Googling symptoms: let’s do it together

Ahmed Rashid

Ahmed Rashid

Ahmed Rashid is an academic clinical fellow in general practice at the University of Cambridge. He also writes the regular monthly column “Yonder” in the BJGP: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature.
Ahmed Rashid

The English Health Secretary, Jeremy Hunt, recently sparked anger when he suggested that parents could look online to determine the severity of their child’s rash. The medical community rightly rebuffed this firmly, highlighting the potential harm that could be caused, notably through the brilliant use of the #rashdecision hashtag on Twitter.

We know, though, that members of the public are increasingly using the internet to seek health information. The NHS Choices website, for example, reports over 15 million visits per month1. Although the pursuit of online medical information seems to be prevalent across all age groups including older people2, it is especially common in younger people, where prior consultation with a health professional before searching is particularly low.3

So, is there some masked truth in what Mr Hunt had to say? Will a time come when the internet can take the place of human clinicians?

A recent clinical encounter prompted me to think about this possibility. One of the joys of clinical practice, and in particular working in general practice, is the stimulation of facing regular diagnostic challenges. The patient, a young man, came to see me with a longstanding skin complaint that affected his feet. Having unsuccessfully searched for a diagnosis online, he was in despair. After examining him myself, I was as stumped as he was and suggested we gave the internet searching another try. His search terms had been “lumpy feet” or variations on that. Having examined his feet, I opted for a more focussed search using keywords “papules medial heel”. I quickly recognised the trusted PCDS (Primary Care Dermatology Society) website, which helped us jointly agree on the diagnosis of piezogenic pedal papules – small fatty herniations through fascial defects of the heels4.

So this means we need new, easier-to-use, online resources with lay terminology and better instructions. Right?

Perhaps we do. And perhaps during my working life, doctors’ roles as diagnosticians will start to diminish. For now though, my experience is that far more patients I meet have accessed inaccurate or alarmist information than those that have benefitted from valuable explanatory material. A recent evaluation of publicly available symptom checkers confirms that there are serious deficits in both diagnosis and triage5. For now then, I’m happy to continue working with my patients to work out how we can best use the technology together.

References

1. Gann B. Giving patients choice and control: health informatics on the patient journey. Yearb Med Inform 2012;7:70-3.
2. Luger TM, Houston TK, Suls J. Older adult experience of online diagnosis: results from a scenario-based think-aloud protocol. J Med Internet Res 2014;16:e16.
3. Powell J, Inglis N, Ronnie J, Large S. The characteristics and motivations of online health information seekers: cross-sectional survey and qualitative interview study. J Med Internet Res. 2011;13:e20.
4. Ma DL, Vano-Galvan S. Piezogenic pedal papules. CMAJ. 2013 Dec 10;185(18):E847.
5. Semigran HL, Linder JA, Gidengil C, Mehrotra A. Evaluation of symptom checkers for self diagnosis and triage: audit study. BMJ. 2015 Jul 8;351:h3480.

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