While the doctor's office is not always available, Dr. Google is there: easy to reach, full of information with zero waiting time. That sounds like paradise, especially in such challenging times as COVID, with even less access to medical services. But then, why are so many doctors against it? How should we treat Dr. Google and how could digital health chatbots and symptom-checkers help patients in the future?
The doctor’s office is difficult to reach: no one picks up the phone, you have to wait long hours in the waiting room, and when you finally talk to a nurse or a doctor, the answer leaves you with even more questions. Sounds familiar? At the same time, Dr. Google is always available: easy to reach, full of information and zero waiting time. That sounds like paradise, especially in such challenging times as COVID, with even less access to medical services. But then, why are so many doctors against it? How should we treat Dr. Google?
Does anyone remember when we haven’t Googled our medical symptoms? It wasn’t so long ago. Larry Page and Sergey Brin started their search engine in 1996 on Stanford University’s network, but it took several years for Google to take over from Yahoo!, and even more until we arrived at the age of Googling. The appearance of smartphones, with the first iPhone hitting the market in 2007, immensely contributed to the spread of the habit of internet search, and the shaping of life in the 21st century.
Before Google took over our life, we had to go to physical libraries for books, we had to read real newspapers and magazines for the news, and of course, we had to go to the doctor’s office for medical advice. The family physician seemed to be the sole proprietor of medical knowledge coupled with patient history relevant to any given patient. Their advice and diagnosis was rarely questioned, and their professional debates about the most efficient treatments remained within their own circles.
This turned upside down with the appearance of the Internet, search engines, and social media. By now, everyone with a smartphone has access to vast libraries of information, and anyone seems to have the chance to become a doctor: even peek into the workings of operating rooms with the right equipment. The gates to keeping information as a privilege for certain groups of people have fallen down, and for some time, experts believed that the age of the democratization of knowledge has begun.
This created the opportunity for anyone to look up their medical condition online, search for medical advice, and seek out other patients who have similar experiences with a certain disease. Patients could feel empowered: the medical world fell to their feet, and at first it seemed, all they had to do was collect the crumbs of information. On the other hand, doctors felt terror and panic: it was the first time in centuries when a patient questioned their expertise, their authority, and asked questions. The power relations between doctors and patients have started to change.
In 2019, only around 13-15 years later, about 7 percent of Google's daily searches were health-related, according to Google Health Vice President David Feinberg, PhD. That is equivalent to 70 thousand searches per minute. In Hungary, the Digital Health Research Group at Semmelweis University led by medical sociologist Zsuzsa Győrffy, PhD, found this year that 81.3 percent of Hungarian patients use the internet in general, and 90 percent of them also made use of it for health purposes. 13 per cent of the respondents even said that they are looking up medical information such as treatment options, therapies, side effects, prescription and non-prescription medicines online every single day.
However, in the past two years we also learned that access to vast amounts of data and information doesn’t mean articulated knowledge and wisdom. A Google search results in data catalogs without any context and any guidance regarding usage. Access to information has its own downside: it takes a learning process to sort through wide piles of irrelevant noise to arrive at valuable information, but in the meantime all that noise creates uncertainty, panic and fear. We not only live in the world of millions of online trained virologists, immunologists amidst a global pandemic, but also hijacked minds falling prey to self-proclaimed medical masterminds propagating against vaccines, uncertain masses wanting to find the ultimate truths, and extremely insecure people lost in the sea of information. The situation even upgraded the phenomenon of hypochondria: if Woody Allen’s famous Mickey from the movie Hannah and her sisters had lived in the digital age, and his Google searches would have resulted in him getting convinced to have developed a lethal condition, experts talk about cyberchondria.
The initial reaction of physicians and doctors was panicking and denial as well. Memes about “Don’t confuse my medical degree with your Google search” have popped up, and some doctors advised patients not to look up information online and rather trust the doctors. However, by now, such a recommendation is unsustainable. Patients worried about their medical status will turn to the most easily available source, and doctors have to deal with it.
The information tsunami can be an enabling or hindering factor for patients wanting to get to medical information to the extent of how deliberately they can filter them - said Rebeka Pozsonyi, communication leader of CEU iLab alumni, Longevity Project. The start-up organizes health-development programs first of all for companies, where they focus on educating employees on how to manage stress, stay active, sleep and eat in a healthy way, and more generally, on how to reach their optimal state of physical and mental well-being.
Pozsonyi in no way objects to health-related internet search, she believes that it could help the patient express their symptoms more accurately and thus help the work of the doctor. “The key is online awareness. That means the user knows how to get credible information. As there is no education fostering this skill, that’s the biggest pitfall. I would recommend that when looking for medical information, users should look for credible sources with traceable authors, continuously updated and fresh pages, and medically sound literature” - Pozsonyi believes. She added that the hardest part is to filter out disinformation and fake news, which assumes some higher levels of health literacy.
However, instead of panicking and turning patients away from Dr. Google, the medical community could perhaps consider working together with patients: recommend credible websites and talk to them about their online findings. It might take some time, but in the long run, educating patients about online medical search might even save time for physicians.
And while a study published in November 2021 found that search engines such as Google and its Russian counterpart, Yandex, are still not managing medical searches well enough, fortunately, plenty of futuristic, forward-looking digital health innovations and research builds on perfecting online medical search - as it evolved into a medical information superhighway. For example, at the Center for Digital Health at Penn Medicine, researchers are looking at correlations of Google searches for medical issues and visits to the doctor’s office. As a result of their preliminary data analysis, they found that medical search histories are peaking a week before doctoral visits. In the future, such knowledge could enhance medical communication, prevention as well as better preparedness.
Or, take, for example, symptom-checker apps. Do you have a symptom and are you concerned about the potential medical consequences? Ask Ada Health, Symptomate, or WebMD for help. Their extensive algorithmic library not only attempts to calculate the most likely diagnosis, but it remembers your searches, and personalizes its responses based on such medical histories. Mental health apps and medical chatbots embody yet another branch of digital health information sources, or even AI-communication platforms. For example, if you feel lonely, you can have a chat with Replika, or talk to Woebot, which promises to meaningfully connect with you. This chatbot is using behavioral psychology to form a bond with users and it gives you a chance to talk about your troubles. Although nothing can replace a human psychologist, it might be useful when someone is coping with dark thoughts at night and no one can be reached.
The general idea is that in the future, these talking or texting smart algorithms might become the first contact point for primary care. Patients might not get in touch with human physicians or medical professionals with every one of their health questions but might turn to chatbots first. If the little medical helper cannot comfortably respond to the raised issues, it could transfer the case to a human nurse or doctor, who could take over and solve the issues via personal visits. That’s still further down the road, and until then, both doctors and patients better come to terms with Dr Google - as it is very likely to stay.
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