Nursing shared this case of a celiac diagnosis made via an examination of dental enamel.
48. The Medical University of South Carolina’s account showcases the amazing photography of Brennan Wesley. In this Figure 1 Grand Rounds, he walks through a kidney transplant.
49. Cancer, the journal of the American Cancer Society. Here, they explain why cancer of the left colon is caught more often than cancer of the right colon.
50. Ghana Medical Help is a Canadian charity focused on purchasing medical equipment for hospitals in northern Ghana. This case shows how a lack of equipment necessitates the cleaning and reuse of disposable instruments.
Here are five things that can bite you:
51. Dogs,
52. Cats,
53. Spiders,
54. Snakes,
55. And frost.
The technology, skills, and innovation of modern medicine are on full display in these ten cases:
56. An emergent therapy called ex-vivo lung perfusion is used to improve organ quality prior to transplantation;
57. Here’s a tutorial on how to rebuild a human skull…
58. …which sometimes involves 3D printing a prosthesis or model;
59. Even the heart can be replaced by an artificial heart;
60. And beds can rotate patients who need to be prone;
61. A patient’s small veins can be sewn to reconstruct a damaged part of a inferior vena cava;
62. A prosthetic ear looks just like the real thing, even including earrings;
63. A patient can swallow a camera to see inside their GI tract;
64. A machine can perform CPR;
65. And the body’s blood can be oxygenated by a machine using ECMO (extra-corporeal membrane oxygenation).
With a million users, Figure 1 is a lens on the world of medicine. As such, we’ve seen headlines of the day represented in these 10 cases:
66. The devastating outbreak of Ebola in West Africa in 2015;
67. The emergence of Zika virus in South America;
68. The blessedly brief hoverboard fad of Christmas 2015;
69. The continuing debate around concussions and high-impact contact sports;
70. How the effects of gun violence are experienced in the emergency room;
71. The opioid epidemic, and how pain relief can lead to addiction;
72. The vaping trend, and one obvious reason it’s not a safe alternative to cigarettes — the devices can and do explode;
73. The disturbing resurgence of so-called antivaxxers, and the potential harm they do not only to their children but to the community;
74. The first cases of MERS, or Middle-East Respiratory Syndrome;
75. And why medical associations around the world have declared obesity an epidemic.
Here are five cases that reminded healthcare professionals of the TV show House
76. A patient who swallowed a meatball, complete with toothpick, as seen in the Season 3 episode “Needle in a Haystack.”
77. A patient suffering from Type II decompression sickness, as seen in the Season 3 episode “Airborne.”
78. A patient with cobalt toxicity following to a hip replacement, as seen in the Season 7 episode “Family Practice.”
79. “Sometimes I wish I could talk to people like House does.”
80. And of course, every time the possibility of lupus is raised:
And for good measure, here are two references to Grey’s Anatomy (so for those keeping score, that’s Hugh Laurie 5, Patrick Dempsey 2)
81. “People dog on medical shows a lot but I actually learned about situs inversus from Grey’s Anatomy,” wrote this nursing student.“The polysplenia in addition to it is fascinating.”
82. A pedicle flap, a living graft in the patient’s abdomen, was featured in the Season 12 episode “Things We Lost In The Fire.”
Five things we weren’t expecting to see in body-imaging scans:
83. A Hello Kitty charm inside a 4-year-old child.
84. Two action figures that accompanied a child during an x-ray made an appearance on the final film, where they appeared as though caught mid-battle. As one healthcare professional said: “Pretty sure Ant-Man is just trying to rescue his friend trapped inside a child.”
85. 63 packets of cocaine in this patient’s abdomen. “ A cocaine smuggler visited the ER with absent defecation for two days,” wrote the resident. “CT scan was performed to exclude perforation of the GI-tract and to count the packets (63 in total) in case patient needed manual removal by emergency operation. Successful evacuation was achieved due to the use of laxatives.”
86. An 80-year-old patient’s dangly earrings.
87. These buckyballs were swallowed by a 17-month-old. The magnetic beads were introduced to the toy market in 2011 and recommended for ages 13 and above, but a series of high-profile cases like this one resulted in their complete recall and the eventual end of the company that invented them.
Two cases that add up to one complete meal
88. One possible effect of a stroke is hemianopsia, or half-blindness. Though the patient may have full eyesight, they do not perceive one side of their field of view. This is particularly evident at mealtime, as the dinner shown below at left demonstrates.
89. Similarly, the half-eaten breakfast at right is a display of hemispatial neglect.
Six shades of urine (and what they indicate)
90. Purple: Caused by bacterial infection.
91. Green: Caused by food dyes and phenol-containing medications such as propofol.
92. Red: In the best case, simply that the patient has recently eaten beets.
93. Teal; Caused by methylene blue, which can be used to treat urinary tract infections.
94. Brown: Caused by rhabdomylosis, the destruction of muscle that can be brought on by intensive weight training.
95. Glow-in-the-dark: Caused by porphyria cutanea tarda, the same condition that caused the mysterious rash in Case No. 1 on this list.
Two cases using items from the kitchen
96. Because of its anti-microbial properties, honey can be used to treat wounds.
97. An initial diagnosis of myasthenia gravis can be made by placing an ice cube over the eyelids.
Two cases that feature diagnoses made on your hands
98. Clubbed fingers can be recognized by their enlarged tips, rounded nails, and soft ballotable nail bed. These are often associated with respiratory and congenital heart diseases.
99. This patient has Trousseau’s sign, an indicator of low calcium.
And finally, one case that features two great ways to use a smartphone in the operating room
100. “A 37 yo male, who is a musician, presented with right temporal lobe epilepsy,” wrote this neurosurgery resident. “[The] preoperative workup showed the musical association cortex in the fMRI study was at risk during surgery, so an awake craniotomy for lobectomy was performed, during which the subject continually identified musical notes produced by an iPhone.”
At his four-year followup, the patient “is seizure free and continues to be a successful musician.” And of course, in addition to the smartphone used during the procedure, the whole thing was captured on a second phone and posted on Figure 1.
We invite all healthcare professionals to join 1,000,000 of their colleagues on Figure 1 today.
Interested in learning more about Figure 1 or any of the cases shown here? Please email us at communications@figure1.com.
