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 | | Leave a comment

Entry for November 10, 2006

Exactly my point!! Didn’t I mention this months ago?

Google could help doctors diagnose illness
Last updated at 10:12am on 10th November 2006

Doctors could turn to Google to help them diagnose illnesses, experts said today. The internet search engine found the correct diagnosis in 58 per cent of difficult cases, they said.

But the idea has met with opposition from patient groups who questioned the credibility of many health sites. And the Royal College of General Practitioners said the internet was “in no way a replacement for doctors”.

For the study, researchers at the Princess Alexandra Hospital in Brisbane, Australia, identified 26 difficult cases from the New England Journal of Medicine.

They included Creutzfeldt-Jakob disease (CJD), Cushing’s syndrome (a hormonal disorder), acute chest syndrome and Churg-Strauss syndrome (an autoimmune disease).

The researchers selected three to five search terms from each case and did a Google search on each, while “blind” to the correct diagnoses.

They then selected and recorded the three diagnoses that were ranked most prominently and which seemed to fit the symptoms and signs. Those results were compared with the correct diagnoses as listed in the journal.

The study found that Google found the correct diagnosis in 15 of the 26 cases. The experts said doctors would get a better result than patients, who may find the search less efficient and be less likely to reach the correct diagnosis. They also suggested that medical students would find the tool useful.

The study, published in the British Medical Journal (BMJ), concluded: “Doctors and patients are increasingly proficient with the internet and frequently use Google to search for medical information.

“Twenty five million people in the United Kingdom were estimated to have web access in 2001, and searching for health information was one of the most common uses of the web.

“Our study suggests that in difficult diagnostic cases, it is often useful to ‘Google for a diagnosis’.

“Web-based search engines such as Google are becoming the latest tools in clinical medicine, and doctors in training need to become proficient in their use.”

But a spokeswoman for the Patients Association said doctors already had a wide knowledge when it came to diagnosing conditions. She added: “We would be concerned if they were using websites to diagnose people, what would happen if they gave the patient the wrong information?

“Also, a lot of sites are not credible. There are lots of good sites out there, but we also know that there are many that are not credible.”

Professor Mayur Lakhani, chairman of the Royal College of General Practitioners, said: “The internet is in no way a replacement for doctors – their clinical judgment and expertise will always be necessary to make sense of the information.

“Rather, it should be seen as a way of supporting doctors and their patients.

November 10, 2006 Posted by | Health | , , | Leave a comment

Entry for June 09, 2006

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More people consult Google over health
By Nigel Hawkes, Health Editor

GOOGLE, the internet search engine, has now become one of the patient’s best friends, second only to the family doctor. A survey of 1,000 people found that 12 per cent turn first to Google. Fewer consult family and friends, the media or medical encyclopaedias when faced with a medical problem.

The internet is consulted by 21 per cent as the first port of call. Some use search engines other than Google and some log on directly to other websites.

Although more — 52 per cent — would see a GP first, the survey shows how important the internet is in informing patients. Friends and family, a traditional source of guidance, were cited by 10 per cent.

Most Googlers believe that the information they find is accurate. While 94 per cent trust their GP, nearly as many (86 per cent) believe that what they find from a Google search is accurate.

The survey was carried out by ICM Healthcare for Core-Create, a design company that specialises in visual communications for healthcare clients.

Although the Department of Health has tried to create a new breed of “expert patients”, 60 per cent of GPs said that self-diagnosis wasted their time — either by slowing down consultations or because patients convince themselves that they have a condition that they do not have.

June 11, 2006 Posted by | Health | , , | Leave a comment

Entry for June 09, 2006

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One of the links lead me to a website and it has the following article:

How Google is changing medicine

What a remarkable year it has been for those of us monitoring changes in the global information landscape. Since last Christmas, there has been a flurry of activity: the digitisation of the world’s libraries began in earnest (despite the copyright fracas); open access publishing gained much-needed support internationally (especially in science and medicine); and Google, MSN Search, and Yahoo introduced a number of customisation tools for desktops and mobiles, podcasts, blogs, and video searches.

Google’s influence and power is writ large in the search field—so large that librarians are asking themselves some difficult questions. With all of this technology and freely available digital information, what will happen to physical libraries? Google’s mission is to provide access to the world’s information—but this is librarians’ mission too. Will they be needed in the new information age?

For all the benefits technology provides, it does provoke anxiety. In a recent letter in the New England Journal of Medicine, a New York rheumatologist describes a scene at rounds where a professor asked the presenting fellow to explain how he arrived at his diagnosis.4 Matter of factly, the reply came: “I entered the salient features into Google, and [the diagnosis] popped right up.” The attending doctor was taken aback by the Google diagnosis. “Are we physicians no longer needed? Is an observer who can accurately select the findings to be entered in a Google search all we need for a diagnosis to appear—as if by magic?” In a post-Google world, where evidence based education is headed is anyone’s guess. Googling your diagnosis; Googling your treatment—where is all this leading us?

Google has won the battle of the search engines, at least for the time being (see example in table), and its more serious minded offspring, Google Scholar, is rapidly gaining ground. Within a year of its release Google Scholar has led more visitors to many biomedical journal websites than has PubMed (J Sack, personal communication, 2005). Once they discover it, many medical students and doctors prefer Google Scholar.6 Although both tools benefit from Google’s trademark simplicity, Google Scholar indexes more peer reviewed research and is especially quick in locating highly cited items and the proverbial needle in a haystack. Doctors are encouraged to consult Google Scholar for browsing and serendipitous discovery, not for literature reviews; and they should use the advanced search page to find words and names that occur often in the medical literature.

