MEDICAL ECONOMICS SPECIAL SECTION: Tech Talk: Part I: Can google make you a better doctor?

November 1, 2007

Can the same Internet search engine that helps you track down a chili recipe help you diagnose and treat patients? Google has more medical credentials than you might imagine. Read on.

Can the same Internet search engine that helps you track down a chili recipe help you diagnose and treat patients?

We're talking, of course, about Google. This gargantuan answer machine in cyberspace may strike you as a poor resource, particularly when you can turn to authoritative health-care Web sites-some, like Google, free of charge-to research a perplexing clinical problem. But, Google has more medical credentials than you might imagine. Google Scholar (http:// http://scholar.google.com/), for instance, searches only scholarly literature, weeding out online pseudoscience. And with a Google tool bar embedded in your Web browser, it's just as tempting to type in "epistaxis" as it is "American Idol."

TWO AUSTRALIAN DOCTORS put Google to the test recently and came away impressed. They selected 26 diagnostic cases published in The New England Journal of Medicine during 2005 and, without reading the differential diagnoses and conclusions, queried Google using search terms derived from each study. They reported in BMJ last December that Google guided them to the correct diagnosis in 15 of the 26 cases. For example, searching on "bullous skin conditions," "respiratory failure," and "carbamazepine" yielded the correct answer of "toxic epidermal necrolysis syndrome." The authors' conclusion: In difficult cases, it's often useful to "google for a diagnosis."

Not everyone thinks Google is such a sharp diagnostic tool. As one hospital librarian notes, the 58% success rate cited by the Australian physicians is just "slightly better than flipping a coin."

ANOTHER BAD REVIEW comes from Eamon Armstrong, an FP at Northern Arizona University who teaches other physicians how to find evidence-based medicine, or EBM, on the Internet. EBM is all about treating individual patients in light of the best available research, says Armstrong, and Google isn't precise enough to locate it in most situations.

"The cases in the BMJ article deal with diagnoses so rare that most physicians will never make them in their lifetime," Armstrong says. "Google is useful for them, but not for common conditions where presenting complaints are vague, like 'nausea, fatigue, generalized muscle pain.' Google would yield a morass of disorganized information with no built-in quality filter. I can't think of a single person in the EBM field who would use Google on a regular basis."

Armstrong says the BMJ study would have been more convincing had it compared Google with EBM search engines such as the TRIP Database (for more information, see "The best treatment? It's at your fingertips," in the March 4, 2005, issue at http://www.memag.com/). Interestingly enough, Jon Brassey, a co-founder and co-director of TRIP ( http://www.tripdatabase.com/), holds Google in higher regard. "Google isn't anywhere near as good as TRIP," Brassey wrote in a blog. "But it's pretty fine."

GOOGLE WAS ONE REASON why Brassey stopped charging people to use TRIP last September. "Why should people pay for TRIP when they could use Google?" wrote Brassey, an information specialist with the National Public Health Service for Wales in the United Kingdom. "If I was hard-pressed financially, I wouldn't bother subscribing to TRIP."

How the CDC helps focus Google searches

Brassey does fault Google for not being transparent about its search and rank methodology, which, he says, often ranks older journal articles higher than recent ones. Although the company's search-engine algorithms are proprietary, at least part of what Brassey complains about may be a reflection of the value "label" placed on any given piece of information by recognized medical sources.