A Medical view on "Googling your symptoms"...

Andy's post (Google Health... some thoughts), although opinionated and not medically based - is correct.

I understand and support the notion that a patient HAS to be educated. They take their pills regularly, they look after themselves, they’re more compliant patients if they understand what’s happening to them.

But... What’s wrong with the Internet is that patients have no guidance on what they’re educating themselves with – what to hold onto vs. what to discard. They end up wrongly informed – which is far worse than not informed at all.

I worry about Google's content rating system. You’re asking non-medical, ignorant people to judge the relevance of medical content. There’s a reason doctors study for 6 years and then practice for 2! It’s like me trying to make a judgement on the performance of the latest BMW – I just don’t have a clue!

Prime Example. Had a patient the other day who’s 6 year-old daughter has rectal prolapse. She’s been seen by a GP and paediatricians and no sinister cause has been identified. Mommy went to the internet and looked up rectal prolapse – and of course - out pops the textbook list of causes. She then arrived at the Practice with her mind made up. Her daughter now had cystic fibrosis – and I should investigate accordingly. Cystic fibrosis is barely even a contender in this diagnosis btw.

Now. I had to explain to Mommy and her superior Internet knowledge that cystic fibrosis occurs in BOYS - almost exclusively! And that if there were any signs of cystic fibrosis – the signs would have manifested as increased mucus at the age of 2!

Two consultation sessions later, and a bunch of time wasted trying to explain to Mommy that just because it's on the internet – doesn’t mean its true... a mild example of what can go wrong with layman internet research.

Don’t believe me? Try it out for yourself. Go to Google.com. Type in “rectal prolapse”. Conveniantly, Google picks this up as a medical term and offers you Treatment, Causes, Diagnosis, For Patients, Alternative Medicine etc. etc. examples. Click Tests / Diagnosis. Result number 3 is E-Medecine. And there, for all to see and interpret, is a pretty damn scary list of causes.

- Advanced age
- Long-term constipation
- Long-term diarrhea
- Long-term straining during defecation
- Pregnancy and the stresses of childbirth
- Previous surgery
- Cystic fibrosis
- Chronic obstructive pulmonary disease
- Whooping cough
- Multiple sclerosis
- Paralysis (Paraplegia)

This isn’t differentiating between age, gender or pre-existing illnesses – three of the most fundamental differentiators. That’s WHY doctors have consultations. To narrow down, or eliminate lists of causes before a proper diagnosis.

Little Susie is now a potential victim of Whooping Cough and Multiple Sclerosis – and if Mommy is paranoid enough… Chronic Obstructuve Pulmonary Disease (Translation: Emphysema. Do you really think the 6 year old has been smoking 20 cigarettes a day for 20 years?)

Empower the patient - definitely! But who's going to help us undo the influence of bad research?

Googling your symptoms & medical history is dangerous territory...

Here's something. Reading an article on the Official Google Blog called "Health Care Information Matters". This is a really fascinating argument that seems to be resurfacing. Interesting link back to the TV Doctor Showdowns that we've been doing... House MD has been making a LOT of jokes in Series 1 and Series 2 about the danger of patients diagnosing themselves. Ah, the Internet. Diagnosis tool of the future. No, you don't have "insert-ridiculously-rare-tropical-disease-name-here"!



So, Google is getting in on the action. Their blog post says:

In the end, one key part of the solution to these problems is a better educated patient. If patients understand their diseases better -- the symptoms, the treatments, the drugs, and the side effects, they are likely to get better and quicker care -- before, during, and after treatment. We have already launched some improvements to web search that help patients more easily find the health information they are looking for. Using the Google Co-op platform, Google and the health community have labeled sites and pages across the web making it easier for users to refine their health queries and locate the medical information they need. Do a search on Google about a medical issue or treatment like diabetes or Lipitor and you'll see some choices for refining your query, such as "symptoms," "treatments," and so on. If you click on "treatment," your search results are refined and reordered so that sites that have been labeled as being about treatment by trusted health community contributors are boosted in the rankings. Note that how trusted a contributor is -– and thus how much they affect your search results -– is dependent both on Google's algorithms and on who the user decides they trust. For example, if my doctor is a Google Co-op contributor and I indicate to Google that I trust her, then when I search, the sites she has labeled as relevant will show up higher in my search results.

