Monday 26 February, 2007

Google-based medicine

Posted in Advice, Emergency Dept., General Practice, Michael Tam, Rants, Wards at 23:00 by Michael Tam

Original article by: Michael Tam :: Printer friendly

Warning: This article is as much tongue-in-cheek as useful advise.

As much as we aspire to EBM (evidence-based medicine) I suspect that many of us perform “GBM” (or Google-based medicine)!

Google has become an invaluable tool as part of my day to day practice. Indeed, I find certain aspects of practice irritating without access to the internet (e.g., the current general practice I’m working in as well as the occasional hospital ED that is restricted by a firewall).

I use Google on a day to day clinical basis in a number of settings:

  • Searching for patient handouts;
  • Looking up clinical information on uncommon and rare diagnoses (e.g., something unexpected on a discharge summary or after a specialist visit);
  • Looking up highly specialised medical terminology (i.e., when the radiologist decides to be clever in a report);
  • Units conversion (e.g., imperial to metric);
  • Information on herbal “medications” that aren’t on the PBS;
  • Information on medications with different international trade names (e.g., the international visitor who has run out of medications);
  • Anticipating “worried” patients by keeping an eye out on the latest “health scare” misinformation touted in the “mainstream media”;
  • Looking for contact details of specialists when the Yellow Pages and White Pages fail.

A shelf full of medical textbooks may seem distinguished but is is also anachronistic and so twentieth century!

The best and most up-to-date medical information that you can access is rarely in a “dead tree” volume.

I do not use Google for diagnostic purposes simply as it’s somewhat of a mixed bag. Interestingly enough, a couple of Queenslanders, Tang and Ng, published a study looking at the diagnostic value of plugging symptoms into Google to see if the correct diagnosis would arise. Impressively, it did so over 50% of the time (admittedly, for the more common diagnoses) (1). My “gut” feeling, however, is that it is still a bad idea to rely on Google for diagnosis though it may be useful for reviewing for possible differentials that you may not have thought about.

Google is also not particularly good for management guidelines. For that, it is still preferable to access known high quality sources (e.g., the “Therapeutic Guideline” series through CIAP).

DO

  • learn how to make the most out of Google and internet resources in general;
  • collect a group of “trusted” clinical websites that you use for your clinical information;
  • insist that your workplace has readily accessible broadband internet on all work terminals;
  • judge online clinical information with a critical eye (who wrote it? evidence? bias?);
  • be aware that there is a whole “alternative reality” of pseudoscientific quakery masquerading as real medicine on the web;
  • realise that many patients consider Google to be authoratative (2) and have a method in educating patients about online self-diagnosis.

DO NOT

  • Use Wikipedia as an authoratative source, EVER (even Jim Wales, Wikipedia founder discourages the practice);
  • use any other online encyclopedia as an authoratative source;
  • use posts on patient forums as any sort of evidence for anything;
  • trust any information where you cannot verify the identity of the author.

Reference articles

(1) Tang H., Ng J. Googling for a diagnosis – use of Google as a diagnostic aid: internet based study. BMJ 2006;333;1143-1145 [Link :: PDF 258 Kb]

(2) Tam M., Su M. 2006, “The world according to Google”, Creation of The Medicine Box, Lulu.

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2 Comments »

  1. Tom Plamondon said,

    I agree with the author view of using internet which I use daily in my practice. I do not use wikipedia or other popular media columns for medical decisions. Usually tap into FP Notebook or onto my Uptodate subscription, or AAFP. Recently, I have found sites like this (written by physician for physicians or med students).

  2. darawk said,

    While I agree with you that using Wikipedia as an ‘authoritative’ source is definitely a bad idea, I think it is important to mention that that isn’t to say it shouldn’t be used as a resource at all. Much of the information on wikipedia is indeed accurate (and there have been a few studies that prove it), and it is the world’s largest encyclopedia by several orders of magnitude. What Wikipedia is extremely useful for is providing a jumping off point for a particular topic. Most Wikipedia pages cite sources, and so if instead of throwing Wikipedia out all together you use it more as a service of collating and summarizing various sources, it can be very helpful indeed. Of course, it’s always necessary to verify the presence, legitimacy, and accurate transcription of the original source material.


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