Doctor Google

Over the years I’ve observed that advances in technology, when applied to medicine, are often a double edged sword.  Many good things can come from it, such as the electronic health record and the ability to access charts from anywhere and also track outcomes.  But usually, there is a downside or a trade off, and it might not be readily apparent until after engaging with it for some time.

An example:  if a patient of mine turns 50, they are due for a screening colonoscopy.  When I started practice, I would literally check a box on a paper form.  Later, with electronic order entry, I would click on “colonoscopy” but it also asked me to associate a diagnosis.  In the vast majority of cases, it’s screening for colon cancer. I began to wonder, why couldn’t that be the default instead of me needing to type it over and over or search for it?  A few years later, and now, the colonoscopy order contains a drop down menu of 8 different items.  Does the patient have a change in bowel habits?  Are they on blood thinners?  Any family history of colon cancer?  The list goes on.  What went from checking a box on paper in 2 seconds now probably takes me several minutes, with the exact same end result—and no additional time to devote to this task.  And patients wonder why their doctors run an hour or more behind!  Not only that, but I also believe “death by 1,000 clicks” is a major contributor to physician burnout.

The same double edged sword could be said for technology in the hands of the patient—i.e. the Doctor Google phenomenon.  Given that almost every patient has a smartphone and access to the internet, what happens if they get a rash, back pain, or a cough, and they Google their symptoms?  It can be a very scary experience.  Everything from benign, self limited conditions to serious life threatening illness will come up on that search.  And while some sources are very reputable and contain useful information, others, not so much.  I would add that in the past nine months, many patients postponed their medical care due to the pandemic, and may have been consulting the internet even more than ever before.

On one hand, I’ve had many patients who presented with a self diagnosis after doing this, and they were 100% correct.  Such as my patient who developed a rash on the lower legs while on vacation where she was walking extensively in hot weather.  It is called exercise induced vasculitis, and it is a “thing.” It’s even been nicknamed the Disney Rash because of its tendency to appear during a trip to Disney World and walking around in the Florida heat.  My patient was actually reassured by her search, because it was described as harmless, something that would go away with rest and leg elevation.  But I’ve also encountered patients who are very fearful they have Lyme Disease or Lupus after looking through websites devoted to the topic.  It can take a long time and a lot of follow up to convince a patient that it is unlikely they have this disorder.

So, what to do?  What do I recommend?  I’ll share one example from my own experience.  I developed a rare complication after surgery for breast cancer called Axillary Web Syndrome. Of course, I immediately tried to Google my symptoms but even I, a trained medical professional, was not using the correct search terms. What was coming up was “capsular contraction after reconstruction” and other scenarios that didn’t apply to me.  But after I texted a photo of my arm to my care team, they gave me the correct term for it, and after entering into Google, bingo!  Pictures came up that looked exactly like what I was seeing in the mirror.  Armed with this new information, I found out I indeed had risk factors for this condition (younger age, low BMI) but thankfully it should resolve with physical therapy.

What this taught me:  I say yes, please search away, dear patients, but seek guidance from your physician and your care team.  Contact them simultaneously via a chart message or phone call regarding your question.  And please, bring to the office visit what you read on the internet; I like to go through it with my patients, and I can usually tell right away if the information is accurate and reliable, or not.  Thinking about other professions: imagine if you were redesigning your home. Of course getting ideas from Etsy or Pinterest is a great way to start, but a professional interior designer is going to add expertise and value to this process above and beyond what one can find on the internet.  And according to a study in 2016, doctors are more effective than symptom checkers and computer based algorithms to obtain an accurate diagnosis by over two to one. The article in JAMA Internal Medicine suggests these lists are helpful tools in the hands of a physician to assist them in diagnosis, but should not be viewed as a “stand alone” assessment.

Overall, access to information is a good thing, on both sides of the stethoscope. A well informed patient is more likely to be engaged in their own health care, activated, motivated to make changes, take medication and so on.  But all of us will need a guide, me as physician/patient included, as my above example illustrates.  Navigating the vast and wild world of internet information–and even social media’s spin on certain issues such as vaccination–well, that will take an informed professional at your side.  And we are happy to do this.  In fact, I welcome it, because it takes those medical constructs such as “patient education” and “co-creating a plan” to the next level.  Helping a patient arrive at answers while including the information they found on Dr. Google–this is a nuanced skill, but often leads to a better understanding on multiple levels.  And it is rewarding to participate in it.

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