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This month, Archives has two articles which contain the name of that most ubiquitous search engine, and which explore the use of the internet by families. In the first, patients whose symptoms had baffled doctors have had their symptoms googled by family members and have resulted in the (correct) diagnosis of lysosomal storage disease.1 In the second, the authors have tried to assess the validity of information produced by Google in response to a series of simple questions.2 They chose topical and controversial questions which might be expected to produce divergent advice. They were able to grade the reliability of advice given by the type of website, finding that those originating from official or NHS sources (URLs ending in .gov.uk or .nhs.uk) were most reliable. Sites maintained by commercial groups, universities, charities and parent support groups were less reliable.
There can be few areas of medicine which have not been profoundly influenced by the development of the internet. Recently, this journal carried an article about paediatricians in Ireland regarding their near universal use of the internet as a source of information.3 Patient and parent use has grown too—although it is now more than 10 years since Gray and de Lusignan4 suggested a transition from ‘Maladie du petit papier’—used in the past to describe the challenges of a patient who appears with a list of symptoms on a bit of paper, to ‘Maladie du grand internet’ which describes the family who attend a consultation with reams of paper printed from a website. Many of us would now relish one or two consultations with a short list on a bit of paper as a bit of light relief. With the increasing availability of internet connection through wireless handheld devices, we might next expect parents to google what we tell them during a consultation, perhaps while recording a video of the entire thing. This may be a challenge for some clinicians.
Many clinicians in the 21st century will now immediately google any clinical entity they are unsure of, as it generally requires less effort than reaching for a textbook. They will usually find what they need, as they will have the knowledge and skills to summarily reject any sources that appear unreliable: it has even been used as a means to making a diagnosis.5 Patients and parents may not always be so well equipped.
The Google corporation was founded in 1998 by two Stanford graduates, Larry Page and Sergey Brin, who developed algorithms which allowed astonishingly rapid searches of vast areas of information, with a business model that made it pay. It has since grown into ‘a symbol not just of the growing power of the internet but of the global economy's rapid transformation’, winning praise from US President Barack Obama.6 The corporation's value is estimated to be at least $20 billion, and the word ‘google’ is now one of the exclusive group of commercially created English words which can correctly be used as a verb.7 The search capabilities now extend beyond web-based materials and journals such as this, to a vast collection of at least one million books. In the USA, it accounts for 65% of all search engine use.8 Additional facilities now available which are of interest to medical professionals include Google Image, where pictures of almost any condition can be found, and Google Scholar, which allows easy searches of the medical and scientific literature.9 Google Docs enabled us to collaborate as co-authors on this article.
Ninety-nine per cent of Google's income comes from advertising, largely by promotion of favoured websites on its search results pages.8 We should therefore not necessarily expect it to be the best tool for concerned parents to get information. It is not only commercial considerations that may unhelpfully influence a Google search: single issue pressure groups are very ‘web-active’. In 2002, Davies et al10 reported a marked antivaccination bias to the websites listed when using Google. There are many other search engines available, some specifically aimed at medical issues (eg OmniMedicalSearch, WebMD) but the ubiquity of Google means that parents are likely to visit it first. Other search engines, with no profit motive, might be preferable (eg web portal http://www.yourchildshealth.nhs.uk/), but are not widely known about and may be less easy to search.
One of the accompanying papers is from The Netherlands and the other from the UK. The country from which the Google search is made is significant: as well as language issues, the searcher may unwittingly stray onto websites from other countries which give advice inappropriate to their own healthcare setting. This would be particularly true for one of the questions used by Scullard (ref), risk of HIV transmission through breastfeeding, where the advice given in African countries is the opposite of that given in the West. Google can be accessed in the UK either through google.com or google.co.uk and the results may be different.
Many paediatricians routinely suggest to parents, after describing their child's problem, that they might ‘look it up on the internet’. Older children and adolescents now use the internet instinctively, and may have found misleading and potentially terrifying information about their condition without telling either their parents or their doctor. Families might not even guess at how far afield their information comes from; a recent development from google includes a translation service (translate.google.com) which, if used inside their browser, is so seamless that users might not even notice that they are reading a translated site. This is not to denigrate non-English sites, but to emphasise how extraordinarily diverse our information sources can become, without us even knowing it. Perhaps we should be more circumspect, by advising patients and parents to be cautious about interpreting what they find, and to read only ‘trusted’ websites that originate from their own country. Perhaps we should go further and suggest specific search engines or web portals that we know are unbiassed and have no vested interest. We should certainly ensure that websites recommended in printed information leaflets are reliable. In the UK, NHSDirect is increasingly popular as an immediate online source of validated and unbiassed information, as are the BBC.co.uk health pages.
The internet age is just dawning, and as health professionals we have a duty to remain abreast of the information our patients and families consult, if only to be able to better guide searches, and place the results into helpful context. Put this in another way: when medicine began its gradual move away from Latin in the sixteenth century, it was hardly a smaller move than the liberalisation of knowledge introduced by the internet. A doctor who does not know what is revealed when patients google their diagnosis is probably letting those patients down.
Competing interests IW owns a share of Oxbridge Solutions Limited, which operates gpnotebook.co.uk. This website provides medical information on the internet. Both authors undertake work for ADC which is paid a small honorarium.
Provenance and peer review Commissioned; internally peer reviewed.