Health and Consumerism

The other thing about Google or Microsoft health (yesterday's post) is that the websites may make medical suggestions to the user based on information it has. This is simply an extension of Google's incredibly powerful personalized advertisement system. It is also an extension of the accessibility of health information.

I have talked to several doctors about this phenomenon. Now, patients will come in with a printout from the internet, sure they know what they have. There are lots of websites out there where you can input your symptoms and get back a diagnosis. As you may expect, not all of them are good. Patients will claim they have things like fibromyalgia or chronic fatigue syndrome, clinical entities that aren't clearly defined and a diagnosis of exclusion. Chances are, they don't have it. But they're sure they do.

On the one hand, health awareness is important. Medicine should not be some black box science that only doctors can interpret. But bad sources of information are bad. Much of an office visit now consists of convincing a patient that his or her self diagnosis may not be right. Indeed, at my last preceptorship, a woman brought in a photocopy of an entry on polymyalgia rheumatica from the Merck manual. Neither my preceptor nor I thought she had it, but we had to concede to running a sed rate to convince her. I think knowing too much about too little impedes efficient healthcare.

Furthermore, if Google or Microsoft starts giving curbside consults (or rather online consults), no matter how good the search algorithm or how complete the library of knowledge, I think it is too dangerous. Patients will demand tests and treatments that are neither indicated nor cost effective. They will challenge medical decisions made by physicians based on internet resources. This is not a good direction for medicine. If doctors could be supplanted by a computer search, we'd already be gone.