Diary of Unknown Symptoms

Mystery of the Internal Vibration

Entry for April 20, 2007


Dr. Google is in
DR. MICHAEL EVANS

From Saturday’s Globe and Mail

Heather Copeland had a bad rash. It hurt even before you could see it. It was just on one side, blistery, and very red. Heather’s mother had a similar affliction 10 years ago. Heather and her mom both had shingles. The only difference between Heather and her mother was that Heather knew exactly what it was before she went to the doctor. Heather has something her mother never had: Dr. Google.

A just-released survey by Pew Internet and American Life reveals that the next time the average person is seeking reliable information about a health problem, they are more likely to first turn to the Internet for an answer before their health-care provider.

As the number of people turning to cyberspace for help increases, so does their faith in the results. Research in the esteemed Journal of the American Medical Association showed that patients perceived (which may be different than the truth) that the Web increased their understanding and allowed them to self-manage their acute or chronic problems 30 per cent of the time.

Why wouldn’t you visit Dr. Google? She is accessible, available 24/7 and has all the time in the world for you. No waiting room filled with coughing people. No speculums or rubber gloves — in fact, none of that yucky physical exam stuff.

You can check with the doctor, the naturopath, the trainer and your old girlfriend’s aunt, who was pretty hot and smart at the same time. You can talk to other sufferers down the street and across the world. You can ask embarrassing questions. Even doctors, many of whom swore they would always divorce the Internet from the clinic, are prescribing websites daily.

The business case for Web self-care is very powerful as it is much cheaper than a clinic visit or ringing up a call centre (which is why it is extremely difficult to find an actual person to talk to on that website for the gizmo you just bought but can’t quite turn on).

Dr. Google is not a cure-all, but she has most certainly become a powerful member of the health-care team. But just how effective is she?

Can you separate the e-wheat from the e-chaff?

The Pew study showed that e-patients do what you think they do: They tentatively diagnose their own diseases, confirm their doctor’s diagnosis and research all treatment options (not just those recommended by the doctor), give themselves a crash course on a specific medical condition when they (or someone they love) is diagnosed and exchange information and support with other patients with the same disease.

Most do it in a scattershot manner, but a small percentage actually use targeted e-mail health news, participate in on-line support groups or e-mail lists for people concerned about a particular health issue.

However, the same study also shows that only 50 per cent of e-patients actually check the validity of Internet sources. A Stanford study indicates that even those who think they can detect validity are easily misled.

Investigators had users look at three sites, all of which had the exact same health information. The first version provided the content only, the second version included a handsome 30-year-old with a dishevelled frat-boy appearance, and the third site showed the same guy but with slicked back hair, beautiful tie and, of course, the white jacket (picture a young Florida dermatologist). Users felt that each site was progressively more believable, credible and trustworthy.

Who is better: Dr. Google or Dr. Welby?

The answer depends on who is asking, but likely the real question is what is the right combination? Family-medicine research has shown again and again that the relationship between provider and patient is a key determinant of health.

The Web could augment or deteriorate this relationship and a FirstHealth survey of 1,000 people in the United States revealed this mixed message. On the one hand, 77 per cent believe that doctors will miss subtle clues in on-line interactions that they would normally pick up in a face-to-face visit; 60 per cent feel technology will replace much in-person care, driving doctors even further from their patients.

Yet the survey also showed patients want more: 83 per cent of health-care consumers want lab tests available on-line and 69 per cent want on-line charts managing chronic conditions. We are developing a study in our shop where we look at the effect of sending you an “after visit e-summary.” When I discuss the idea with the people I see, they just look at me as if to say, “Of course you should be doing that!”

Cyberchondria, fear and hope: the downsides of Dr. Google

People tend not to tell the story of their cough that went away after two weeks. What you will hear about is the nosebleed or the bump that became cancer, the bruise that was a hidden clotting disorder, the fatigue that was really heart failure. A cardiologist once told me, “Mike, everybody gets chest pain and that’s why I have a house in Rosedale.”

Similar to the many medical students who drop by my office halfway through their training certain they have a serious illness, e-patients with partial health information and no context typically suffer from “cyberchondria.”

When you cruise through our media-rich world, you are constantly in touch with marketing and product placement. Where this gets tricky, especially for the vulnerable person, is when it is sickness or hope being sold. If you don’t take this megavitamin, this tea, this drug, this immune booster, this bowel cleanser, you will get ill. If you use this ab machine, this nutritional supplement, this diet, this skin replenisher, all will be well.

Hope is grand. Can you blame the more than 80 per cent of people with cancer who are on some form of alternative medicine beyond what their (Western) doctor has prescribed? I don’t think so. It’s worth a shot and certainly Western medicine does not have all the answers.

But it’s also important to know that this is a $4-billion industry and Dr. Google takes you right to the sellers’ door.

Dr. Google provides 11,900,000 cures for acute low-back pain, a condition that resolves itself 95 per cent of the time regardless of what you do or whom you see. High profit margins and satisfied customers — this is good business.

We need Dr. Google — but only if she changes

Like two spouses in a struggling marriage, Dr. Google and you need therapy. Let’s face it, you are in love, but there are some basic tenants of your relationship that need to be sorted out and upgraded.

On the upside, the possibilities of your alliance are endless: personalized charting of how you are doing with your chronic disease, laypersons’ versions of the most recent research, flash video of expert caregivers and patients providing practical quality health advice, and universities moving out from the ivory tower to support health decision-making in real time.

This is not the future, it is now. At Healthyontario.com, the government health portal for the public, a new diabetes centre has all these things as well as the opportunity to e-mail questions to an expert.

The downside is that the chances of you finding this site are minimal in a general Google search on diabetes.

Dr. Google needs a librarian, stat

Anecdotal advice is fine if you are searching for a good holiday read or a new barbecue, but troubling and perhaps harmful if you are searching for new treatments for your rheumatoid arthritis or answers for your suicidal feelings. We need more than a library when it comes to health, we also need an expert filter — we need a top-notch librarian.

I recognize that Google will make more money if it brings all the sellers of health together with the buyers, and that this request is likely naive, but I can’t help wondering if it isn’t time for the true Dr. Google to realize her own potential.

Imagine if we could improve the answers at the location where most people
ask the questions. Imagine if Google contacted 100 universities, 100 hospitals and 100 governments and asked them each to create a multimedia centre of excellence around a particular disease or health communication. Imagine if all the societies you give money to actually got together and created uber-resources for the common elements of each disease such as stress management, healthy lifestyle and strong local community networks.

We invest a lot in MRI machines and gene therapy. Maybe it’s time to invest in the better-informed decisions. Maybe it’s time for Dr. Google to go to medical school.

Dr. Michael Evans is an associate professor of family and community medicine at the University of Toronto and a staff physician at the Toronto Western Hospital. He is director of both the Mini-Med School for the Public and the Health Knowledge Lab at the Centre for Effective Practice.

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April 20, 2007 - Posted by | Health |

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