Is there a Google in the house?

[GomJabbar]

Medics might find Dr Google a help, says study

"Our study suggests that in difficult cases, it is often useful to google for a diagnosis," said Hangwi Tang, of the Princess Alexandra Hospital in Brisbane.
----------------------
"Web-based search engines such as Google are becoming the latest tools in clinical medicine, and doctors in training need to become proficient in their use," Tang said in the study published online by the British Medical Journal.

[rkawakami]

Yeah, leave it to them Aussies to advance the science of medical diagnosis by checking on the collective intelligence of the internet .

58% isn't all that bad actually... Lots better than say, playing the lottery!

[GomJabbar]

Misdiagnosis occurs more frequently than we would like to believe. I once had a rash that developed one summer at work. I tried treating it with some antifungal cream I had available, but was unsuccessful (I suspected a skin fungus because I was working in a hot and humid environment). When I was able to go to a doctor, I chose a skin specialist. He thought I had lupus and peeled off a dime-sized patch from my upper arm with some sort of electric knife (I forget what he called it just now). The test was negative, but left a scar on my arm. I didn't trust that skin specialist anymore and decided to try some Lamisil cream. The Lamisil got rid of it.

Difficult cases are just that. I suspect that a busy doctor does not always have the time or inclination to pour through all the published medical information on a hard to diagnose case. If Google or other search engines can help speed the process, then I am all for it. Of course, anything found will have to be scrutinized with an eye towards the reputation of the source.

[christopher_wolf]

Only a matter of time to wait and hear for a malpractice suit based off of that.

What an *amazingly* bad idea.

[bill bolton]

Only a matter of time to wait and hear for a malpractice suit based off of that.

In the case of patient presentations which are "difficult-to-diagnose", the risk of a malpractice suit will always exist for any diagnostic approach.

The study was specifically about patient presentations which had been peer reviewed, through publication, as "difficult-to-diagnose".

For a "difficult-to-diagnose" circumstance, a strategy with provides a ~60% hit rate on formally correct treatment approaches/protocols is certainly "non-trivial" in both clinical outcome and health informatics terms

Cheers,

Bill

[christopher_wolf]

I am maintaining a very healthy skepticism on that. Last time that I saw Google used for that was, in a real setting, a disaster and not all that useful. If one has to do a cost benefit analysis for it and it turns out to come to 60% then it pretty much should be classed as a minor last ditch effort at best even though the risk of malpractice does exist for any approach.

It doesn't replace trained a group of medical professionals and experts thinking through it. If it is to be used as a tool by trained and certified experts and to search within a restricted access medical database, then yes; but not out in the web wilderness simply looking for the first hit that comes up. That's what one does when either one is too lazy, has something better to do, unable to, or unfit to come up with an answer.

[skitty4gzus]

In my opinion, through the "improvements" in the media realm, doctors and professionals are made out to look like bumbling idiots. The media has made doctors, police, teachers, politicians, you name it, to be morons. But, the fact of the matter is these folks are the real deal and take their positions very seriously. I know there are probably exceptions as there is to everything but come on. If it was that easy to find the answers to severe and troubling medical conditions why would we even go to the doctor? To top that, if doctors were that "uneducated and lazy" why aren't we all doctors pulling in 6 figures or more a year? We aren't because it takes a tremendous amount of DISCIPLINE, training, teaching and perserverance. If finding these answers to rare cases and diseases was that easy than it would be a 9 to 5 job not an 18 hour a day demanding lifestyle. I dont doubt you can find some public information about some common diseases and maybe even a how to on how to do brain surgery. But, reading about these things doesn't make us doctors, instead we are mere informed observers.

[GomJabbar]

The author of the skeptical article (Andrew Orlowski) referenced above is just expressing his opinion, the same as I and everyone else is doing here. He has no specific qualifications to make his opinion carry extra weight. As such, it is not the last word.

Google is just one tool in the shed. Generally, other tools are more appropriate. But to dismiss it out-of-hand is being narrow-minded IMO.

For example; if a patient comes in with an acute condition, that patient does not always have the luxury of time to be treated successfully. Suppose that patient had just returned from visiting a tropical rainforest. Does anyone really know all the diseases lurking there? Is a doctor practicing in the USA or Canada (as an example) going to easily come to a diagnosis of a tropical disease that could kill in a short period of time? What about doctors in third world countries? I do not believe they always have an extensive library or other resources at hand to diagnose everything they may come across. Again, time is a factor. The patient in question may not survive a lengthy diagnosis.

