My Google Reader accidentally picked up an intriguing abstract that examined a research study of resources that medical students use in solving diagnostic cases.
The abstract was picked up because it contained the word “exercise” that is one of my PubMed filter queries. Although we often think that most diagnostic decision-making occurs from learned information stored in physician’s brains, information resources can be very helpful. What information resources are medical students using to help them with the diagnostic process?
Graber and colleagues asked this question and designed a learning experiment. One hundred and seventeen medical students were presented a challenging case and asked to provide their top three diagnoses as well as listing all the resources they used and the helpfulness of each resource. This experiment occurred as part of a examination of the web-based decision support system known as Isabel. The top six most used resources (and the percent of medical students who used the resource in the experiment) were:
- Medical books (73%)
- Google (70%)
- Other students (69%)
- Journals (49%)
- Residents and attending (29%)
- Isabel (28%)
Of note, here were the students ratings of the top resources by usefulness (Likert Scale 1-not helpful to 5=extremely helpful:
- eMedicine (4.0)
- Medical books (3.9)
- Up-to-Date (3.8)
- Google (3.6)
- Other students (3.5)
- Journals (3.4)
- Residents and attending (3.4)
So this group of medical students reported frequently using Google to assist in a diagnostic assignment and they rate it as extremely useful. The students also endorsed eMedicine a web-based medical information resource and the Up-to-Date subscription medical information resource. (Disclosure: I have written two chapters published by eMedicine). It is not clear how the students defined using “journals” in this study. I would have thought that PubMed would be a particularly good gateway for searching for diagnostic information by finding journals relevant to a specific clinical case presentation.
The use of Google for aiding in diagnosis is not limited to medical students and physicians. Bouwman and colleagues describe two cases where parents were able to diagnose their child’s rare lysosomal storage disorder using Google. Both cases had received extensive evaluation by medical personnel that did not result in a correct specific diagnosis. Both child’s parents arrived at a correct diagnosis by using Google search. In case one, the parents searched for “unexplained recurrent fever,” “pain in feet,” and “skin rash” leading them to a site describing Fabry disease. In the second case, parents typed in a sign their son exhibited “bowed fingers” and were led to a site for their son’s correct diagnosis of mucopolysaccharidosis.
Google can also provide false, irrelevant medical information when it comes to diagnosis. Most clinicians have experienced patient’s making an incorrect self-diagnosis from information they obtained on the web. It is best to use multiple sources of information when puzzled by a case presentation. However, it appears that Google Search is playing an important role in how clinicians and the general public collect diagnostic information. We need more research examining the potential power of this tool and the limitations.
William Yates is a family physician who blogs at Brain Posts.
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