When you hear hooves...hmm....ask Google

Well, the googleblog categorically mentions that Larry and Sergey would rather not prefer that you use the word Google as a verb. I tried to mull on a PC title for this posting ....obviously the verb 'googling' was out. Putting the word in capitals as 'Google it' was softer, but all the same fiendish as a Modi.So, disclaimer: I am not cocking a snook when I write"ask Google." It is for shortage of ideas. Ask.com has a much more friendly interface, but not a 'Google scholar' or 'pages from India.' I use Scirus and Healia, but Google has not disappointed me for medical queries. They even ante dated Stumbleupon with 'I am feeling lucky' button.

There was an article in the BMJ about Google getting the answers to problems posted in Case records at the MGH from the NEJM 58% of the time. We all know BMJ publishes junk research from time to time - the romance in the ER one was a ludicrous example.But come to think of it logically, how frequently would you hit something like Muckle Wells syndrome depends on how the person who asks the query enters the search item. He has to look at the rash and fever and look for cognitive shortcuts. He has to know whats important to add to the search list and what to discard.He has to know that the scenario fits sarcoid more than amyloid. We know of this as an anchoring heuristic- a familiar point which he/she knows and builds the case diagnosis from there. It is impossible to know every bit of information that exists about every condition in medicine.Google does all that for you...it keeps your Harrison handy on your laptop, it has the mind map like circuitry, and it can put your a+b+c together like Greg House would.Some of us like to do such syndrome hunting- e+g+h is Whipple's or Prader Willi or other such Gestalt stuff. But guys, to carry French's index of differential diagnoses and Wallach for interpretation of diagnostic tests and do it manually you would waste a hell of a lot of time reaching anywhere.

I do not see using Google for this as being wrong, or as an insult to anyone's intellect.For reasons: a) The possibility that you will arrive at a wrong diagnosis seems faint given that you are entering true factual data of positive findings that you have elicited.The issue is of sensitivity not specificity. b) Since you cannot present this as Evidence based hypothesis testing, you would obviously investigate further to test the biological plausibility of the idea before choosing to intervene on a 'hit' given by Google. c) In all cases you would follow the traditional iterative process of forming hypotheses while asking history and conducting exam, use the other two cognitive short cuts- representativeness heuristic (Spot Diagnosis method) and availability heuristic (past experience), and ask Google only when you are clueless at the end of your interrogation.

There are cases of the obsessive compulsive, patients who Google too much- the recent TIME article on one such patient is a good example.I have had an encounter with an acquaintance who waxed eloquent about her not being a vaccine person what with all the "autism going around", and defended her argument saying that "the evidence is there, you cannot deny it". I hadn't seen the evidence she alluded to, and had to take a step back there.But having seen what she was referring to, I wish I could have told her then that the most viewed videos on Youtube aren't exactly what you would call Evidence. I do share Jay Parkinson's frustration when my half read misinformed relatives choose to harp on a antediluvian dichotomy of allopathy Vs homeopathy/ ayurveda, and the latter being 'holistic', 'attacking the root cause of illness' , and choose to base their ideas on word of mouth or vague search results. But do you get confrontational with such people? I would disagree. It is better to be a facilitator in care of such patients, but to care to correct them when their enthusiasm veers them into wrong directions.

Moral: Let's accept Google as a useful tool.
But then, a fool with an idea is still a fool.

Came across this assortment of postings on the use of Google in medicine on the Clinical Cases blog.