Physicians rely on search engines to help find clinical information

Physicians use many information sources to help them diagnose or treat their most difficult cases. It turns out many rely on Google to help them find those sources.

A survey of more than 300 doctors by Wolters Kluwer Health, a provider of textbooks and point-of-care information tools, found that two-thirds of physicians use Internet search engines such as Google and Yahoo to look for information related to the diagnosis and treatment of patients.

The results were similar to those in a study commissioned by Google that was released in November 2009. It found that 86% of physicians use the Internet to gather health, medical or prescription drug information, and 71% said they start with a search engine.

The Wolters Kluwer survey did not ask physicians what they search for, but the Google study showed that 57% use search terms related to conditions, 36% use terms related to treatments and trials, and 33% look for branded medication.

Karen Abramson, president and CEO of Wolters Kluwer Health Medical Research, said medical journals were still the most-used source of information. She said many physicians probably are using Google to help locate medical journals online. But she wonders if they find what they are looking for, whether what they do find is good information, and how long the searches take.

"We know that people really don't read beyond the first page of Google results," Abramson said. "And [we don't know] whether or not the Google search engine is going to rank the right article that is out there somewhere and whether or not that article becomes visible. That's really what you potentially miss as a physician using a broad-based tool like that as opposed to a clinical decision support tool ... that is designed to take you specifically to the answer."

A spokesman for the website PubMed, an online repository for biomedical literature, said a large number of users come to the PubMed site and other authoritative sources at the National Center for Biotechnology Information from Google searches. But they have no way of tracking how many users are physicians, he said. PubMed was developed and is maintained by the NCBI at the U.S. National Library of Medicine, which is located at the National Institutes of Health.

A variety of searches

Forty-six percent of the surveyed physicians said they frequently use search engines such as Google or Yahoo, and 32% said they occasionally use them. But they also use other online resources, such as free online services like WebMD or MayoClinic.com (42% frequently, 34% occasionally), and online subscription services (36% frequently, 31% occasionally).

Nearly nine of 10 physicians said improved access to online medical information has improved quality of care, and 63% reported having changed an initial diagnosis based on new information found online.

While use of Google could result in users having to scroll through a few pages before finding the right answer, a 2006 study found that there's a good chance the right answer will be located.

Researchers at the Princess Alexandra Hospital in Brisbane, Australia, were assigned 26 difficult cases that were featured in the New England Journal of Medicine but were blind to the actual diagnosis. Google searches revealed the correct diagnosis in 15 of those cases, or 58%.

One author of that report, Dr. Hangwi Tang, a respiratory and sleep physician at Princess Alexandra, said that "the intended message of the paper was that in cases of 'mystery illness,' a Web search may be fruitful in finding articles which may suggest a diagnosis which would not have otherwise been considered because of its rarity and unfamiliarity with its symptoms and signs." But, he warns, "any article located from the Web should be critically appraised in the usual manner."

The authors acknowledged other limitations to using Google and other search engines.

"Arguably, everything could be found on the Web if only one knew the correct search terms," the authors wrote. They suspected that cases with unique symptoms and signs that can easily be used as search terms are more likely to produce a correct result. Many times the efficiency of the search depends on the physician's knowledge base going in, the researchers said. The research was in the Dec. 2, 2006, issue of BMJ.

Abramson said the fact that physicians are resorting to using Google indicates a need for them to have better access to trusted resources and tools, such as clinical decision support tools that contain evidence-based knowledge that can be accessed at the point of care.

Dr. Tang says: "We are less concerned about the philosophical objections of how an article is located than with its usefulness in patient care. To state the obvious for those who have missed the point, there is no danger of Google misdiagnosing life-threatening disease, as search engines cannot make diagnosis. Only doctors are capable of making diagnosis, and misdiagnosis."