This week, Google announced that it will be including medical data fact-checked by healthcare professionals in search results. Given that so many patients already turn to Google and the Internet for self-diagnosis and treatment planning, we reached out via e-mail to a variety of primary care physicians to ask:
Is this a step in the right direction, or is the move away from the physician's office and into self-diagnosis an unhealthy one?
Will this contribute to the "medicalization" of America or reverse that trend?
The participants this week are:
Zubin Damania, MD, founder and CEO, TurnTable Health, a direct-pay primary care clinic in Las Vegas
Edward A. Kulich, MD, FAAP, a pediatrician in private practice and founder, kidshousecalls.com in New York City
Shirin Peters, MD, a primary care physician in private practice at Bethany Medical Clinic of New York
Erik H. Suh, MD, a primary care physician in private practice at Eastside Primary Care and Wellness in Los Angeles
Dana S. Simpler, MD, a primary care physician in private practice, part of the Mercy Medical Center, in Baltimore
Vandna Jerath, MD, FACOG, a primary care physician in private practice at Optima Women's Healthcare in Parker, Colo.
Beware Unknown Searches
Zubin Damania, MD: "All docs should support patient empowerment. But no docs should support Jenny McCarthy empowerment. Unfortunately, Dr. Google doesn't discriminate well between recommendations with massive evidence supporting them and recommendations with massive tinfoil hats protecting their supporters. Between paranoia-inducing journeys on legitimate medical sites and psychosis-inducing jaunts on certain discussion boards, patients risk having their unique story remain unheard -- and in that story lies their answer. A great primary care doc with the time to listen can hear that unique tale and parse what patients are reading online. It's our responsibility to create the medical environment where that sacred interaction is given the space to thrive."
Edward Kulich, MD: "Self-diagnosis is usually a step in the wrong direction. Too much information is most certainly a bad thing. It is a common phenomenon that when medical students are in their second year of med school and begin to learn about all the diseases that can afflict people, they begin to wonder if they have a particular ailment. Without appropriate experience and context, parents and patients can literally drive themselves crazy with the glut of information that is just a quick 'Google' away."
Shirin Peters, MD: "The trend for patients to turn to Google for diagnosis and treatment is likely not a step in the right direction in my opinion. Patients who turn to Google for information are 'worriers' and nervous-types at baseline, and will find a spectrum of possible diagnoses for any single symptom they search. This often leads to panic, and patients come to my office for further clarification in a state of stress. At times patients ask for very specific treatments for very rare conditions because they are convinced this is their diagnosis (after Google searching) and it takes considerable effort to convince them we first need to do diagnostic testing."
Erik Suh, MD: "Dr. Google has both a good and bad side to him. The good side is that he is very informative when you ask him about certain conditions and symptoms and he is accessible and on call 24/7. The bad side is that he will freak you out with too much information. He is more like a robot without personality and has bad bedside manner."
Embrace the Searching
Dana Simpler, MD: "Many patients bring their Internet search to their office visit, where some physicians embrace the interest in understanding disease, while other practitioners may find it counterproductive. I personally think that more information is great. Patients are living with and thinking about their medical problem 24/7. If a patient can find a novel treatment for their problem, I am all ears. We should discourage patients from doing self-treatment based on an Internet search. What may seem like an innocuous symptom to a lay person could be a big red flag to a seasoned practitioner."
Vandna Jerath, MD: "Some people may indeed use 'Dr. Google' for self-diagnosis and treatment; however, most will use this as an opportunity to educate themselves on their symptoms or condition, research options, locate experienced healthcare providers, and find support groups of patients with similar conditions. The accessibility and availability of the Internet can be positive and productive and should not be viewed as unhealthy. As patients research their conditions and become more informed, their doctor's appointments will become more productive and they ultimately will have a more positive healthcare experience. The more patients are educated (by both the Internet and their healthcare provider), the more they will engage and invest in their own healthcare and, ultimately, will feel empowered about their health. "
Please Search Responsibly
Kulich: "I don't think this will contribute to the medicalization of America, or reverse it, but I do believe that it is almost impossible for people to stop Googling things that their doctor tells them. The problem with this is that there is no filter between legitimate websites and junk science. People are just as likely to stumble onto the opinion of a famous person without a medical background as they are to find an official statement by a professional medical group. I frequently have to put things in context for patients in anticipation of them Googling what I say."
Peters: "I do think Google searching medical symptoms will contribute further to the medicalization of America. Many patients who would previously have stayed at home and waited for symptoms to pass (which would happen in the majority of cases) are now informing themselves of the worst case scenario and presenting to their doctor's office asking for testing and treatment. Doctors are much more inclined to treat a patient that wants a medication or comes in asking for a specific treatment."
Jerath: "Although the Internet and Google do currently contribute to the 'medicalization' of America as we have seen with the anti-vaccine movement and other conditions, this trend can be improved. It is the responsibility of physicians and other healthcare providers to actively participate and contribute to the Internet having proper and reliable information. There is good health information and bad health information that can be found via Google. It is our responsibility as healthcare providers to provide accurate information, evidence-based medical research, reasonable healthcare options, and proper resources for our patients."
Damania: "The jury is out, but even the speculation is pointless since the genie is out of the bottle with regards to Dr. Google. As physicians, our focus should be on restoring the primacy of the doctor-patient relationship, with adequate funding of primary care, appropriate team-based supportive structures that include empathic nonclinicians such as health coaches, leveraged technology, and appropriate changes to medical education that fosters the skills docs need to curate their patients' online adventures in self-diagnosis. "