Paging Dr. Google: Should I Use the Internet to Diagnose Myself?
Lots of people rely on Google to look up symptoms. But can it cause more harm than good?
I've always been smitten with doctors – especially those TV docs from the 1960s: Ben Casey, Dr. Kildare (be still my beating heart) and Marcus Welby. They are the exemplars par excellence of what a family doc should be. I also loved watching the tough female physicians on the TV series "Strong Medicine," set in Philadelphia, which is where I attended nursing school and became highly skilled at injecting oranges with sterile water, which would undoubtedly have impressed any real-life doctors I might have met.
My favorite doc now is Dr. Google and I'm not alone.
A 2021 JAMA Network Open survey of 5,000 participants found that in any given year, almost two-thirds of American adults go online to search for health information for themselves or for others.
"When used properly, the internet can help people to become well-informed and to understand that they have health care choices and options."
The reasons for "Dr. Google's" popularity are obvious: You can search online 24 hours a day, you don't have to deal with sick patients in the waiting room and you're never asked for your Medicare or insurance card.
You can also manipulate your search to get the results you want or start your search anew if you don't like the results. Dr. Google can be reassuring, but occasionally terrifying.
Perusing the many sources of information — and misinformation — can contribute to a bad case of cyberchondria, an intensification of irrational fears about common symptoms in those who already tend to see worst-case scenarios lurking around every bend.
It can also increase the "nocebo" effect, in which people with expectations of adverse effects (such as bad side effects from treatments or medications) are more likely to experience them.
A Family Reunion
Dr. Google has many "cousins" that people also turn to — both when they have a new health-related problem or a chronic illness like diabetes or arthritis.
Facebook groups, such as those for long COVID, and other virtual communities like those found on HealthBoards, a long-running social network support group which consists of over 280 Internet message boards for patient-to-patient health support, or PatientsLikeMe, which prides itself on being the world's largest integrated health management and real-world data platform, are all popular.
While they can provide terrific support and often offer useful information, caution is needed since many are not professionally curated and may be rife with unsubstantiated opinions or advice.
Some tech savviness is needed to navigate the web for online health information and to differentiate between the unproven, the quackery, the probably plausible and the solid medical explanations and guidance.
Internet research requires digital literacy, skill in querying search engines using keywords, interpreting results, dealing with hyperlinks, accessing video clips, interpreting interactive graphics and assessing a source's reliability.
e-Health literacy encompasses having the skill set necessary to effectively utilize the health-related materials and resources that are available online. It includes being able to weed out erroneous or poorly presented information and, according to the National Institutes of Health, requires six core skills:
- Health literacy
- Traditional literacy (the ability to read and understand text and speak, read and write a language coherently)
- Information literacy (the ability to understand how knowledge is organized and to locate, evaluate and utilize the information effectively)
- Scientific literacy (possess the knowledge and understanding of scientific concepts and processes so one can understand, reason, and interpret scientific data)
- Media literacy (ability to access and critically think about media content)
- Computer literacy
To Use or Not to Use, That is the Question
Most health care providers believe that using the internet for health searches does not undermine the doctor-patient interaction. Knowledgeable patients can contribute positively to a collaborative experience, even though that may lengthen the visit, by being cognizant of relative merits, limitations and risks of a suggested medication or test. Patient-centered decision making (decisions based on patient values and goals) can be the result.
Paula Belsh, a nurse at Kaiser Permanente in Oakland, Calif., says, "I have found that many patients have done their due diligence, researching their medical conditions and the planned or proposed treatments. We encourage them to use medically respected websites such as that of MD Anderson Cancer Center or the American Diabetes Association, and to look at more than one source."
Belsh might ask patients to show her the sites they've used or to explain their understanding of a disorder so she can correct any misperceptions. "When used properly, the internet can help people to become well-informed and to understand that they have health care choices and options," she says.
Easy Tips To Improve Your Health Literacy
- Repeat what the doctor tells you in your own words
- Bring a friend or loved one to your appointment
- Keep a running list of questions for your doctor
- Ask for a translator if needed
- Ask for patient hand-outs
Dr. Google: What You Need to Know
Symptom checkers (online software which uses computerized algorithms to ask users a series of questions or have them input symptoms themselves) have two main functions: to assist with self-diagnosis and to facilitate next-step decisions.
A 2015 study in the British Medical Journal, which audited 23 different symptom checker programs found that they were better than general internet-searches but still had to be used cautiously.
"I have found that many patients have done their due diligence, researching their medical conditions and the planned or proposed treatments."
The algorithms listed the correct diagnosis first in only 34% of cases, the right diagnosis was included in the top three diagnoses in 51% of cases and an accurate diagnosis was within the top 20 diagnoses given in 58% of cases.
It's important to note that symptom checkers don't factor in family history, medications you use, chronic conditions or other individualized health features. Triage decisions, which are decisions made by the individual, such as, "should I call an ambulance?" were found to be diagnostically sound in only 57% of cases, although this number was significantly higher in emergency cases such as possible heart attacks or strokes.
Symptom checkers obviously have limited ability to diagnose and triage, although there are variations in reliability and some can provide useful information. Still, it's important to recognize that, when in doubt, err on the side of caution and call your physician.
e-Health Browsing Tips
- Use search engines which have their own built-in health information curated by major medical centers such as the Mayo Clinic.
- PubMed, the most popular and best-known medical search engine, contains full text journal articles and lets you search through resources of the U.S. National Library of Medicine. The Cochrane Library is a collection of databases containing high-quality, credible research.
- Visit reputable websites of well-known institutions or organizations.
- Look for ".gov," ".edu" or ".org" in the web address, which indicates that a government agency, educational institution, or professional health organization runs the site. Sites of reputable health organizations such as the American Heart Association are full of useful information about wellness and staying healthy as well as about illness.
- Look at the credentials of the people who wrote or reviewed the content, when it was written, and what the site's editorial policy is.
- Check for scientific references like those found in professional journals such as the New England Journal of Medicine and Journal of the American Medical Association.