For practicing physicians, there’s a tricky balance in believing that the internet can help save lives.
I’m a doctor who encourages families to look up health info online and one who believes technology will afford improved partnerships. Yet, when we’re in the old-fashioned exam room, there isn’t always a place for the internet. Many clinics block video-streaming sites and don’t allow for traditional email exchanges between clinicians and patients. It’s hard to “send” patients information discussed during the visit. In the 10 or 20 minutes we have together, time is precious. Truth be told, health care remains wary of doctors and patients communicating when they’re not in exam room. Most insurers won’t reimburse or pay for electronic communication between patients and their clinicians. So doctors are often forced to bring you into the office to provide expertise. New data today may help change this paradigm. Reality is, many of us are using the internet as a tool for health care.
For at least 1/3 of American adults, the internet is a diagnostic tool
Yet, it’s not just insurers who may be wary of online info. Recently I read a patient review (online) from a parent who was frustrated I’d encouraged them to read the content on this blog. The comment implied that perhaps I was “pushing it.” And that’s the tricky part–when I first started writing this blog I was bashful to mention it in clinic. I wanted patients to feel comfortable NOT pressured. But now that I have over 350 blog posts showcasing research and pediatric health information it’s tantamount that I share it. I mean, if I’m in the midst of a 15-minute visit and we touch on topics like getting a carbon monoxide monitor, the choking game, the Tdap shot, and the effects of TV on their kid’s developing brain, how could I not augment a parent or teens’ understanding by offering more information online?
Numerous studies find that what parents learn in the exam room with doctors isn’t retained. That’s where Dr Google comes in.
Like any other pediatrician, I want parents to know as much about their children’s health as possible. The internet is another tool. I firmly believe the future job description for primary care docs will include filtering and offering up great online sites for parents to read about, search, and ask questions about their children’s health. Thing is, many people are using Dr Google before the visit.
Dr Google And Going Into See The Real Doctor
New information from The Pew Internet & American Life Project today showcases some realities about our relationship with “Dr Google.” The Pew surveyed over 3000 Americans, inquiring about their relationship with health information seeking online in the previous year. Some of what they found:
- One in 3 U.S. adults (and nearly 1/2 of college-educated adults) use the internet to diagnose themselves or someone else they care about. After these “online diagnosers” have finished a search, their clinician is more likely than not to confirm their suspicions. So it’s not just that people go online to diagnose a medical problem or concern, they take what they learn online and head in to see their physician. Nearly half (46%) say that what they find online made them feel they needed to see a clinician. Further, 41% of those that went into the doctor’s office had the diagnosis they found online confirmed by their physician.
- Women are more likely than men to go online looking for a diagnosis for themselves of a loved one. You’re also more likely to go online to diagnose if you’re a young adult, white, have a college degree or live in a home earning more than $75,000.
- There are some issues though, outside of the obvious concerns for quality of information. One in 4 people looking online for health info report they have hit a pay wall. This means patients are blocked from information they’d like to see. Some can go on Twitter and ask a clinician to send the study of interest, but not most. Of those that get blocked, surprisingly 83% of people who couldn’t get into the medical research they like continued to look for the information elsewhere. Turns out all of our late-night online searching has made us resourceful online diagnosers!
- Seventy-seven percent of people reported using a search engine first for finding out about a potential diagnosis. Only 13% of people went directly to a health site first (something like Seattle Children’s, MayoClinic.com or WebMD). And not surprisingly only 1% said they surveyed their social network (Facebook) first.
To be honest, nothing about this data surprised me even though The Pew mentions this is the first time anyone has measured these findings in a straightforward, national survey.
