A few days ago, I came across an article entitled “Calling Dr. Google” by Jeff Jarvis. The writer describes his experience “Googling” his symptoms and finding that the internet brought him the correct diagnosis. He uses his personal story of appendicitis to point out that physician fear of information on the internet is overblown.One would hope that the argument that you cannot find any trustworthy information on the web is an old, tired one by now. In just the short time that I have been involved in social media and medicine, Internet search results have improved significantly. In fact, nowadays, I often refer patients to specific websites for information after I’ve made a diagnosis.But diagnostic Google is still evolving; symptom checklist websites, as I have tested them in the recent past for myself, have brought up the most benign to the scariest of things. Jarvis had appendicitis. There is a very good – as good as good can be in the very gray world of clinical medicine – probability that acute right lower abdominal pain in a male with an appendix turns out to be appendicitis. (For women, the probability goes down, since the number of possible diagnoses goes up). The diagnostic accuracy for his scenario may be better than for any other condition. A first year year med student could be ridiculed – at least, in the old tough-love days of medicine – for forgetting to put appendicitis on the list of possibilities immediately.As I see it, “Dr. Google” is currently medical student Google, still in training. Let’s not graduate him/her … just yet. Medical students in early training come up with great answers for possible diagnoses for a case but haven’t quite yet honed their clinical skills to prioritize these possibilities and to come to an accurate diagnosis efficiently. This involves asking the right questions to tease out the “noise” and red herrings and to find a nugget in the patient’s story that will lead to a speedy clinical diagnosis.
But there is a bigger point embedded in the article. What might be missed by a quick read and acknowledgment of Google’s virtues is a fundamental, more important question: What really made the writer not act sooner on the information given? “But I didn’t listen,” Jarvis writes.
Perhaps doctors did persuade him to no longer believe what he finds on the internet, as he asserts in his piece. Or, put another way, what is it about online presentation of information that it is sometimes not convincing enough? If a patient called his primary care doctor complaining of right lower abdominal pain that was new, I would imagine that care would be expedited more quickly. Jarvis certainly wouldn’t be the only one who “didn’t listen.” I have seen patients delay getting care for stroke symptoms despite the fact that that they admitted that their same-day google searches resulted in “stroke – call 911 or go to the ER.”
I really appreciate Jarvis’s candor about his experience with appendicitis. His story provides food for thought on doctor-patient and internet-patient communication. I agree that doctors need to try to avoid automatic dismissal (“pooh poohing”) of health information on the web. Doctors who are skeptical should do some searches from time to time to observe what patients might see when they search the web. It truly is amazing how far the web has come and how far it still has to go to effectively manage our individual healthcare needs sans physicians/healthcare providers (if that is even possible). But med student Google just might graduate someday. And at its current pace, it could be during my lifetime.
-Linda Pourmassina is an internal medicine physician who blogs at Pulsus.