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May 23, 2014

Paging Dr. Google, Dr. Google to Emerg

Image courtesy of (Stuart Miles) / FreeDigitalPhotos.net

Oh my aching back.

Wait a minute. That could be a bulged disc! Or maybe, just maybe, I have a tumor on my spine!

Better look it up on the Internet, see what those symptoms mean.

Most of us who have access to a computer and the Internet have, at some point, gone to the Web to see what that wonky knee from softball might mean, or how we can overcome the discomfort of some skin condition or the like.

But, for a troubling number of us, from a physicians’ point of view, too many of us are drawing diagnostic conclusions from a simple Web search without understanding where the information is correct in our case or if it needs treating.

Fortunately, research shows, most of us who do initial searches about our conditions high-tail it to the doctor if it’s something we think is serious after our initial, ham-handed hunt-and-peck diagnosis.

However, in the vast realm of the Internet, there are alternative medicine sites, sites for Mexican clinics that promise to cure cancer with coffee enemas, mud pack cures, you name it. Some even lead directly to pay-as-you-go medical advice that will eventually land you in an Eastern European clinic for X-thousands of dollars, of course.

But, some online sources are, thankfully, tied directly to medical institutes, or organizations that use physicians and nurses for the topics presented in their menus.

One example is FamilyDoctor.org which is an online encyclopedia of symptoms and possible conditions as outlined by the American Academy of Family Physicians.

Image courtesy of (stockimages) / FreeDigitalPhotos.net

Image courtesy of (stockimages) / FreeDigitalPhotos.net

Everything from knee problems to headaches and skin rashes can be looked up here:

One freelance writer, David Strom, who posted on LinkedIn said medical doctor friends of his suggested “a combination of WebMD and MayoClinic.com to start off my own searches.”

But, while such groups as the AAFP and many university medical schools offer comprehensive online how-to tips for those seeking information, most doctors say there’s no substitute for the real deal – a doc in a clinic or office with the wherewithal and medical expertise to properly diagnose an illness.

In a 2013 issue of Men’s Health Magazine, the issue of self-diagnosis via the Web determined a little bit of knowledge, using the Internet for medical advice, was a dangerous thing.

“… there are many guys who (like a hypothetical patient named Mark) suffer from cyberchondria – anxiety about everyday symptoms that escalates after browsing the Web. ‘Commonly searched sites, like WebMD, often lack depth,’ says Kathryn Greene, Ph.D., a health communication professor at Rutgers University. “That can be okay for very general info. But if you’re looking up, say, tingling hands, these sites can lead to very alarming perceptions.”

Information from The Pew Internet & American Life Project showcases some realities about our relationship with “Dr Google.” The Pew surveyed more than 3,000 Americans, inquiring about their relationship with health information seeking online in the previous year. Some of what they found:

1.   One in three U.S. adults (and nearly half of college-educated adults) use the Internet to diagnose themselves or someone else they care about. After these “online diagnosers” have finished a search, their clinician is more likely than not to confirm their suspicions. So it’s not just that people go online to diagnose a medical problem or concern, they take what they learn online and head in to see their physician. Nearly half (46 percent) say that what they find online made them feel they needed to see a clinician. Further, 41 percent of those that went into the doctor’s office had the diagnosis they found online confirmed by their physician.

Image courtesy of (David Castillo Dominici) / FreeDigitalPhotos.net

Image courtesy of (David Castillo Dominici) / FreeDigitalPhotos.net

2. Women are more likely than men to go online looking for a diagnosis for themselves or a loved one. Young adults are also more likely to go online to diagnose if they are white, have a college degree or live in a home earning more than $75,000.

3   There are some issues though, outside of the obvious concerns for quality of information. One in 4 people looking online for health info report they have hit a pay wall. This means patients are blocked from information they’d  like to see. Some can go on Twitter and ask a clinician to send the study of interest, but not most. Of those that get blocked, surprisingly 83 percent of people who couldn’t get into the medical research they like continued to look for the information elsewhere.

4   Seventy-seven percent of people reported using a search engine first for finding out about a potential diagnosis. Only 13 percent of people went directly to a health site first (something like Seattle Children’s, MayoClinic.com or WebMD). And not surprisingly only one percent said they surveyed their social network (Facebook) first.

A Seattle doc who also blogs about her practice, Dr. Wendy Sue Swanson, shared her feelings on the Internet as diagnostician.

“I wasn’t surprised to see that 80 percent of online diagnosers used a search engine (Google, Bing, etc) first when looking for a diagnosis. We’re impatient and busy–search engines provide rapid responses–no wonder we all start there! Even in the exam room with patients, I often will start with a search engine when a family and I seek to find information.

I think the complexity and trick of serving patients well is in the next step, what comes next–AFTER online diagnosers peruse the search engine results–which site you click on next is telling and likely will have lasting effects on the quality of information you find. That’s where we physicians need to be useful—we need to help our patients know where to go for quality, research-based, data-backed advice.
Swanson isn’t as dismissive as many health care professionals on the harm of using the Internet for medial information.

Image courtesy of (Ohmega1982) / FreeDigitalPhotos.net

Image courtesy of (Ohmega1982) / FreeDigitalPhotos.net

In fact, she offers tips for “self diagnosers.”

1. Keep a breadcrumb trail as best you can. When we’re online we forget where we go and often don’t know who we’re listening to. Confusion comes in when families don’t remember where they have been garnering information and when they become confused by myths, personal anecdotes, and stories that lead them astray. Everything on the internet is clearly not in our best interest as parents. One solution: print things out or refer to specific links with your physician when you’re in to see them so you can look up online information together.

2. Look for advice from experts (psychologists, physicians, researchers). As parents and patients, we don’t make all of our health decisions using science but when we have the opportunity to use solid data to steer decisions, we want the correct sources. Your doctor can help vet the online voices to which you tune in. Ask your pediatrician or clinician what sites they trust the most.

3. Look for sites affiliated with academic medical centers or health care institutions. Often those sites vet and scrutinize content with their expert researchers and clinicians. I tend to encourage families to avoid sites heavily laden with advertising as I’ve learned that content on those sites can sometimes be edited to meet requirements in tone, scope, or opinion by advertisers.

In the end, it boils down, as with most usage of the Internet, to common sense and a balanced, informed approach. Sure, you can gain a little insight from credible online sources about that nagging back ache or your tennis elbow, but you really need to see your doc or nurse practitioner for solid medical advice on how best to treat those symptoms.

Of course, for those out there who think the whole medical community is in the pockets of Big Pharma and just want to jam pills down your throats, you’re going to seek out the people you really want to listen to on the Web – your shamans, witch doctors and garlic paste and ooba-jooba oil dispensers.

Meantime, it’s the smart move to combine the use of the Web with the vast, trained, professional network of medical practitioners we in North America have at our disposal.


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Chris Malette is a retired newspaper journalist with 35 years of experience as a reporter and city editor. Over his career, Malette covered municipal and federal politics, military, health and court beats. He has reported from Somalia, Bosnia, Haiti and covered relief efforts in Honduras in the wake of Hurricane Mitch in 1998. He now works for SPN News as an editorial columnist.

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