Blog | Tuesday, February 9, 2016

Should patients consult Dr. Google?

You see your gastroenterologist with long standing stomach pain. You have undergone a reasonable evaluation and all the endoscopic bodily invasions and imaging studies of your abdomen have been normal. Repeated lab work provides no clue explaining your distress. You have been twice to the emergency room and were sent home with prescriptions that didn't work. You are frustrated and so is your gastro guy. You are convinced that there is a diagnosis that has been missed and you have the Google search to prove it.

Every physician has had patients who come into the office with reams of paper from an internet search. Usually, this approach uses a net that is just slightly over-sized for the task at hand. It would be like using a butterfly net to catch a paramecium.

Plug a few symptoms into a search engine, and then be prepared to take a year or so to review the results. Pick a symptom, any symptom.

Whistleblower Search Suggestions
• causes of stomach pain
• causes of fatigue
• causes of fever
• causes of joint pains
• causes of dizziness

The above searches might crash your computer and I hope I will not be legally vulnerable should this occur.

The internet is a powerful medical tool. Most physicians, including me, rely upon it. It contains an encyclopedic reference on all knowledge, but hasn't yet been able to rival living, breathing human healers with respect to medical judgment. Of course, artificial intelligence will surely enter the medical arena in our own lifetimes. Technology will continue to “byte” into the medical profession, bringing great rewards and many costs to society. While we can argue over technology's merits and drawbacks, its victory is inevitable.

I counsel patients daily that we physicians cannot eliminate all diagnostic doubt. There is no CAT scan, laboratory study, physical exam or professional opinion that is 100% certain of anything. All of us want reassurance that we are well. Every physician has been asked throughout his career by worried patients, “are you sure I don't have cancer?” Seasoned physicians are very careful with our speech and choose words carefully. We rarely speak in absolute terms.

We can't exclude every diagnosis, but like lawyers, we strive to surpass a reasonable doubt threshold. How much uncertainty are you willing to accept? How much doubt will your doctor tolerate?

Of course, this varies with the circumstance. We are likely to push harder to explain rectal bleeding and weight loss in a 60-year-old man than we would in an 18-year-old college freshman with stomach aches.

The hypothetical patient at the beginning of this post wants more work done. Assume the physician has already excluded 85% of the common causes of stomach pain. How much more medical work and money is worth reach the 90% level? 95%? If we use the patient's Google search as a road map, then the diagnostic journey is likely to be an endless excursion into the abyss.

When we search Google to find a restaurant, a vacation site, a plumber or a movie review, most of us well click on a few hits, even though there may be hundreds or thousands of search results. We can't spend our lives swirling and spinning in a search engine, even if it means we did not hire the best plumber. We make a reasonable effort and then we make a decision.

While I admit that the stakes are higher with one's health than with a clogged toilet, patients need to be wary of an avalanche of medical information that spews forth unfiltered noise and static.

I'm not suggesting that if you have an unexplained symptom that you simply accept it. Of course, one reason your symptom might be unexplained is because a diagnosis has been missed. There is a role for a second opinion or pursuing additional medical studies. But, not every symptom can or should be explained. Every case is different. Knowing when to pull the trigger or to hold your fire—the essence of medical judgment—is not something I would consult Dr. Google on. I'd talk to a real doctor instead.

If you feel I've missed the mark on this post, go for a second opinion. Google is just a click away.

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.