Me: “Good morning! What brings you in to the office today?”
Patient: “I’m here because I have a headache”
Me: “OK, can you tell me a little bit about your headache? When did it start? Has it happened before? Where is it located? Is it off and on or continuous? What makes it better or worse? What type of pain–throbbing, burning, sharp/stabbing, achy? Is the intensity mild, moderate, or severe?”
Patient: “I don’t know the details, doctor, but I typed in my symptoms into Google, and I’m really worried that I may have cancer. All of my symptoms on google matched for brain cancer!”
Ah, the virtues of the inevitable “Dr. Google”. Back in the day when Google was really skyrocketing during my early years of practice (around 2005), I very specifically remember that very smart people were stating emphatically that Google would replace the outdated, outmoded, and outflanked good ol’ family doctor of yesteryear. Yes, there was no way, no how we humans were going to be able to keep up with the billions of points of medical data available to the fingertips of anyone and everyone who could type in their symptoms to produce an air-tight diagnosis that even top medical specialists would envy.
The sheer excitement from anticipation bursting out of Google’s algorithms would lead us to the ever elusive, correct diagnosis, every time. Dr. Google was going to put us doctors all “out of business”. Patients wouldn’t even need to leave the comfort of their own home and know their diagnosis. How simple! How convenient! Yet, how naive.
I can reliably say that Dr. Google has significantly increased traffic to my already busy clinic with the “worried well”. Now, can Dr. Google help aid me in discovering otherwise esoteric, unfamiliar diagnoses that I would have otherwise missed? Yep. However, the ratio is probably somewhere around 90:1 that google sends in these people who are fine or who will be fine with some time vs. those who won’t be. Why did this “medical informational tsunami” that would wipe out doctors like me never occur? It’s one word. I’ll spell it out for you:
C-O-N-T-E-X-T
Yes, context is, in this case, everything. Let’s go back to the scenario in the beginning–The patient has a headache, looked up some of his symptoms, in which Google spit back an answer that it may be dangerous–like brain cancer, subarachnoid hemorrhage, or temporal arteritis. But without the context needed by trained professionals, any lay person can start thinking that they may know something.
While I don’t doubt that any lay person can learn a lot about health and medicine, they likely won’t know about context. Such context may include the following: While brain cancers do usually cause headaches, your odds of it are extremely low to begin with. That doesn’t mean it’s impossible, nor should we rule it out completely, at least in the beginning. But migraine headaches, tension headaches, cluster headaches, and sinus headaches, are far, far more common, even when they present quite unusually. Save yourself a lot of money and skip the MRI if your headache isn’t showing some major red flags.
Now, don’t get me wrong–this explanation in no way should make light of potentially very serious diagnoses. They can and do happen–all the time–somewhere. We doctors have a solemn duty to provide our very best clinical acumen in both ruling in, and ruling out terrible diseases. Sometimes we do miss things because we are too careless or lazy. But that should always be the exception, not the rule. We should never pigeon hole ourselves into one line of thinking but should be checking our biases frequently. However, the sheer cost of putting everyone with a headache through a CT scan or MRI defies credulity. And would cost somebody somewhere a boat-load of cash.
A lot of information doled out by a search engine without context, and all at once, may all be technically “correct”. But, like trying to read Greek for the first time, without proper interpretation by someone who is well-versed in the nuances of Greek language and culture, it is unhelpful and may actually be harmful. Yes, it may be harmful in ways that lead to overdiagnosis, overanxiety over nothing, and overutilization of scarce resources. Next time you want to use Dr. Google to diagnose your symptoms, tread lightly. Seek balance. You might even check with your doctor.