Thursday, November 8, 2018

Don't rely on Dr. Google

I have a wonderful cartoon on my desk that is appreciated these days by most doctors. A patient is sitting on an exam table, saying to the doctor: "I already diagnosed myself on the internet. I am just here for a second opinion." While the internet is a wonderful source of ideas, it is like an oriental bazaar, with trash and treasure intermingled and often indistinguishable. Nineteenth century America had travelling snake oil salesmen and 21st century America has the Internet. The biggest problem with using search engines to suggest what you have and what to do about it, which most people forget or never knew, is that placement on the page of "hits" is NOT by goodness of fit. Sites pay directly for high placement, and clever consultants teach you how to get high placement for your site by fine-tuning the descriptors. The best answer to your question may be half way down the second page, and you may never look that far. I tried to convince my patients to always start at the NIH PubMed site, which has a wealth of reliable, vetted and unbiased material. If you do not find what you want there, the next place to look is on sites maintained by large hospital systems such as the Mayo Clinic, that offer validated facts and opinions. The commonly used patient symptom checkers are used by millions, and can be helpful but can be very wrong. Part of the problem is their limited databases. Researchers from McMaster University's ophthalmology department entered 42 scenarios of patients with known eye diseases into the WebMD Symptom Checker and found that while the correct diagnosis did appear in the top three 40% of the time, it was not listed at all 43% of the time! Someone has to pay for these "free" services, and it is usually pharmaceutical companies that want you to use their products. The internet symptom checkers thus give priority to conditions for which there are linked ads. So...it is OK to start with "Dr. Google," but caveat emptor: let the buyer beware. For more see my new book, Prescription for Bankruptcy.

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