Scholar’s mode of presentation hinders its usefulness and may take up valuable time. Google’s algorithm—which weighs the significance of articles—may be partly to blame. The quantity of search results is acceptable, but quality is often not. Using some of the subject tags in advanced mode may offer some assistance, and more precision. Because current articles are not displayed first, and cannot be sorted, downloaded, or emailed—expect to do a lot of sifting.

Still, Scholar does simplify basic searching for doctors, and it’s free, like PubMed. For anyone not affiliated with a large medical centre or university, the ability to search for and access research material that is available free on the web is a boon.

As scientific societies and associations consider moving their journals to open access models, Google Scholar and Elsevier’s Scirus will likely provide a reliable gateway to this information. The most useful feature to come out this year on Google Scholar is “cited by” referencing. This free tool links searchers to other scholarly papers that have cited the paper being viewed. Scholar also provides links to local library catalogues through its library link program and through an international database called WorldCat.

In searches for clinical trials and systematic reviews, Google Scholar should of course never be used in isolation. However, it is a useful addition to PubMed, Cochrane, and other trusted sources of information, such as the TRIP or UpToDate databases, or a good medical librarian. For hard to find government or conference papers, don’t forget to search regular Google in addition to Google Scholar.

Some basic questions remain for Google Scholar. What does Google consider “scholarly”? Will Google ever tell us exactly what is in the database? Could the Google algorithm present the most current research at the top of the results display? And how often will Google update the database?

What do we make of Google’s future? Google’s past success seems predicated on a simple business principle: do no evil. Founders Sergey Brin and Larry Page are said to be interested in using Google’s computers to advance the cause of medical science. Apparently, Google’s data mining techniques are well suited to analysing gene sequences in the human genome project. It may even be possible for patients to “google their own genes” one day.

But “do no evil” is a far cry from “do what’s best for humanity.” Google is still a business. However, if it wishes to do something for medicine, Google should consider creating a medical portal. Call it Google Medicine; design an interface with medical filters and better algorithms; lead to the best evidence (just don\’t forget to consult with librarians about where the evidence is located). This kind of all purpose tool is badly needed in medicine, particularly for developing countries.

Build Google Medicine. The benefits to human health would be immeasurable.

Dean Giustini, UBC biomedical branch librarian
University of British Columbia, Vancouver, BC, Canada

June 9, 2006 Posted by | Health | | Leave a comment

Entry for June 09, 2006

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Calling Doctor Google…

For a while now I’ve been thinking about writing a book about my experiences with the Ontario Health Care System. I was thinking using the title: “Calling Doctor Google”

I mention this to a friend who says I should google that title to see if it has been taken already. Good idea! Let’s see what comes up.

One of the searches pulls up a blog written by a librarian dated December 23rd, 2005 at 3:01 pm. The entry is called “Calling Doctor Google” and it talks about how the medical community is using google as a diagnostic tool.

Within a year of its release Google Scholar has led more visitors to many biomedical journal websites than has PubMed (J Sack, personal communication, 2005).

I was particularly interested to see the table from the BMJ’s web access stats, which lists Google as its number one referrer, by far, in November 2005 (345,756), and Google Scholar as its number two referrer (105,185). PubMed trailed significantly far behind — fourth place was PubMed Medline (14,522) and fifth place was PubMed Central (9,616). Of course, one shouldn’t read too much into this relatively raw access-data. A lot of factors must play into the numbers.

Who are these searchers? Medical consumers typing in terms in google, hoping for consumer information? If they end up going to the BMJ, that’s probably more than most of them want to know, at least in an initial search. Or are they physicians realizing google is a shortcut to particular articles? Does this set of referrals include, for instance, academic-affiliated researchers? Many of them probably have access to their own institutional subscriptions to BMJ, and if requests are being routed through a local proxy then how is that reflected in these numbers?

Still, anyway you slice it, it’s obvious that Google — or maybe it’s better to describe it as “general search” — is becoming significant for medical research. And Google Scholar is more successful than I’d realized.

And then this cropped up in the editorial, too:

In a recent letter in the New England Journal of Medicine, a New York rheumatologist describes a scene at rounds where a professor asked the presenting fellow to explain how he arrived at his diagnosis.[4] Matter of factly, the reply came: “I entered the salient features into Google, and [the diagnosis] popped right up.” The attending doctor was taken aback by the Google diagnosis. “Are we physicians no longer needed? Is an observer who can accurately select the findings to be entered in a Google search all we need for a diagnosis to appear—as if by magic?”

Ten years ago librarians were all a-twitter about the fear that search engines (Yahoo! and Altavista were the big contenders then) would displace librarians. Most librarians blustered it out: “Nothing can replace a librarian!” but there was definitely some anxiety in the ranks. Now physicians. Relax, docs. Librarians, doctors, and search engines, all will find their place in the brave new world of infinite search. And it’s important that consumers have access to as much information as possible to critically evaluate and assess all the other info streamed at us daily. For example, since the FDA has deemed it acceptable for drug companies to “inform” us about their wares via millions of dollars of direct-to-consumer advertising, consumers get barraged with info about commercial drugs provided by commercial for-profit entities. In that information environment, it’s vital for consumers to have consumer-directed diagnostic information to assess Big Pharma’s claims.

Ultimately it will improve healthcare. What did you think all those consumer health awareness services were about if not, ultimately, this?

June 9, 2006 Posted by | Health | , , | Leave a comment

   

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