Another factor is money. As an extreme case; if someone homeless is brought in off the street, is the medical provider going to send a team of specialists and run a battery of expensive tests to diagnose a puzzling condition? Is the doctor assigned to the case going to spend hours (and the medical providers money) searching for the correct diagnosis in a difficult case involving an indigent person? I think not. Third world countries often have to use less than perfect tools to get the job done, but they do have a measure of success.

I certainly do not believe doctors and professionals are bumbling idiots - far from it; yet some can be snobbish. Their manifesting of this trait does not help them help the patient. I realize doctors and professionals undergo extensive training to get where they are, and they are to be commended. I certainly do not feel that Google (or similar devices) should replace a physician. And while the average person should not self-diagnose, this also applies to doctors and other professionals such as lawyers. It is hard to be objective when you are the patient or client. That said, it is well to inform oneself of any conditions and treatments that exist in one's ownself. This can aid in evaluating a doctor and proposed treatments.

Finally, it is wise to be open-minded to sources of information not strictly deriven from the medical establishment. For instance, many prescribed medications come from natural remedies that medicine men have been using for centuries. That these medicine men did not have a university degree does not invalidate all their remedies handed down for generations. Of course there is a bit of "snake oil" here too. Not every treatment that a medicine man might use will have success. I would certainly want to verify their previous success rate on a specific form of treatment before I would ever consider it as legitimate.

[bill bolton]

If it was that easy to find the answers to severe and troubling medical conditions why would we even go to the doctor? To top that, if doctors were that "uneducated and lazy" why aren't we all doctors pulling in 6 figures or more a year?

Talk about shooting from the hip!

The article citation is BMJ, doi:10.1136/bmj.39003.640567.AE (published 10 November 2006)

"Patients doing a Google search may find the search less efficient
and be less likely to reach the correct diagnosis. We believe
that Google searches by a “human expert” (a doctor) have a better
yield, as Google is exceedingly good at finding documents
with co-occurrence of the signs/symptoms used as search terms
and human experts are efficient in selecting relevant documents.

Furthermore, doctors in training would find the Google searches
educational and useful in formulating a differential diagnoses.

The role of diagnostician remains one of the most challenging
and fulfilling roles of a physician. Physicians have been estimated
to carry two million facts in their heads to fulfil this role. With
medical knowledge expanding rapidly, even this may not
be enough. Search engines allow quick access to an ever increasing
knowledge base. Google gives users ready access to more
than three billion articles on the web and has far exceeded
PubMed as the search engine of choice for retrieving medical
articles."

The full, peer reviewed article can be found at:

http://www.bmj.com/cgi/rapidpdf/bmj.39003.640567.AEv1

Cheers,

Bill

[GomJabbar]

Excellent citation Mr. Bolton! Well said.

[bill bolton]

The author of the skeptical article (Andrew Orlowski) referenced above...

.... starts out with a quotation...

"Searching with Google may help doctors to formulate a differential diagnosis in difficult diagnostic cases," they conclude.

That quotation is not in the published paper.

What the paper actually said was ...

"Furthermore, doctors in training would find the Google searches educational and useful in formulating a differential diagnoses."

... and this was not even in the Conclusions section of the paper!

The rest of Orlowski's "analysis" then plumets downhill from the deliberately perverted pseudo quotation, in terms of any reasoned commentry of the published paper!

Andrew Orlowski is a person "to avoid if you value your own [intellectual] health, we suggest."

Cheers,

Bill

[christopher_wolf]

So let's see here...

We are going to trust people with Google to make medical decisions who are not doctors? That's the worst case. I think that people fail to realize that this is simply a searching tool, much like you would search a medical database, and doesn't replace people that actually have to think about stuff. Google is merely a tool to be used and *cannot* enable a person to become better at medicine by simply searching.

I have reviewed quite a few actual research papers (that one is so-so, not too bad but not great either), and Orlowski did a good job in taking apart the article (although he does place wit in more sections that most others would and can come off as very cross, so not a real peer review). It seems that in the web age, pretty much anybody with a blog and a blissful sense of ignorance can say anything they want and believe it is the truth; the dangerous part is when others sink into such sense, do not critically think about things, and starts thinking they can do anything by a few mere clicks and some typing. Futher, there is some idea that because reading stuff and becoming an armchair philosopher as a "hobby" makes people expert in real life subjects. This is a trap that most students fall into as well and it is most insidious. The internet is only useful if one knows what they are doing; for those who are clueless, it is detrimental and you can get them to believe just about anything. Although I think natural selection should handle those who use Google and the internet for a medical condition without a doctor quite nicely. The upside is that we get more candidates for the Darwin Awards.

It is only a *tool* and nothing else; it does not replace a human mind, except perhaps a lack and blunt one. In the hands of a professional that knows what exactly they are doing, then it is similar to a mere search function that helps the user find wat they are looking for, which has been around since even before grep. Hence, I fail to see how it is exciting development in any way.

