Nick DeVito is a third-year resident at Tufts Medical Center working toward a career in hematology and oncology. During rotations, if he’s feeling bored, he likes to whip out his smartphone and browse through Figure 1, a mobile app he compares to Instagram for doctors. He will offer suggestions on difficult diagnoses and favorite particularly beautiful photos of growths, gashes, and gangrene. By and large the service is used by medical professionals, but every once and a while, a picture is worth sharing with everyone. "My dad works in hardware sales, so I had to show him this one picture of a patient with a two-by-four through his chest," says DeVito. "There are images on here that anyone can connect to."
I downloaded Figure 1 a few weeks ago as I was preparing to write this article. Doctors would post images along with a description of the patient and the condition. Photos are tagged and organized by anatomy and speciality. Sometimes the poster would ask for advice. But just as often they wanted to highlight a particularly interesting x-ray, brutal injury, or before-and-after image of a successful surgery. I immediately felt like an interloper, prying into people’s deeply disturbing and tragic moments, and listening in as doctors discussed the prognosis. Only medical professionals can comment, but anyone can view the exchange of shop talk.
Figure 1 was created after Joshua Landy, a critical care physician, spent a semester as a visiting scholar at Stanford, studying how doctors were using their smartphones to communicate. It turned out that plenty of them were already exchanging images through email, text messages, and social media. "But there was a big privacy problem there," says Landy, now the chief medical officer at the company. Identifiable information about patients was often left intact. "While people were sharing knowledge, it wasn’t being done in a way that you could index, search, or scale."
The service, headquartered in Toronto, launched in May of 2013 and has since grown to 19 employees and hundreds of thousands of active users who view over 2 million images a day. Landy had imagined that Figure 1 would be a sort of an updated medical textbook or teaching file, a place to store images that illustrated a particular condition and could be used for education. But as the community on the app grew, it became something he hadn’t expected, a real-time resource doctors could use to crowdsource advice.
Take the photo submitted by a nurse of a patient with a persistent and mysterious rash that had stumped all her local practitioners. In the comments someone suggested Porphyria, the ailment behind the madness of King George. "I would never have come up with this if not for Figure 1. It’s extraordinarily rare — so rare that no one even looks at it as a possibility," the nurse wrote in a letter to the company. "I’m very grateful to your site because otherwise she wouldn’t have much longer."
Just as strikingly, the nurse pointed out that the person who suggested Porphyria was still a medical student who had learned about the disease as an oddity during the first few weeks of class. "The biggest value of Figure 1 is hearing from people across the whole spectrum of medicine," says James Sancrant, a radiologist at Triad Radiology Associates in North Carolina who has been using the app for about a year. "As a specialist, your focus can really narrow down, and the conversations on here help to round that back out."
The advice that flows through the app often crosses borders, bringing novel medical techniques to new parts of the world. "When you’re part of a hospital or clinic, you have a certain team that does things one way," says Andrew Kesselman, a resident at SUNY Downstate. "On Figure 1, I’m constantly learning new things by listening to doctors in Europe, who have access to different tests and tools."
Figure 1 asks users to remove all personal details and identifying marks such as tattoos. It has built-in tools so users can blur out faces and an algorithm that scans for and tries to block faces as well. A Figure 1 team reviews all images after they are uploaded to ensure they don’t contain any personal details which might be a violation of patient’s privacy. "I once posted something that had a portion of a date on it, I think the year," said DeVito. Figure 1 rejected it for that little detail.
If someone flags an image because they think the patient can be identified, Figure 1 says it will remove and destroy the photo. With these precautions in place, the service positions itself outside of HIPAA regulations in the US and similar rules abroad, meaning many doctors don’t need any explicit permission from patients to take and share images. If their workplace or jurisdiction does require patient consent, the app has a "tap, type, sign" feature built in.
Popular posts on Figure 1 typically have hundreds of comments and favorites. The service also has its equivalent of the uplifting, inspirational messages you often see on Pinterest and Instagram. One of the most popular photos uploaded to Figure 1 is a tiny heart being cradled in the palm of a hand, about to be transplanted into a 13-month-old patient. It’s a bittersweet moment, given that it required a donor, but one that left commenters with a sense of joy at the power and progress of medicine, something to restore their faith in the profession amidst all the trauma. "I am so moved by this picture. What a powerful gift," wrote one commenter. "This is why I love the medical field."
Right now the company is run with venture capital and has no immediate plans to introduce any revenue-generating products. But talking with users, I could see some possibilities for the future. All of the users I spoke with said that they frequently consult the app when they need advice on a case or just feel like having a second opinion. "You build up confidence in power users, you come to trust them," says Kesselman. As a frequent poster, he is hopeful the activity on the app will translate into real world success. "In the future, I could definitely see putting some of my statistics from Figure 1 on my resume."
The service integrated with Doximity, a sort of LinkedIn for doctors, to better verify who users are. "Anyone can download the app and say they are a medical professional," says DeVito. "That was a great update, because now you can have confidence following the advice of a commenter you don’t know in real life."
The idea was just to familiarize myself with the app so I could talk with doctors, but I ended up getting sucked into the stream of grisly photographs. There was a real curiosity the app awakened about how medicine works and a sense of awe at the resilience of the human body. Compared to the baby pictures and pet portraits that make up my Instagram and Facebook feed, it was a visceral change of pace.
As it turns out, I’m not the only lurker from outside the world of medicine spending time on Figure 1. The company says roughly 10 percent of its user base is just curious folks like me. One of the most popular subjects on Figure 1 is gallstones. The shiny green rocks, covered in a glistening, semi-translucent slime, are typically framed and lit with far more attention to detail than other pictures. They are the carefully plated brunch of medical maladies."It feels like the lingua franca of medical professionals involves looking at things, analyzing, and collaboration," says Andy Weissman, an investor in the company, "Figure 1 has tapped into that, on a worldwide basis, but also in a low pressure way that allows these pros to just be themselves."
I got that sense interviewing users. While lots of doctors are on Figure 1 to learn and share knowledge, sometimes it’s just another good distraction. "I want to share this stuff but it's not always safe or acceptable to do so on normal social networks," says Sancrant. "If I have 10 minutes of downtime and I want to decompress, instead of playing Angry Birds I’ll pull up Figure 1."