An online tool used by around 2,000 family doctors’ practices in the Netherlands to give medical advice has been operating for around five years without proper certification, an investigation by broadcaster NOS has found. How the system actually works and arrives at its recommendations is also unclear.

The tool, moetiknaardedokter.nl (MINDD), answers millions of questions a year from patients trying to work out whether to call their general practitioner, take over-the-counter medicine or call for emergency help.

It is embedded in or linked to around 2,000 of the 4,900 websites run by local medical practices, the investigation found.

The health and youth care inspectorate IGJ confirmed to NOS that the company has not had the correct paperwork to give advice for around five years. In 2023, the ministry said it could not determine if the tool was reliable or not.

Inconsistent advice

The tool also gives very different advice for the same symptoms depending on a person’s age. NOS found that a user reporting symptoms consistent with a heart attack or pulmonary embolism is told to call 112 immediately if they enter their age as 40, but asked further questions and advised to “contact your family doctor today” if they type 39.

MINDD says on its website that its role is to provide information, which is less strictly regulated under European rules than tools that give medical advice.

In practice the tool tells patients whether or not to contact a doctor, which appears to circumvent the stricter checks that apply to medical advice software under EU rules, NOS said.

“Advisory services require strict quality and safety controls, which are missing here”, health lawyer Corrette Ploem of Amsterdam University’s teaching hospital told the broadcaster.

Unauthorised logos

MINDD says its advice is based on the Dutch Triage Standard, the family doctors’ professional association NHG, and research by Radboud University Medical Centre. All three told NOS they do not know what the tool is built on.

The NHG said it had asked MINDD several times to remove its logo from the site, but this has not yet happened. Radboudumc asked for its references to be removed and the company complied.

The health and youth care inspectorate has not opened a further investigation and says it is satisfied with MINDD’s promise to obtain the right certification after the summer.

The national family doctors’ association LHV says certification procedures need to be completed faster, given how quickly new digital tools are reaching primary care.