Patients’ interest in their medical conditions and management ranges from uninterested to obsessive and includes everything in between. Some patients rely solely on the clinician for information and direction. Others arrive with a thick folder of printed information from a variety of mostly electronic sources, and they are intent on securing responses to a lengthy list of questions about their diagnosis and treatment strategies. As a busy clinician, I often find myself irritated when some or all of the information is quoted from dubious sources or is based on speculation, hearsay, and/or a paucity of valid evidence.
WHAT THE INTERNET PROVIDES
Without time or geography to limit our access to the Internet, individuals are increasingly enticed by the blinking cursor that beckons, “Go on. Ask me anything, anything at all.” It is hard to resist the urge for an instant curiosity fix. By searching the Web, individuals can save the time, inconvenience, and costs inherent to a medical consultation and perhaps even avoid embarrassment related to a symptom or health concern. The Internet empowers individuals with information, which, in turn, might prompt one to schedule a medical appointment.
In 2006, a group of doctors from the Princess Alexandra Hospital in Brisbane, Queensland, Australia, Googled symptoms associated with 26 hard-to-diagnose cases.1 They selected three to five terms to describe each case. In 15 of the 26 cases, Google—or, as I like to say, Dr. Google—provided the correct diagnosis. The average doctor has been estimated to carry about 2 million facts in his or her head; Dr. Google has instant access to 1.5 billion articles.2
In September 2014, WebMD/Medscape Digital Technology surveyed 1,406 clinicians and 1,102 patients. Among the results, 84% of patients and 69% of clinicians felt patients should use Internet resources to assist in their diagnosis.3
HOW PATIENTS USE THE INTERNET
A Nielsen Online Survey in March 2014 found that the average Australian citizen spends more time online (13.7 hours surfing the net per week) than watching television, that 80% of the total population (men, women, and children) use the Internet, and that health information is the largest single search subject. According to a study by the Pew Internet Project, eight in 10 Internet users, or approximately 95 million American adults, have searched for health information on the Internet.4 Some even use the Internet for ideas on creating sick notes for work and school.
In May 2014, Synovate Healthcare reported that 5% of 9,642 multinational health consumers surveyed used the Internet as their primary source for health information. As a result, 18% of those surveyed saw their doctors less often, which has ramifications for health care providers but could incentivize health insurers to reduce their costs to encourage patients to visit their physicians more regularly.
WHAT INFORMATION DO PATIENTS FIND?
Online information is almost unlimited. It encompasses some purely scientific evidence, some evidence-based research, and an array of opinions that include alternate views about anything and everything. There is also an abundance of material that could be described as fraudulant, exploitative, dangerous, and even demonic.
A recent Google search for “glaucoma” yielded 19,900,000 results in 0.27 seconds. How reliable is that information? Findings and claims include “prawns plus vitamin C will result in death through arsenic poisoning,” “satay sauce is lethal unless followed by cucumber,” “miracle cure,” “secret ingredient,” and “I lost 20 kg in 2 weeks!” How is all the information to be sorted meaningfully, and who validates what is true versus false?
In a relatively new undercurrent, pharmaceutical companies are battling for market share online. Some strategies have included co-incentives for doctors to recommend specific websites, which, in turn, promote specific medications. Invariably, these approaches encourage access to biased or at least incomplete information. Input from professional associations would seem vital for a balanced view.
RECOMMENDATIONS FOR CLINICIANS
If we clinicians wish to use the potential of the Internet to improve outcomes, then we need to recognize that patients are increasingly accessing the Net. We need to facilitate their access to valid, relevant, and helpful information with guidance to reliable sites and assistance in evaluating that information.5 Websites likely to house valid information include those ending in .gov (government departments), .edu (universities, medical schools), and .org (not-for-profit organizations, patient associations, and hospitals). Patients need to understand that, if something online seems too good to be true, it probably is.
To optimize outcomes, we need to be open to the concept of patients’ augmenting the information we provide with what they discover online. We need to communicate effectively the need to make that information relevant to their diagnosis and management by individualizing it, and we need to exploit this strategy to reinforce the doctor-patient therapeutic alliance. n
Ivan Goldberg, AM, MBBS (Syd), FRANZCO, FRACS, is the head of the Glaucoma Unit at Sydney Eye Hospital and a clinical associate professor at the University of Sydney in Sydney, New South Wales, Australia. Dr. Goldberg may be reached at +61 29 231 1833; eyegoldberg@gmail.com.
1. Tang H, Kwoon Ng, JH. Googling for a diagnosis—use of Google as a diagnostic aid: Internet based study. BMJ. 2006;333(7579):1143-1145.
2. Dr. Google: the latest tool to help doctors diagnose unusual cases. News Medical. Published November 13, 2006. http://www.news-medical.net/news/2006/11/13/20947.aspx. Accessed March 2, 2015.
3. WebMD/Medscape Digital Technology survey reveals unique insights into how patients and physicians perceive the role, potential and risks associated with digital health technologies. Published September 22, 2014. http://investor.shareholder.com/wbmd/releasedetail.cfm?ReleaseID=872030&CompanyID=WBMD. Accessed March 2, 2015.
4. The danger of using the Internet for self-diagnosis. August 25, 2010. http://www.medicineandtechnology.com/
2010/08/danger-of-using-internet-for-self.html. Accessed March 9, 2015.
5. Diaz JA, Griffith RA, Ng JJ. Patients’ use of the Internet for medical information. J Gen Intern Med. 2002:17(3);180-185.