Is there a Google in the house? For the sake of sanity and common sense, no.

[GomJabbar]

So let's see here...

We are going to trust people with Google to make medical decisions who are not doctors? That's the worst case. I think that people fail to realize that this is simply a searching tool, much like you would search a medical database, and doesn't replace people that actually have to think about stuff. Google is merely a tool to be used and *cannot* enable a person to become better at medicine by simply searching.

I don't think anyone here was saying that we should entrust Google to make medical decisions. I agree with this point; Google is simply a searching tool - albiet one of the more successful ones (generally speaking). Yet, by searching and reading, Google (or other search engines) *can* enable one to become better at medicine by learning things that were not previously known (by said reader). Also it can help refresh a doctor's mind with things that may have been learned but perhaps forgotten at the moment. Search engines such as Google may help by connecting the dots in certain cases.

Search engines such as Google can aid physicians and their patients alike. Yes there is a downside in that an ill person may end up incorrectly self diagnosing themselves by leaving the physician out of the picture. Physicians know better which questions to ask for arriving at a correct diagnosis. Physicians also have diagnostic tools and tests that are unavailable to individuals on their own. These may be necessary to arrive at a correct diagnosis. Finally, physicians have their peers to consult for additional professional input regarding a particular case. Individuals on their own do not have this.

I do not think this is so much an exciting development as a realization that there may be more effective ways of doing certain things in certain situations.

[christopher_wolf]

It's the obvious. Why on earth have there been Journal Clubs and Conferences? For fun? No, not fun, mainly for professionals to go to and learn of the developments of the field. PubMed has been searchable before the general explosion of Google and it has been done many times before. Useful tool or not, it is a re-development of the same thing that has been occuring time and time again. There have *always* been more effective ways of doing certain things in certain situations in a certain way...for certain appplications, certainly.

There are other things that actually deserve more attention in the medical sciences, but rarely get it because of "sensational" tendancies of some press in small matters. It is also considered best to have an article, in the sciences, reviewed/publish and supported by many experiments first before ever being brought to the attention of the press at large; it is considered, in institutions, as a slight deviation from ethics if it should get wide press *before* it has been tested and reviewed thouroughly, many examples of the bad things that can happen if such occurs are present.

[bill bolton]

Orlowski did a good job in taking apart the article

No, he just did a hatchet job, using gutter press tricks.

[christopher_wolf]

Orlowski did a good job in taking apart the article

No, he just did a hatchet job, using gutter press tricks.

The article wasn't that great to begin with and I went through most of it. As I said before, it isn't bad, but it isn't great as a piece of research work that is supposedly meant to clarify and educate the reader. Orlowski has certain traits, sometimes going too far with them, but he does make *valid points* in that report. Points that I am sure were sticking points in the peer-review of that article and still remain.

One mustn't be so quick to disregard writing, with points, merely because of flash of wit, journalistic manuervering, and futuristic presumptions; should that have been the case, *both* the original article and Orlowski's write-up would both be rendered useless tat. That isn't how any decent journal reviewers review and critique work. Both have their points that are not to be taken out of context.

[bill bolton]

One mustn't be so quick to disregard writing, with points, merely because of flash of wit, journalistic manuervering, and futuristic presumptions

One must be quick to disregard commentry which includes deliberate and outright misrepresentation, such as bodging up a psuedo "quote" to produce a meaning that is very significantly different to what was actually said or written.

That is way beyond "journalistic manuervering"!

[christopher_wolf]

One mustn't be so quick to disregard writing, with points, merely because of flash of wit, journalistic manuervering, and futuristic presumptions

One must be quick to disregard commentry which includes deliberate and outright misrepresentation, such as bodging up a psuedo "quote" to produce a meaning that is very significantly different to what was actually said or written.

That is way beyond "journalistic manuervering"!

Like the original article's scant information on how this would be of help to the medical profession at large or how it was very vulnerable to be taken out of context to a near mediocre presentation in the paper? This was on a subject that has little deviation in practice from a search on PubMed no less, without a clear path for others to follow and test; it wasn't ground-breaking, but that doesn't excuse it for not presenting everything equally and give an explanation of the problems *they* encountered instead of jumping straight to conclusions and thoughts. In addition, both did a poor job, from a literature point of view, of preventing things from being taken out of context, as this subject has shown its wont again and again. As sensationalist a piece as Orlowski's was to the press, the original article was just as much to the journal. Therefore, they probably did deserve each other and, as goes with such writings, will not get taken as seriously as one might want.

