BMJ  2006;333:1270 (16 December), doi:10.1136/bmj.39058.709537.3A

Letters

Use of Google as a diagnostic aid

Authors' reply to responses

A common misinterpretation of our paper in the lay press was that doctors and patients could magically become diagnosticians simply by using web search engines.¹ The art of diagnostic reasoning is difficult, and doctors become competent at it only after years of training and seeing patients.²

Our intended message was that in cases of "mystery illnesses," a web search may be fruitful in finding articles that may suggest a diagnosis that would not otherwise be considered because of the rarity of the illness and unfamiliarity with its symptoms and signs. Any article located from the web should be critically appraised in the usual manner. We are less concerned about the philosophical objections of how an article is located than with its usefulness in patient care.

To state the obvious, there is no danger of "Google misdiagnosing life threatening disease" as search engines cannot make diagnoses. Only doctors are capable of making diagnoses (and misdiagnoses). If the probability of a diagnosis exceeds the testing threshold,³ then tests would be performed to prove or disprove the diagnosis. However, the diagnosis has to be considered in the first place and search engines may act as a diagnostic reminder.

We do not think that our article downplays the role of medical librarians in the practice of evidence based medicine. We have benefited enormously from workshops and help from librarians. Most questions in clinics can be answered using Pubmed, the Cochrane Library, journals, Uptodate, etc. However, if traditional sources of information have failed to answer these questions, then it would be unwise to ignore the web as a resource.

The sight of clinic patients clutching internet printouts fills some doctors with dread and may affect the doctor-patient relationship.⁴ Information found on the web is of variable quality but risk of harm to patients is probably small.⁵ Doctors in training should become proficient at using the internet because they can guide their patients to reliable websites. When used properly, the internet empowers both patients and doctors and may improve the quality of care.⁴

¹ Princess Alexandra Hospital, Brisbane, QLD 4102, Australia

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Competing interests: None declared.

References

1. Tang H, Ng JHK. Googling for a diagnosis—use of Google as a diagnostic aid: internet based study BMJ 2006;333:1143-5. (2 December.)[Abstract/Free Full Text]
2. Bowen JL. Educational strategies to promote clinical diagnostic reasoning. N Engl J Med 2006;355:2217-25.[Free Full Text]
3. Pauker SG, Kassirer JP. The threshold approach to clinical decision making. N Engl J Med 1980;302:1109-17.[Abstract]
4. Murray E, Lo B, Pollack L, Donelan K, Catania J, White M, et al. The impact of health information on the internet on the physician-patient relationship: patient perceptions. Arch Intern Med. 2003;163:1727-34.[Abstract/Free Full Text]
5. Crocco AG, Villasis-Keever M, Jadad AR. Analysis of cases of harm associated with use of health information on the internet. JAMA 2002;287:2869-71.[Abstract/Free Full Text]

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Googling for a diagnosis—use of Google as a diagnostic aid: internet based study

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