My clinical practice and experience is likely skewed (by age, education, socioeconomics, and race). The number of people who reported going online to diagnose (35% overall) seemed lower than I would expect. Most parents whom I talk with in clinic have been online to read about their child’s development, their immunizations, their sleep, or their diet at some point. Many new parents do significant amounts of reading even before the baby arrives! In my opinion, we forget that when we’re reading about prevention strategies (safe sleep, vaccines, ways to feed a baby, ways to protect them from chemicals, ways to avoid the “flu,” etc) we’re reading about health. Often people think about health care as only problem resolution—we only think we’re doing medical “research” online when we’re curing illness/anxiety/pain. In my world prevention is key. The internet is one of those keys.
Online Search With Google:
I wasn’t surprised to see that 80% of online diagnosers used a search engine (Google, Bing, etc) first when looking for a diagnosis. We’re impatient and busy–search engines provide rapid responses–no wonder we all start there! Even in the exam room with patients, I often will start with a search engine when a family and I seek to find information.
I think the complexity and trick of serving patients well is in the next step, what comes next–AFTER online diagnosers peruse the search engine results–which site you click on next is telling and likely will have lasting effects on the quality of information you find. That’s where we physicians need to be useful—we need to help our patients know where to go for quality, research-based, data-backed advice.
Parents Learn Much About Their Children Online
Most parents learn about their children’s health outside of the pediatrician’s office. I think it’s more common that a parent looks things up online when worried about something new like a lump on a infant’s head or a new rash. In my experience nearly 1 in 3 or maybe 1 in 2 of my patients will tell me they have been online in those acute care type visits.
Contrastingly, in acute care visits for things like cough, ear infection, or colds parents rarely report that they have been online.
Tips For “Online Diagnosers”:
- Keep a breadcrumb trail as best you can. When we’re online we forget where we go and often don’t know who we’re listening to. Confusion comes in when families don’t remember where they have been garnering information and when they become confused by myths, personal anecdotes, and stories that lead them astray. Everything on the internet is clearly not in our best interest as parents. One solution: print things out or refer to specific links with your physician when you’re in to see them so you can look up online information together.
- Look for advice from experts (psychologists, physicians, researchers). As parents and patients, we don’t make all of our health decisions using science but when we have the opportunity to use solid data to steer decisions, we want the correct sources. Your doctor can help vet the online voices to which you tune in. Ask your pediatrician or clinician what sites they trust the most.
- Look for sites affiliated with academic medical centers or health care institutions. Often those sites vet and scrutinize content with their expert researchers and clinicians. I tend to encourage families to avoid sites heavily laden with advertising as I’ve learned that content on those sites can sometimes be edited to meet requirements in tone, scope, or opinion by advertisers.
It’s my opinion that the last thing we physicians should do is shut down our patients’ online searches. It’s a new world; we must join our patients online since nearly 1/2 of many groups are using Dr Google to diagnose. We must guide families to trusted and valuable voices and then help confirm or redirect the results of their online learning.
Ned Ketyer says
Congratulations on creating a terrific blog! I referred to today’s post on my blog, The PediaBlog. I really appreciate what you are doing — I’m trying to do the same here in Pittsburgh. I’d like to periodically refer to your blog and direct my readers there. Keep up the wonderful writing!
Trisha Torrey says
Thanks for taking the time to tell us how you help your patients use the internet. So many doctors want to pretend the web just doesn’t exist, or get frustrated when their patients ask questions about something they read online, so I appreciate that you instead try to help them do it the right way.
One big piece of advice to offer them is to be sure to choose only reliable and credible websites for their information. What most of that advice boils down to is, “follow the money.” The very slick appearing site that seems wonderfully user friendly is often the one that was built for drug company, specifically to encourage you to ask your doctor for a certain drug, procedure, or device.
Here’s more: https://patients.about.com/od/researchandresources/a/internetcred.htm
Keep up the good work collaborating with Dr. Google.
Every Patient’s Advocate
I read something that went like this once: knowledge will tell you that a tomato is a fruit, but experience will tell you not to put it in a fruit salad.
An important aspect of this new online health information trend is the issue of context, discernment, experience and general knowledge that can only be provided by a doctor.
