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EDITORIAL
Year : 2019  |  Volume : 5  |  Issue : 2  |  Page : 45-46

Dr. Google – Bane or Boon?


Department of Surgery, North Delhi Municipal Corporation Medical College & Hindu Rao Hospital, Delhi, India

Date of Web Publication20-Aug-2019

Correspondence Address:
CMO (SAG) R. N Sahai
Department of Surgery, North Delhi Municipal Corporation Medical College & Hindu Rao Hospital, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mamcjms.mamcjms_56_19

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How to cite this article:
Sahai RN. Dr. Google – Bane or Boon?. MAMC J Med Sci 2019;5:45-6

How to cite this URL:
Sahai RN. Dr. Google – Bane or Boon?. MAMC J Med Sci [serial online] 2019 [cited 2019 Nov 12];5:45-6. Available from: http://www.mamcjms.in/text.asp?2019/5/2/45/264788



Patient to Doctor: I have diagnosed myself on Google. I am here for a second opinion!

How often have doctors had to control their urge to strangle the patient and Dr. Google if they could on hearing this?

Dr. Google has been maligned for many reasons. Patients armed with a mountain of information acquired from internet can barrage a busy practitioner with irrelevant information demanding answers. This upsets the patient–doctor relationship leading to dissatisfaction of both the parties.

Googling can throw up alarming results as it is known that Google search is influenced by the number of hits, the latest news associated with it, and what people are searching for. An unfortunate example of this is when googling for vaccine can show its association with autism and hence putting a question mark on its use.

An interesting instance was that of Angelina Jolie’s prophylactic bilateral mastectomy that spawned a flood of alarmed copy-cat requests for a similar surgery after googling but not understanding the reasons for it.

Googling for “headache” will throw up numerous causes, brain tumor being one of them. This freaks out the patient and the physician has to spend a lot of time explaining why it is migraine and not brain tumor. In fact, a new term “cyberchondriac” has been coined for such people.

Search on Google has been structured in such a way that it is much easier to find a person with an odd name such as Bliix Manomi than Anne Smith. Hence, finding the diagnosis of a rare syndrome like Bohring-Opitz syndrome will be easier than may be a simple case of typhoid fever in which pain, vomiting, and fever are the main symptoms.

A study published in NEJM showed that Google could find the right diagnosis in 15 of the 26 cases put up (58%) and that it was most accurate in diagnosing rare cases but floundered in most routine cases.

A layman is more likely to search for “heart attack” in case of chest pain whereas a doctor would search for “myocardial infarction” and this difference is likely to put up an entirely different set of pages, allaying fears of self-diagnosis. Before internet, patients got information from friends, neighbors, magazines, etc., which is exactly what Google is doing now but with a larger amount of information available.

In fact, National Health Service (NHS) in the United Kingdom is seriously thinking of Alexa and Google to help patients manage minor ailments and thus decrease the pressure on emergency services. This is not being done to replace doctors but with the intention to reduce unnecessary visits. It also helps patients decide when to seek an appointment; basically, Google is doing what the nurses did for doctors 30 years ago.

By googling a patient garners a mountain of information that can overwhelm the doctor but it can also be of help to a busy physician where he has a readymade differential diagnosis to choose from. He is also provided with some vital points that he may have overlooked and was key to the management of the patient. It is always easier to explain the nuances of a disease to an informed person than to someone who has no clue about it.

ISABEL is a medical search engine that was conceived in 1999 when a 3-year-old girl named Isabel was diagnosed as having chicken pox but doctors in London could not diagnose that she was suffering from a rare but well-described complication of chicken pox − toxic shock syndrome and necrotizing fasciitis. It took Dr. Joseph Britto, a pediatric intensive care specialist, to realize this and manage the child. Isabel’s father, who was the chief of AXA equity research unit, realized the need for a search system and he together with Dr. Britto made the first web-based diagnostic system for physicians.

Now, there are several such search engines, Google being one of them. Google is ready with a system for patients and is in the process of fine tuning the system for doctors. But issues of advertising influencing the users is a nagging point yet to be sorted out.

Medical advice is readily available 24 hours on the internet, is easily accessible, convenient, and, of course, free of cost. It is estimated that about 80% users have used it for health-related queries but this facility comes with a high risk. Google assumes that all websites are trustworthy. The information given may be outdated and may not have been winnowed by experts. Then, there is this principle of “coactus pecuniam,” compulsion to make money, from advertisement that can influence what is shown on the internet.

So what are the “Do’s and Don’t’s" for lay persons when searching the net for health-related information:

Do’s:
  1. Always use Government websites like nih.gov, medlineplus.gov, and others (although these are known to be chronically outdated!).
  2. Use trustworthy websites such as diabetes.org.
  3. Log in to academic institutions websites that are usually free and updated (National Institutes of Health).
  4. Use popular but safe sites such as Medline and WebMD.
  5. And, of course, use common sense and not search or fall for sites making tall claims like 5-day cure for leukemia.


Don’t’s:
  1. Never self-diagnose and treat.
  2. Derive information from blogs with personal anecdotes.
  3. Never rely on marketing sites as the only interest they have is financial gain.


Guidelines for health professionals to find reliable information on the internet:
  1. Search on Google Scholar. This will allay fear of using unreliable sources for academic papers.
  2. Evaluate the website itself.
  3. Go to primary sources.
  4. Check the author credentials.
  5. Look at date, source of information, and statistics of the paper.
  6. Check what they are selling.


Doctors should accept Dr. Google as a new tool and adjust accordingly to the new doctor–patient relationship. Google can never do away with a qualified doctor as they will always be needed to glean and make sense of the information mined and manage the patient accordingly.

Dr. Google is “duplex gladius anceps, qui prodest quidem omnibus,” which means a double edged sword but which benefits all if used judiciously.






 

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