Tuesday, May 09, 2006

Dr. Google

How many of us haven't, at one time or another, googled a worrying physical or mental health symptom or returned from a health care consultation to look up a diagnosis or treatment on the Internet?

A recent study by Pew Internet/American Life revealed that the Internet is one of the first places people turn to when seeking information about a health problem. Indicative of the influence of the Internet, 58% of people who found the Internet to be essential for health research said they had located their most important piece of health information online.

What kind of health information are people looking for?

The report shows that people use the Internet to self-diagnose, learn more about specific conditions, research treatment options, compare experiences with and seek support from others with similar conditions, as well as pursue additional professional advice.

Dr. Google is in

And why not? As doctors have less and less time to spend with their patients, it's easy to understand why people seek out health information on the Internet.

Dr. Google is there whenever you need him and the information available is almost limitless. Try Googling physical problems such as thyroid disease and diabetes or mental illnesses such as depression and anxiety. You'll get 20.5 million, 98.6 million, 159 million and 99 million pages of information respectively.

The Internet can also facilitate access to all kinds of experts from around the world: from traditionally trained medical and mental health practitioners, to a wide variety of alternative health specialists and to those individuals whose expertise lies in their personal experience with a particular condition.

Add in the anonymity inherent in the Internet environment and researching that worrying health issue on the Internet is an attractive option.

So it's all good?

Well, actually, no. While there is no doubt that the Internet can be an extremely useful physical and mental health resource, there are a number of concerns that need to be taken into account when using the Internet in this way.

Quality of information

Most concerns relate to the accuracy of the information made available. There are no restrictions on who can set up a medical or mental health website and verifying the credentials of an individual or organisation responsible for a website can be difficult, if not impossible. While only 6% in the Pew Internet/American Life survey reported getting bad information, how many people actually think to verify the information they get online?

An additional problem is that the information available can be biased. Often, sites may be set up by commercial organisations and pharmaceutical companies. In many cases, the commercial connection will not always be obvious. This raises the question as to whether the information provided is skewed towards a particular interest.

Within the Internet environment, there is no filter for good or bad information. The only moderator is the individual who is viewing the information.


In the past couple of years, there's been a lot of discussion about cyberchondria, an excessive preoccupation with one’s health caused by often erroneous Internet information. While medical information has always been available, the size of the audience, increased accessibility , volume and depth of information online generates great potential for augmenting health concerns.

In regard to health, everyone differs in how much information they want and can cope with. When accessing the Internet for health research, those individual informational preferences cannot be accounted for. Individuals can therefore often come away overburdened with information.

While not wishing to detract from the potential benefits of online support groups, the anecdotal evidence available in chat rooms and on bulletin boards can be a minefield for those already pre-disposed to health anxiety. There can often be a high degree of inaccuracy inherent in such information and, occasionally, personal experience can be subjected to a degree of sensationalism. As individuals recount their own experiences, the story of the rash that disappears without a problem is less likely to be heard. The headache that turned out to be a brain tumour more so. Distancing oneself from the experiences of others can be difficult when facing health concerns.

What should I be aware of in using the Internet as a health resource?

Health on the Net Foundation (HON) has developed a "code of conduct", which holds participating health Web sites accountable to basic ethical standards of information presentation. Look for Web sites that adhere to the HON Code of Conduct. Such sites will contain the HON logo.

Be aware of sites sponsored by commercial interests where information may potentially be biased towards the company's interests.

Be wary of any web site that charges for online consultations or diagnosis. It is difficult to be certain that you are communicating with a health professional and an accurate diagnosis without face-to-face contact is unlikely.

If asked to provide personal details, consult the site’s privacy policy to ensure prevention of unauthorised access or use of your personal data

If you have a specific area you wish to research, consider asking your health care provider for guidance in finding reputable sources of information. Similarly, if you encounter information that concerns you, ensure you clarify it with your health care provider.


Tiesha said...

This is a really interesting and great post. I've done this! It's important for us to take this into consideration too. Patients are more informed than they used to be...not always with good information, but more informed. It's part of our responsibility as people who provide care one way or another to serve as a resource and guide to our paitients. I love the tips you have! I think the internet is in general a good thing. I just think it's kind of sad that providers don't have enough time for their patients. Thanks again for this post!

jumpinginpuddles said...

we live in the country where a wait for a doc can be a week, sometimes its better to go to the net first rather than wait it out and waste their time.
Other times ive phoned the doc and asked for a script and said symptoms diagnosis script rather than waste your time. We have been given it. Why because he knows we are right.
reality is google is faster than appointments, reality, docs are paid shit for long hours lots of grief and high insurance premiums. End of the day google wins, sad but true. Docs make the same mistakes as google seems fair in the long run to me.

Dr. Deborah Serani said...

I have been using the internet for many years helping to educate, diagnose and find resources. I think it is the single most important asset in my practice. I have linked and found amazing things. Now blogging will be added to that. It is the "new" frontier.

:) Deb

healthpsych said...

Hi Tiesha's Place, jumpinginpuddles and Deborah,

I totally agree that the internet is an amazing resource for both physical health and mental health issues. That just needs to be qualified with the need to be aware of the variations of quality of information. Some health professionals provide 'internet prescriptions' for their patients ie. recommendations for tried and tested resources which I think is great. At least, people are steered towards decent resources.

As for cyberchondria? Well, this was the subject of my earlier thesis and I found that the health information on internet in itself doesn't really exacerbate health -anxiety. In truth, what is important is the unique set of circumstances and vulnerabilites of the individual.

Deborah, it's great how you have utilised the internet to provide information and expand knowledge. I find your blog extremely educational...I'm still working my way through the earlier posts. An excellent resource.

Anonymous said...

Today an article titled" Googling for a diagnosis-use of Google as a diagnostic aid: internet based study" appeared in the November 10 issue of the BMJ, British MedicalJournal.

The article's authors , Hangwi Tang and Jennifer Hwee Kwoon NG, discuss the success of using Google search to diagnose patients by putting in their signs and symptoms(3-5).

The diagnostic cases(26) were taken from the New England Journal of Medicine 2005.

The results were impressive. What the Google search found were numerous revelant articles and citations which when read by physicians could selected the correct diagnosis 58% percent of the time.

Currently, the searches are performed by typing in multiple signs and symptoms, ie,

sore throat, rash,.... fever, etc.

Some shortcomings were noted. For one, searches were less likely in complex diseases with non-specific symptoms or " common diseases with rare presentations."

One can anticipate various ways to increase the accuracy of diagnosing:

- input of vital signs: HR, T,BP, O2 sat
- input of lab values
- input of signs and symptoms in appearance order
- imaging study results

This paper shows there is a tremendous interest in medicine in using Google as a search tool in the diagnosing and possible care of patients.

One can imagine the benefit to young doctor in developing country who now have access to a grand medical library in their hands.

Ward Merkeley, M.D.
Spokane WA