Do no harm? When Dr. Google’s ‘opinion’ clouds care

Sure, Dr. Google is always 'in' when it comes to patients' health-related inquiries, but trust in these opinions is misplaced at best when it supersedes their actual doctors' orders. Such is the focus of a new AOA Ethics Forum discussion available for doctors' discussion.

Each minute, Google fields 70,000 health-related searches or about 1 billion questions a day, Google's Health Vice President David Feinberg, M.D., revealed in 2019. In the same report, Dr. Feinberg took pride in how the world's most popular search engine makes health information "accessible to everyone." But that accessibility, in and of itself, has also drawn its fair share of criticism.

Recently, Google—and others—have faced backlash for not cracking down on the spread of misinformation, particularly related to vaccinations. The negative response drove Google to create "knowledge panels" to provide more authoritative information for medical conditions. However, many feel the need for free, reliable health information has become reduced to the ability to "navigate the seemingly endless, often contradictory stream of online health information."

While most Americans turn to online searches for general health information, about one in three go online at one time or another specifically to determine what medical condition they or someone else may have. This down-the-rabbit-hole search experience has given rise to the term cyberchondria, or compucondria, a buildup of irrational concerns about common symptoms based on online searches.

Consider Google's No. 1 health search for 2017: what causes hiccups? Although a general curiosity likely factors into this top search as opposed to a genuine medical concern, those of the latter persuasion might learn hiccups are (rarely) symptoms of thyroid enlargement, neck tumors or kidney failures. That line of thinking could account for why health-related Google searches double in the weeks before a patient visits the emergency department.

Although the web does have good medical information, it's often hard to distinguish the accurate from the misleading. That's why the AOA's Ethics Forum tackles this increasingly pertinent subject.

New case study

In a new case study on the Ethics Forum, the AOA's Ethics and Values Committee (EVC) looks at the rise of "Dr. Google" health searches, patients' self-diagnoses and the prioritizing of online advice over provider knowledge, as well as strategies doctors of optometry can take to educate patients.

"Patients shouldn't expect a website to replace their doctor," reads the case study, authored by EVC members Hilary Hawthorne, O.D., and Morris Berman, O.D. "The eye doctor has superior knowledge about eye health to Dr. Google. Nothing can replace a well-performed history and physical exam in an office setting with access to diagnostic instrumentation. Seeking professional eye health care helps immensely in arriving at a correct diagnosis and treatment plan."

Patients' resistance of professional medical advice based on unreliable web sources is an increasingly common situation in today's practice, the case study notes. While being mindful and respectful of the doctor-patient relationship, it's important to address patients' concerns through a conversation about the reliability of information found online. Additionally, here are some tips to discuss with patients seeking the most from their health-related internet search:

• Eye doctors should recommend specific resources for learning more about health issues.
• Eye doctors should remind patients prone to fact-checking that they can double-check information with a second, reliable source and consult with their care provider.
• Encourage patients to contact their eye doctor via phone, email or schedule an in-person appointment to discuss any concerns.
• Patients will benefit from their visit if they prioritize their concerns before arriving for the appointment.
• Patients should be careful when reading nonmedical sources or websites and take this information with 'a grain of salt.'

Access Dr. Google—the full case study.

Have questions? Get answers

The Ethics Forum provides an opportunity to review a hypothetical case study concerning ethical challenges and includes suggestions on how doctors might handle the situation based on the AOA Standards of Professional Conduct and Code of Ethics. If you have any questions on ethics, please submit them to EthicsQuestions@aoa.org, and the EVC will respond to your questions as soon as possible.

So, too, if you have an ethical challenge or situation you wish to share, please submit a case description to Ethics@aoa.org. The case description will be reviewed by the EVC and may be featured in future Ethics Forum discussions.