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Will Your Doctor Google You?

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A new study from Australia has purported to show that physicians faced with difficult cases would benefit from Googling the symptoms and the disease or treatments. Not all the medical profession is jumping into the great search engine of the Internet. I was intrigued by the present and future possibilities and the alternatives for physicians now who use the Web for professional information.

Medical News Today reported in “Google Good Source For Doctors To Diagnose Hard Cases” by Christian Nordqvist that researchers from Brisbane, Australia (as reported in the British Medical Journal) found using Google to search for information in difficult medical cases helpful 58% of the time.

The basis of the study was that physicians needed ever higher amounts of knowledge to accurately diagnose illnesses — especially those less ordinary. The two they used (of 26 “hard-to-diagnose” cases), found in the New England Journal of Medicine, were Cushing's syndrome and CJD (Creutzfeldt-Jakob disease).

The report showed the physicians used three to five search words in Google for each medical case. Theoretically, they did not know what the correct diagnosis should be beforehand. The three highest ranked diagnoses based on symptomatology (when compared with the New England Journal) were taken. “They say that 58% of diagnoses carried out using Google searches were correct.”

The British Medical Journal reports the results as the Google searches came up with a correct diagnosis in 15 cases, which translates to 58% of the time — which shows a "95% confidence interval 38% to 77%."

They conclude, “As Internet access becomes more readily available in outpatient clinics and hospital wards, the web is rapidly becoming an important clinical tool for doctors. The use of web-based searching may help doctors to diagnose difficult cases.”

What I found the most interesting in these articles about a mass data search for important diagnostic tools in medical treatments was not the somewhat simplistic study but the response in the comments (just like Blogcritics, medical people can now discuss medical journal articles as they appear) section of the BMJ. The first was Dr. Joseph

Britto, who is the CEO and Clinical Director of Isabel Healthcare Inc. in Reston, Virginia, which provides an Internet-based DDSS (diagnosis decision support system) for professional healthcare providers. His system, he feels, is far superior and more professional for medicos. I must quote him, since the programming math is far beyond me. His “Isabel” system:

    uses natural language processing algorithms that searches by context and meaning a database of medical textbooks and journals – to 'understand' rather than just ‘find.’ Isabel suggests diagnoses rather than documents and these diagnoses are filtered using the patient’s age, gender, pregnancy state and geographical-region prevalence heuristics. Further, as a quality metric, we analyze and make available on Isabel results of Isabel’s diagnostic performance on current NEJM CPC cases. A study submitted for publication looked at Isabel’s performance on 50 NEJM CPC cases from 2005 using whole text data entry [entire case presentation cut and pasted verbatim] and entry of extracted clinical features. Isabel came up with the final diagnosis in 74% and 96% respectively.

Joy Kennedy, a reference librarian from Virginia, commented that she was initially shocked at the idea of using Google for such technical research, but then decided “By using Google to search the web, they were essentially doing a full text search of a giant database. Admittedly this database contains good, bad and indifferent material but the concept is not an unreasonable one. There is great value in searching the full text of journal articles, tables of content of books and other, more reputable tools…”

Similarly, an Emergency Physician from Spokane noted “One can imagine the benefit to young doctors in developing countries who now have access to a grand medical library in their hands.”

Not only can a young doctor in a developing country use the giant search engine to figure out what is going on in the system of his patient, but the expatriate or traveler on the edge of the jungle in a developing country can use it to help with the self-care necessary when you are far from first-world resources.

Here in Mexico, a medical emergency is going on with my wife, and the medical resources are limited to my excellent cardiologist and little else. Medicine is decades behind and this jungle-edge area is even further removed from modern practices or cleanliness. The idea of Internet advice for third-world doctors and searches (Google or otherwise) available to help young and poorly-educated physicians seems like a worthy goal for Google and for services like Isabel. In medicine and the sciences, the more information, the better the service.

My little test of Google was to search “Dengue and dengue hemorrhagic fever,” which produced 290,000 results. They were primarily of the layman's type and included warnings of symptoms and outbreaks in places like Puerto Escondido and CDC travelers' warnings. I chose the subject which may not be a difficult diagnosis for most physicians who have any contact with tropical, contagious diseases; but there were also sites such as the National Library of Medicine and the National Institute of Health. Both showed more substantial articles on what is now considered an worldwide pandemic. It had piqued my interest after the brother-in-law of our bodyguard survived a bad attack just recently. A judicial policeman in an area of cruise ship excursions, rich part-time visitors and poor fishermen, the mosquitos found him anyway. A Mexican doctor would probably be able to diagnose it quickly. A North Dakotan might not immediately recognize the symptoms.

With my limited knowledge of both information technology and medicine, it is my belief that any addition to the arsenal of information available to medical professionals in both the developed and undeveloped world will be of immense benefit to global health and to the hope of stopping or slowing the scourges of pandemics that continue into the 21st century like dengue, polio, avian flu, and others.

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