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In Practice: Dr. Google has mixed results

Using the search engine can be a boon for physicians — if they do it right.

August 23, 2010|By Rahul K. Parikh, Special to the Los Angeles Times

During an otherwise unremarkable afternoon at the office, I was sitting at my desk plowing through paperwork when a colleague came knocking — and forever changed how I practice medicine.

"Hey, Rahul, what's McMurray's sign?" he asked.

It is said that a physician needs to carry some 2 million facts to practice medicine. Though I knew that McMurray's sign had something to do with examining a patient's knee, it was one of the 2 million facts that, like some tattered scraps of paper pushed to the back of a file cabinet, I had long since forgotten.

I shrugged and turned toward my bookshelf to pull down a decade-old volume of Nelson's Textbook of Pediatrics. Somewhere in that tome was the definition of McMurray's sign and how to elicit it on exam.

Just as I was reaching for the book, I had another idea. I turned back to my workstation, clicked on that little "e" to bring up my Internet browser and went to Google. I typed "McMurray's sign" in the search box and hit "enter," and up popped several links to YouTube videos. We clicked on one and, like two medical students learning the basics of our craft, watched the short mini-lecture that showed an instructor moving the knee joint to check for a positive McMurray's sign. And with that, my colleague was off to try it on his own patient.

Eureka. No more pencils, no more books. With a computer and Google (sorry, Bing, statistics show that Google is where we go first and frequently) in your office and your exam rooms, it's a whole new world — for better or worse.

I've used Google regularly in my practice for the last four to five years, and statistics suggest I'm not alone (though it's Google's data, so it's perhaps best taken with a grain of salt): Eighty-six percent of doctors say they now regularly use the Internet on the job. Of that group, the majority start at Google, which they use as a springboard to look for general information about diseases and drugs.

And why not? As writer and physician Atul Gawande likes to point out, in medicine today there are 13,000 diseases, 6,000 drugs and 4,000 medical and surgical procedures. Even for the best and most motivated of physicians, it's a Sisyphean battle to keep up. Having the Internet at my fingertips makes me a better doctor, though I'll admit that sometimes it feels a bit like cheating on an exam.

Use it judiciously

I was sitting with the parent of a new patient a while back. As she was filling me in about her son's medical history, she told me his father has a history of retinitis pigmentosa. Like McMurray's sign, it was a distant but familiar phrase. As I was nodding my head listening, I stopped typing into his chart, brought up Google and typed in "retinitis pigmentosa."

A mere 0.36 seconds later, I got links 1-10 of 866,000. I clicked on a Medline link and glanced over some bullet points to see if I needed to send this child for any screening tests. Because, as I read, the "signs and symptoms often first appear in childhood, but severe vision problems do not usually develop until early adulthood," I knew I just had to make sure I did his vision test annually. Didn't miss a beat.

Most doctors seem to agree that using Google to educate yourself or patients makes sense (for a pediatrician like me, that means showing parents pictures of different diaper rashes and kids pictures of poison oak so they don't walk into a plant for the ninth time this summer). But things get trickier — and more controversial — when doctors start using Google to make diagnoses.

There's a now famous story first told in the New England Journal of Medicine about a trainee in allergy and immunology who was presenting a case to some colleagues. The audience included a visiting distinguished professor in the same field. The case was of an infant with diarrhea, an unusual rash and multiple immunologic abnormalities. The attending physicians and house staff discussed several diagnostic possibilities, but no consensus was reached. They were stumped. Finally, the visiting professor asked the trainee if she had made a diagnosis. She reported that she had: The child had a rare syndrome known as IPEX.

The distinguished physician asked the young trainee how she'd figured this out.

"Well, I had the skin biopsy report, and I had a chart of the immunologic tests. So I entered the salient features into Google, and it popped right up," she was quoted as saying. The author of that letter to the New England Journal, who was present at the meeting, wondered: "Are we physicians no longer needed? Is an observer who can accurately select the findings to be entered in a Google search all we need for a diagnosis to appear, as if by magic?"

He needn't worry. It turns out that we're not all as good at Googling as that young doctor was.

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