[pianowizard]

I came across this thread too late and with 17 posts already, I didn't have time to read all of them carefully, so if I am repeating something someone has already said, I apologize.

I guess we aren't sure whether that physician Reuters quoted was talking about using Google to look up medical journal articles etc. or stuff intended for lay people. If it's the former, I don't have any problem with physicians getting information through Google. As a scientist, I often use Google for info for my own research, too. We have search engines dedicated to biological publications (with Pubmed being the most popular and extensive), but sometimes it's just easier to find these publications through Google.

[christopher_wolf]

The original quote wasn't quite that contextually accurate, which lead to some confusion, I should think, and the actual article wasn't that great of a help in understanding it nor was Orlowski to any presentable extent, even on their own. That is the main problem here.

[GomJabbar]

I don't have any problem with physicians getting information through Google. As a scientist, I often use Google for info for my own research, too. We have search engines dedicated to biological publications (with Pubmed being the most popular and extensive), but sometimes it's just easier to find these publications through Google.

Thank you.

That is the point I was trying to make here. Unfortunately since I do not have letters behind my name, my reasoning and opinion can be.....suspect.

[christopher_wolf]

Which ironically, I am a scientist and engineer by the way (research in both Med and BioE), is *excatly* what I said from the beginning and was immediately misunderstood.

This all demonstrates the use of proper context from the beginning avoids useless confusion and amplification thereof (title, hyperbole, etc).

[pianowizard]

Which ironically, I am a scientist and engineer by the way (research in both Med and BioE), is *excatly* what I said from the beginning and was immediately misunderstood.

Perhaps the letters behind my name helped? LOL!!

[christopher_wolf]

Which ironically, I am a scientist and engineer by the way (research in both Med and BioE), is *excatly* what I said from the beginning and was immediately misunderstood.

Perhaps the letters behind my name helped? LOL!!

I don't know about the "letters", I myself think it was the "Piano *Wizard*" part mostly that really did it, don't you?

I used to play the piano alot, but not too much any more, through most of Moonlight Sonata and Rachmaninoff pieces (the latter was painful). Not too much time left for it, I am afraid.

Back to writing a Biophysics Review for a Journal. Good luck in yor research.

Oh yes, "Letters behind the name."

[GomJabbar]

From the "beginning".

Only a matter of time to wait and hear for a malpractice suit based off of that.

What an *amazingly* bad idea.

I guess I misunderstood that second sentence.
Not 'nuff schoolin' on my part.

[christopher_wolf]

That's the thing, there is never really "enough" schooling for anybody, just more things to learn; which is great.

[pianowizard]

Back to writing a Biophysics Review for a Journal. Good luck in yor research.

Thanks for wishing me good luck. If things go well, I will be applying for faculty positions next summer and become a professor within two years. BTW, do you know Frank Werblin at UC Berkeley? He too started out as an engineer back in the early 1960s, then did his PhD on the biophysical properties of the retina with the same guy that I did my PhD with (almost four decades later!), and has been a professor at UC Berkeley since around 1970. I thought you might know him personally because you two have similar backgrounds.

(Since this is the "Off Topic Stuff" forum, it's okay to digress from the thread's topic, right?)

[christopher_wolf]

Yup, he is a Professor of Neurobiology here.

Funny you should bring that up as we just finished up with a series of guest presentations on the biophysics of the retina. I have also read his well done papers on methodsfor generating precise temporal patterns of retinal spiking using prosthetic stimulation ( J Neurophysiol 95: 970-8 ) and even a paper that was included in an EECS NOLTA conference. Some pretty good models of retinal interactions and the development of the rather elegant modes defining the patterns of excitation and inhibition.

What is your research field? (Don't worry, this is OT after all )

[skitty4gzus]

wow Chris you are even smarter than i thought. Hey maybe you can find out some information for me. I just saw where you have done some research on the eye. Well I had a work injury a few years ago and I lost almost all the vision in my right eye. I have retinal scarring and a traumatic cataract on that eye and the Dr's around here are pretty nervous about doing any surgery. Not to mention there are "no known" surgeries or treatments for such a condition. Maybe there are some more geniuses at Berkeley or you know someone who might have some knowledge that could help me out? just wondering

[pianowizard]

What is your research field?

I am still working on electrophysiology of the retina, similar to Frank (so of course, we go to pretty much the same conferences every year). But I have started to study light-evoked neuronal responses in the suprachiasmatic nucleus (SCN) as well. My long-term research project is to determine how light (detected by retinal neurons) resets the master circadian clock in the SCN.

How do you like UC Berkeley? Rich Kramer, another professor at Berkeley who studies the retina, invited me to apply for a faculty position there but I am not sure I would like to live in the Bay Area.