This presents an interesting quandry. Do you empower patients with the information, to help them through weak "support" sections of a national health system at the risk of placebo sickness? As a non-medical patient essentially - I think the risk is terrifying. Google my symptoms - and come up with the wrong set of suggestions? I would get hives on the spot.

How much can we trust the Google Search Algorithm, or its users' quality rating of the information it returns? When it comes to correctly equipping me with the right information about my health? I don't know...

The post goes on:

Patients also need to be able to better coordinate and manage their own health information. We believe that patients should control and own their own health information, and should be able to do so easily. Today it is much too difficult to get access to one's health records, for example, because of the substantial administrative obstacles people have to go through and the many places they have to go to collect it all. Compare this to financial information, which is much more available from the various institutions that help manage your financial "health." We believe our industry should help solve this problem.

I'm all for empowering the individual - it's something Google does really well. But a Doctor's handwriting is illegible for a reason! I'm kidding. But the pressing issue here is having health records available via the Internet. Just by definition - private medical records opened up to a world of hackers / crackers and identity thieves has me quivering in my paranoid Internet boots!

How does that suddenly translate to a South African context - where we hold things like HIV status absolutely SACRED. In SA, a medical representative is not even allowed to consult/reveal HIV status to a spouse.

Am I being naive in terms of how such information could be protected on the Web? Or will this open a whole new bag of stigma worms in a country like ours?

Kudos to Google for continually trying to improve and empower. Perhaps we need to take a quick step backwards and consider the consequences?

TV Doctor Showdown. To be continued...

Just realised I don't know any more TV doctors. Well enough to write about them at least.

Thinking of adding Dr. John Dorian (Scrubs) to the contestant list - but I used up my "Appletini, STAT!" picture... and that just ruins the comedic value of the post. I've got the one above, but those shifty eyes...

Then there's George Clooney (so hot!) and a couple of others. Further research and some DVD box sets needed. The Showdown will continue at a later stage.

In case you missed out, here are the current contestants, in order of merit:

1. Dr Perry Cox (Practices in Scrubs and scored 6 / 10)
2. Dr Gregory House (Practices in House MD and scored 5 / 10)
3. Dr Meredith Grey (Practices in Grey's Anatomy and scored 4.25 / 10)

The origin of the word... STAT!

This word, STAT has always bemused me, being around Doctors so much. STAT. What is it? It sounds so doctory... We all know what it means, but can only the cool doctors say it? Or is it part of medical vocab and something more serious. Good 'ol SA Doc tells me it NEVER gets used in the South African context. Porter! Move that bleeding patient. STAT! Unlikely.

So, turned to AskYahoo (nice service by the way) for an answer.

We've all heard the harried medical team on ER call for something "stat." From the context, we knew it meant "quickly," but had no idea what the normal definition of the term was. We turned to the Net to cure our ignorance.

After various searches on phrases like "stat terminology" and "stat meaning" failed to provide an answer, we sat down and rethought our strategy. Several of our searches had turned up acronyms for the term, and while they weren't what we were looking for, they did point us in a new direction.

Remembering a helpful site we'd used in the past, we pointed our browser to Acronym Finder, a web site devoted to decoding mysterious combinations of letters. Typing in "stat," we hit the "Find" button and awaited a diagnosis.

As it turns out "stat" stands for a number of things, ranging from the obvious (statistics) to the not so obvious (Society of Teachers of the Alexander Technique). However, the very first entry provided the answer to your question. "Stat" in medical parlance is actually not an acronym; it's short for statim, the Latin word for immediately.

That made sense, considering many medical terms have Latin origins. Next time we get a similar question, we'll know to head to our Latin dictionary. Stat.

Hope that helps eh? In the immortal words of Dr John Dorian.

"Appletini. Stat."

Call for BritMedBlogs... How about the South African ones?

Great fan of the NHS Blog Doctor - such a spoofy, yet real insight into a health system where you have to get a consent form before giving an injection! Here's to hoping that Dr John Crippen Esquire - take's a look at some of the fantastic medical blogs coming out of South Africa!

Read more here... NHS Blog Doctor: The BritMeds

Or take a turn by some of SA's finest...

• All Scrubbed Up (you're on it, wombat)
• Just up the Dose (angsty, studenty, funny)
• Try not to Kill yourself this Year (pity it's closing)

I actually thought there were a couple more when starting this post. Hmm. Any others out there? I'm sure I'm missing a bunch...