Kill or cure: how useful is Dr Google?

Men do it, women do it, young, old, even doctors admit to doing it sometimes. In fact, if there’s anything surprising about the news that 50pc of us seek health advice online, it’s that the figure is so low.

According to new research carried out on behalf of the RCSI, half of all Irish people surveyed say they use the internet to investigate potential health woes.

The knee-jerk reaction to such a statistic is to fear that these keyboard patients are putting their health at risk by not heading directly for their GP’s busy waiting room.

But is the internet really such a bad place to venture when you’re worried about your well-being?

Several months ago, I was told I would need a biopsy on my breast. I was breastfeeding at the time and advised to stop to have the procedure. Reluctant to do so if not absolutely necessary, I sought other opinions online, contacting one of the world’s leading lactation experts, Dr Jack Newman, via the web, as well as experts in La Leche League.

Their response was that I did not have to stop breastfeeding. I went back to the surgeon who told me she too had done more research and agreed the biopsy could be done without cessation of breastfeeding.

If it hadn’t been for the web, I wouldn’t have known where to turn. It was a prime example of how access to specialist information online was able to help and empower me as a patient to make an informed choice about my care.

“Times have changed and the days where a patient happily accepted a diagnosis of a medical condition they had never heard of and a treatment plan which was communicated with little supporting information are gone and I don’t think that’s a bad thing. An informed patient is an empowered one,” says Sheena Mitchell, owner and pharmacist of Milltown totalhealth Pharmacy and founder of wonderbaba.ie. She set up the children’s health information resource website to allow Irish parents access to evidence-based information and guidance.

But she worries that parents online don’t always know how to differentiate between reliable content and unregulated information. Indeed, the RCSI poll found that 69pc felt they couldn’t trust information found online.

“My main concern is the quality of the information patients are accessing online,” says Sheena. “I would guide patients to start with useful resources like the HSE and NHS websites and those of registered charities relating to a particular condition they are interested in, such as The Athsma Society of Ireland or ACT for Meningitis.”

Simply Googling terms makes it difficult to separate the wheat from the chaff. And smaller, specialist organisations should come with a warning since it’s not always clear if they may have a commercial interest in the information provided.

But it’s also perhaps an appropriate time to flag up that misleading medical information isn’t solely associated with the internet. Complex medical studies are often oversimplified in the news with declarations that ‘a new study has revealed X causes Y’.

Here, the online world can offer much greater value and transparency. Many scientific publications are open to access online, and you can read for yourself how the findings are often far less black and white than the headlines would suggest.

The online world also gives instant access and platform to a world of expert analysis, voices on Twitter like Dr Jennifer Gunter (@DrJenGunter), Professor Timothy Caulfield (@CaulfieldTim) and @justsaysinmice (to name three of my favourites) debunking science claims, correlation equated with causation and tenuous links between mouse research and human impact.

So of course there are benefits to having health information online, but what about symptom checkers? What about when you’ve got a bit of a dodgy rash, or a few vague ailments and you just want to know what’s wrong without seeing a GP?

Well, here all the medical voices are in agreement – you cannot reliably self diagnose online. “Self diagnosis by non-medically trained patients can result in a failure to identify serious underlying conditions and can also result in the aggravation of pre-existing conditions through the use of inappropriate or unsafe treatment,” says Sheena emphatically.

Part of the problem with most symptom checkers is they are rules based systems only covering a few hundred diseases. But the technology is evolving and improving. Isabel Healthcare is a machine learning based system, based on systems that have been used by doctors and hospitals for over 20 years, covering more diseases than traditional symptom checkers and with a 96pc success rate in generating the correct diagnosis within its list of potential diagnoses once the patient inputs their symptoms. Isabel currently generates up to 300,000 queries a month with Irish users accounting for 1.5pc of web-traffic.

“Doctors would rather patients use a site like Isabel which has been designed to do this job and has been properly validated rather than Google [or another search engine], which will just return thousands of answers,” explains the site’s founder and CEO Jason Maude.

Which isn’t to say Isabel should take the place of meeting with a doctor. “We do not recommend using Isabel instead of seeing a doctor,” says Jason. “But it’s a way to make the consultation more productive. It allows the patient to become better informed and have confidence to discuss their diagnosis with their doctor and ask better questions.”

He believes the health-tech market will only get bigger. “I think these tools will grow dramatically in usage. Patients are the most underused resource in health. Informed patients make much better patients and their outcomes are normally better. As clinicians slowly get overwhelmed with increasing demand and greater complexity, they will gradually start of encourage, then demand, patients use these tools to help them do a better job.”

Since MyClinic.ie was founded in 2015, over 15,000 Irish patients have used the online healthcare service to order repeat prescriptions, avail of home blood testing and access video consultations with healthcare professionals. All this can be done from the comfort of their own home, seven days a week and, with video consultations costing €30 instead of the typical €60 faced in a GP surgery, at a significantly lower cost.

“Providing access to healthcare professionals using digital technology can help to remove some of the biggest barriers preventing people from getting appropriate health advice when they need it: access, time and cost,” says Dr Daniel Clear, Managing Director of MyClinic.ie.

Last month, a study compiled by UK health and well-being provider Benenden Health found that over 100 million health-related Google searches were made in the last 12 months. Interestingly the top searches were health topics that often come with stigma or embarrassment attached – mental health and sexual health.

Myclinic.ie sees a higher proportion of consultations for so-called ’embarrassing’ conditions like STIs or male sexual health problems. “This is clearly an area where technology and remote access to doctors can help remove such barriers to care,” says Dr Clear.

From accessible, cost-efficient health care and expert, evidence-based information to ever-improving diagnostic tools that empower patients and help over-stretched GPs – there’s no denying the internet can be a powerful force for good in patient care. Should it take the place of registered professionals? Absolutely not. But nor should we be afraid of the very real ways in which the virtual world can help to make us feel better.

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