Doctors offer insights and caveats for Internet searches

Two recent studies have concluded what physicians such as Susan Andrews, MD, already know.

First, that patients need help navigating health information on the Internet. Second, that physicians shouldn't be afraid to try a Google search if they need help with a diagnosis.

Dr. Andrews, a Murfreesboro, Tenn., family physician, refers patients to specific health sites if they want more information. But she said she also uses Google several times weekly to search for information that can help her diagnose or develop treatment plans for her patients.

"I mean, [patients] can't have the filter that I have because I have had 30 years of training" and experience, Dr. Andrews said. "I can look at a long list of Google results and [quickly] know which ones are from quacks."

Still, for either physician or patient, Dr. Andrews and others say the watchword is proceed with caution.

On Oct. 28, the Washington D.C.-based Pew Internet & American Life Project released a study that found 80% percent of adult Internet users research health information online. But 75% of them fail to check the source and date of that information. Pew says 113 million adult Americans have searched for health information. Manhattan Research in New York last month pinpointed that number at an estimated 116 million this year, up from 75 million in 2001.

J. Carson Rounds, MD, a family physician in Lake Forest, N.C., and president of the North Carolina Academy of Family Physicians, reported the quality of the information his patients find on the Web is usually bad, and that patients are often unable to tell him the source of their information. Dr. Rounds recommends a few sites to patients, but he said he might need to do more research on his own. That's because the Pew Internet survey "tells you that a lot of people go looking [for health information online] whether they bring it to our attention or not," Dr. Rounds said.

Kevin Pho, MD, an internist at a five-doctor group in Nashua, N.H., said he encourages patients to ask him about anything they find online. "The key is the interpretation," Dr. Pho said. "That's where the physician role comes in."

Meanwhile, a study published in the Nov. 10 online British Medical Journal suggests physicians can also benefit from some Google searching.

In that study, two Australian physicians selected 26 difficult-to-diagnose cases published in the New England Journal of Medicine in 2005. Next, while being unaware of the correct diagnoses, they entered three to five keywords for each case into Google. The search engine provided a link to the correct diagnoses in 58% of all cases.

Dr. Hangwi Tang, the lead author of the BMJ study, wrote in an e-mail to AMNews that he is not advocating that doctors use search engines to diagnose patients.

"However we sometimes see patients with mystery illnesses," said Dr. Tang, a respiratory and sleep physician at Princess Alexandra Hospital, Brisbane, Australia.

"The traditional approach for these is that we discuss it with other doctors, search PubMed/Medline or even go to the library. I'm advocating Web searching as another tool in these scenarios."

When doctors use search engines to come up with a diagnosis, they should tell their patients, Dr. Tang said.

Dr. Andrews searches while she's in the exam room with patients.

"Say it's something I knew what you were supposed to do 10 years ago but I have the patients in my office again and I haven't seen anybody with [that problem] for a couple of years," she said.

"While they are there, I'll look it up on the Internet to see if I'm still right. And, I tell them that's what I'm doing." Dr. Andrews says she prefers to use Google because she can get a wider array of results than if she searched on only one medical journal's Web site.

Dr. Pho, who writes a blog commenting on internal medicine and medical news, said he would use Google if other tools failed to suggest a diagnosis, or if he wanted to learn about other possible diagnoses.

"I think Google is a good tool, but I wouldn't rely on Google because if you use it all the time you would only be right 58%" of the time.

Were he to use Google, Dr. Pho is unsure whether he would inform patients. It's not that he thinks using a search engine is something he should hide or be ashamed of; but, he said, he doesn't tell patients when he uses other tools such as Harrison's Principles of Internal Medicine to treat or diagnose them.