Although I agree with everything Dr. Swanson eloquently expressed, I’d also like to remind patients that consult with Dr. Google to not underestimate a doctor’s ability (professional training and experience) to view things from a variety of perspectives that are driven by other conditions, symptoms, onset, labs results, family history, health history, current medication and a variety of other factors.
Consequently, I believe that that the best thing both parties can do (patients and providers), is to continue embracing the partnership, acknowledge each other’s strength, and leverage the online resources so that we can achieve what all of us want. Which is maximize our children’s health.
Wendy Sue Swanson, MD, MBE says
Thanks, Brandon. The tomato metaphor –LOVE!
Lacy Bauer says
You have a wonderful resource in your accumulated blog posts. Your writing is clear and direct, empathetic and relatable. How much more useful it is for you to be able to tell a patient that there is more information available on your blog about the topic(s) that just arose during the office visit, than to simply refer them to Dr. Google generally, in hopes they will be able to discern a credible source from the rest! I am sorry that a parent felt you were pushing and was not instead grateful for this amazing resource.
I love being electronically connected to my family’s doctors because there are questions that come up after the visit that I forgot to ask, follow up information to share, etc. Once when my son was an infant, he developed a nasty looking rash after exposure to grass in our front yard, and I was able to upload pictures of the rash, send a link to the pictures to the pediatrician, and she was able to write back and say it was just a contact rash and nothing to rush to urgent care over. Thanks for all that you do!
Heidi Roman says
Thanks so much for this great summary and analysis of the new Pew data. One of my passions is figuring out how to make “Dr. Google” more accessible for my patients and their families. Their access still tends to be quite limited due to literacy level, language, internet access, among other barriers. I think things are improving with arenas such as mhealth, etc but still see this as a new disparity that we need to address as more and more health information moves on-line.
Susannah Fox says
Thanks so much for covering our research in a thoughtful way – this is exactly what we are hoping to spark, a conversation about the impact of the internet based on facts, not conjecture.
We’ve got more data coming out on health: a report on “trackers” next week, then a deep dive into how caregivers and people living with chronic conditions use the internet (two separate reports, due out in Feb/March).
I’m very happy to answer quick questions about our findings on Twitter (@SusannahFox) or, if you have more to say, you can find me on e-patients.net and susannahfox.com.
Jalil Thurber M.D. says
I think it is wonderful that people become informed prior to visiting the doctor. However, using a search engine for self-diagnosis is not the best approach for self-assessment. As an emergency physician, I have seen many people make needless and costly ER visits after ‘googling’ their symptoms online. In many cases, an online search for answers actually led to an unfounded escalation of fears. A recent study by Microsoft, found that the medical content on the internet is skewed towards more serious conditions. This is part of the reason why ‘googling’ your symptoms is not the best way to arrive at a diagnosis. However, the internet is a powerful tool and it can be leveraged to help ‘online diagnosers’ arrive at the answers they seek. At Symptify our contribution to this problem is the creation of a proprietary, patent-pending algorithmic engine that renders virtual consultations by asking users a series of questions regarding their symptoms. Because Symptify takes into account the users own medical history it gives personalized and precise results. This has helped many people become more knowledgeable regarding their health conditions and help them avoid cyberchondria. Symptify also facilitates a user’s access to healthcare providers by allowing them to transmit their consultation record and medical profile to participating facilities. Check it out at: http://www.symptify.com
-Jalil Thurber M.D.
The first step to therapy is identifying the disease.
Carolyn Biglow says
Please also help your patients by guiding them to resources such as MedlinePlus, PubMed Health, KidsHealth and other reputable websites. Educate patients about only accessing health information on websites that are non-biased, and preferably display the HON Code. Also, other experts that patients can look to are medical or hospital librarians, as well as public librarians who have expertise in patient health resources. Librarians are always excellent sources of information, and we are literally human “search engines”!