Google for Diagnosis

“The complexity of modern medicine exceeds the inherent limitations of the unaided human mind.” David Eddy, MD

There was once a time when medical students and residents were expected to memorize the information required to practice good medicine. Physicians would attend continuing education courses to keep this memorization up to date. Patients would expect their physicians to be completely knowledgeable about their medical problems. Those days are gone, yet the expectations still linger on.

In November 2006, the British Medical Journal (BMJ) published a study, “Google for a diagnosis …”2. Two authors from Australia took 26 of the challenging case records published in the 2005 issues of the New England Journal of Medicine. Google searches revealed the correct diagnosis in 15 (58 percent) of the cases. The online responses to this article were legion, sometimes emotional, and revealing how timely the topic of Internet search for diagnosis is3.

The Internet has changed how we do about everything. Dictionary.com is must faster than grabbing the book off the shelf and looking for the right page. In my medical office, copies of reference books will not be replaced. Online reference materials are better, faster, and cheaper.

For a decade, the Internet has become the place to go for information. Until recently, we had our list of favorite websites, and we might spend time “surfing” the Web for information. We would have our online list of reference materials, like a new virtual library. As Battelle has described in his popular book, The Search, all that has changed to using Google or one of its rivals like Yahoo4. These search engines make 10 billion decisions in a second and eliminate the hit or miss of limited reference sources. Search may even be rep lacing popular Web references like UpToDate and First Consult.

The question of using Google as an aid in diagnosis brings speed and practicality up against evidence-based medicine. Google and similar search engines were never designed for evidence-based medical diagnosis. They simply put us in touch with the world’s information, based on frequency of use and general accuracy.

For many years, there has been a quest for computerized diagnosis decision support systems (DDSS). One such product is Isabel (www.isabelhealthcare.com). Isabel claims to be able to help physicians reach a correct diagnosis in 96 percent of cases. I looked over Isabel and was impressed, but it was not near as fast as Google. If I want to make a difficult diagnosis accurately, I would use Isabel. If I wanted information, I would use Google.

Some responders to the BMJ article touted PubMed as the website of choice for medical science as an aid in diagnosis. One physician used PubMed for the same 26 cases and found important diagnostic information on 23 (88 percent). I suspect this took most of a day to do. PubMed is a great site for the National Library of Medicine and brings up a list of articles, but may not readily help decision making at the point of care.

Google is not resting on its success. Google Scholar gives you access to the world’s scientific information. Google Health, like Yahoo Health, is a vast medical library of information. The entire world’s knowledge is now democratized, everyone has equal access, so patients will use these searches for self diagnosis and treatment.

So, where does this leave diagnostic decision making in 2007? I would say this. Think off the top of your head at your peril. In seconds your patients can know whether your thinking and advice are on target or off base. Medicine today is about knowledge management and clinical decision support. Tools for doing this better are amazing but still in their early days. We all need digital brains to help us on a routine basis.

Balance speed and practicality with evidence and good medical knowledge. Google will not be with you in court if you use them to make a wrong diagnosis or pick a wrong treatment. Our job is to put information together in the care of patients for accurate diagnoses and the correct treatments. This is what both medical education and medical practice are about today.

Do not practice medicine without a computer on and connected to the Internet. Better yet, have this in every exam room, with a screen that can be view by the patient. Gone are the days when patients might not have faith in you if you needed to look things up. Now, patients may wonder about you if you do not look things up! We all need clinical decision support. No longer do you need a library of websites to wonder through. Search is fast and simple. Google may the place to start, but not necessarily the place to end your search.