Features

Calling Doctor Google

08 February 2018

The rise of the internet has given us all a world of health information at our fingertips. Journalist Juliette Astrup looks at how researching symptoms online impacts on community practitioners.

Gone are the days when trained professionals were the sole guardians of knowledge about health. The internet has given everyone access to a wealth
of information – summaries of every condition, lists of symptoms and menus of possible treatments.

It is no surprise that almost one in two (47%) of us now use ‘Dr Google’ before consulting our GP, according to a 2016 YouGov survey. The poll, of more than 2000 British adults, also showed that one in five members of the public (21%) has challenged their GP’s diagnosis, and that half
believe that their GP should always give them the prescription, treatment or referral to a specialist they request (Bradshaw, 2016).

The growth of NHS Choices, the official website of the NHS in England, reflects this mushrooming demand for online health information. According to NHS Digital figures, visits have skyrocketed, more than doubling from almost 196 million in 2012 to a peak of more than 583 million in 2015 (NHS Choices, 2017).

Enid Povey, clinical lead for NHS Choices, says: ‘The way the world is now, people want to manage their own health and wellbeing. I think, more and more, digital is not an add-on – it needs to be embedded into care.’

 

Rebalancing act

The shift in the dynamic between clients and healthcare professionals is happening across the board, and is something health visitors must be prepared for in practice.

Michelle Moseley, Wales chair on the CPHVA Executive committee, and programme manager for the specialist community public health nursing programme at Cardiff University, says: ‘I’ve been challenged on weaning practices, for example, and on vaccinations, particularly MMR. Health visitors have to be well equipped, and respond with advice and knowledge that is evidence-based.’

And while it is important to help parents recognise that not everything they read online is valid, rubbishing the information they bring to you is a mistake. 

Michelle says: ‘You need to take time to build that relationship and not just disregard what they are saying – look into it and come back to them. 

‘Go into the details with them at whatever level is best for them and really explain it – give them the information so they can make an informed choice.

‘We don’t have any right to bamboozle parents into taking onboard our advice and support. They need to have the balance of evidence, and base their decision on that, provided it doesn’t breach safeguarding thresholds.’

While it has been embraced by the public, the use of online health resources has its potential pitfalls as well as benefits.

At the Royal College of General Practitioners conference last October, chair Professor Helen Stokes-Lampard said: ‘Dr Google can be a challenge for all healthcare professionals – but ultimately, patients taking an active interest in their health is a good thing.

‘The point to get across is that Dr Google is not a medically trained professional,’ she added. ‘Reputable websites, such as NHS Choices, produced by clinicians, can be incredibly useful, but people need to be cautious as there is also a lot of disreputable information available online too.’

 

Getting the right answer

Asha Day, vice chair of the CPHVA Executive committee and a health visitor at the Leicestershire Partnership NHS Trust, agrees guidance is needed. 

‘You can enter the symptoms of a headache and come up with a brain tumour, or the symptoms of arthritis and come up with lupus,’ she says.

‘Some clients have gone on a website and not realised it was a patient forum, for example. When they ask questions, they are getting opinions, not a qualified medical opinion.’

She said the expectation of a ‘quick answer’ fostered by the internet could also be unhelpful: ‘Sometimes you have to think much more laterally than four or five words put into Google. It’s not always about signs and symptoms, it’s about the bigger picture – the social determinants of health, the family, the extended family, housing and everything else around keeping well. Google is not a sophisticated tool.’

That lack of sophistication could also leave people overwhelmed, she added, new parents in particular. ‘It’s information overload,’ she says. ‘You put “crying baby” into a search engine and what are you going to get out of it?’

‘There is the danger that the more information you read, the more it becomes another anxiety about what you are not achieving, as opposed to being positive,’ says Jackie Swithenbank, a health visitor for 17 years and clinical practice teacher at Aneurin Bevan Local Health Board in south Wales.

‘From a professional point of view, that is a big concern – that clients will perpetuate that lack of confidence in themselves and lose all sense and reason. We need to try to steer them away from that and get that balance.

‘As professionals, we need to keep reminding our clients that their skills, their intuition and their experience with their children are an important part of the package. As well as information, it’s “this is what I’m seeing”, “this is what I’m feeling”.’

Such easy access to so much potentially worrying information has already been linked to increased health anxiety (Muse et al, 2012), resulting in the coining of the new term ‘cyberchondria’.

Researchers involved in a recent study looking at cognitive behavioural therapy treatment for extreme health anxiety, fuelled in part by cyberchondria, estimated unnecessary appointments and tests could affect one in five hospital outpatients, and could be costing the NHS at least £420m a year (BBC, 2017).

 

Enabling conversations

There is also the risk that internet research can provide an unhelpful distraction, says Leicestershire-based community nursery nurse and Community Practitioner editorial advisory board member Barbara Evans.

‘It’s very easy for parents who are struggling with a child to get fixated with a possible diagnosis which they have found online which appears to fit the bill, when other diagnoses, if you were to look at them, might also fit. That can sometimes distract from what’s really going on with that child.’

At the same time, Barbara says parents’ concerns should ‘never be dismissed’ and can result in things getting looked at earlier than they might otherwise have done.

She adds: ‘If there are things they are worrying about, it enables them to raise it, so it’s not a bad thing.’

Jackie agrees: ‘You can help them unpick what they are reading and it becomes a learning process, giving them the skills to unpick further information, and go back to what they know about their own child as parents.’

She adds: ‘I don’t think our clients are under any illusions – they know there is a lot of information out there that is questionable. The important thing is they make sure they are looking at the reputable sites, and we empower them as much as we can, as early as we can.’ 


References

BBC. (2017) Anxiety over health 'caused by cyber-chondria’. See: bbc.co.uk/news/health-41176729 (accessed 5 January 2018).

Bradshaw, Pallavi. (2016) ‘Dr Google' in the patient chair. See: medicalprotection.org/uk/about-mps/media-centre/media-gallery/mps-blogs/blogs/patient-care/2016/10/17/%27dr-google%27-in-the-patient-chair (accessed 5 January 2018).

Muse K, McManus F, Leung C, Meghreblian B, Williams JM. (2012) Cyberchondriasis: fact or fiction? A preliminary examination of the relationship between health anxiety and searching for health information on the Internet Journal of Anxiety Disorders 26 (1): 189–96. See: docs.google.com/document/preview?hgd=1&id=1-YnpbzFdWJKcB8cVHP251ND5ItIGXhMUZQFy1ktO8Zg (accessed 5 January 2018).

NHS Choices. (2017) Email message to author, 6 December.

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