The Googlification of Medicine

“So, what brings you in today?” I asked Ben, a 40-year-old man who was sitting across from me.

“Well,” he answered. “I have a few different symptoms. The biggest one is that I am always tired, but I’ve also been gaining weight, and my knees hurt some in the mornings.”

I mentally began to go through what doctors call a differential diagnosis – things that can cause the cluster of symptoms that a patient has. I usually let the patient explain what symptoms he is experiencing and then ask questions to try to hone in on the specific diagnosis.

Ben went on for a little while longer. Then, he proceeded to pull out a piece of paper. “So, Doctor,” he told me. “I’ve done some research into my diagnosis, and I think these are tests that I need to have done to work things up.”

I looked at the list. It was pretty long and included some things I probably would have ordered anyway, like a blood count and thyroid level, but also some very odd things like a Vitamin B1 level and a DHEA level. He also wanted a CT Scan of his head, chest, and abdomen.

“This is a lot of testing,” I said. “I’m not sure we need to do all of it. Can we talk a little bit more about your symptoms and then try to hone in on what testing would be best to sort it out?”

Ben was not impressed. “I have done my research!” He told me firmly. “These days, with the internet, you can find out things that your doctor wouldn’t tell you about – maybe things he doesn’t even know to test for. The problem is that I need YOU to order these things for me so my insurance will cover them. Otherwise, I wouldn’t even be here.”

With that, we’ll leave Ben and his uncomfortable doctor behind. There have always been patients who brought in articles from magazines telling the reader, “Six things your doctor won’t tell you about your health” and listing testing that should be done. It does seem to have gotten worse.

A lot of patients know more than their doctors. They can search for their symptoms on the web and find out all sorts of things that could cause those symptoms.

Beyond that, artificial intelligence is smart. Chat GPT, an artificial intelligence platform, was able to pass the three parts of the US Medical Licensure Exam.¹ It didn’t do terribly well— it only got just above a passing grade, but I suppose that’s good enough that it could open an office across the street from mine and start seeing patients.

In some ways letting patients have access to this level of information is a good thing. Doctors aren’t some sort of high priests who are given special rights to access the Holiest of Holies of medical information. More than that, doctors are anything but perfect, and you have only to read online reviews to see that they don’t listen well, botch procedures, and struggle with difficult diagnoses.

It can be challenging, though, when patients believe that they know more than their doctor. I have always said that if you know more than your doctor, either you need a healthy dose of humility or a new doctor— or maybe both.

Get Wisdom!

Proverbs 4:5-9 says, “Get wisdom, get understanding: forget it not; neither decline from the words of my mouth. Forsake her not, and she shall preserve thee: love her, and she shall keep thee. Wisdom is the principal thing; therefore get wisdom: and with all thy getting get understanding. Exalt her, and she shall promote thee: she shall bring thee to honour, when thou dost embrace her. She shall give to thine head an ornament of grace: a crown of glory shall she deliver to thee.”

Proverbs 18:15 speaks of getting knowledge, but it indicates that before we seek knowledge, we should make certain that we have wisdom and understanding.

The author of the book of Proverbs was Solomon. We know that early in his reign he had a dream in which God appeared to him and offered him whatever he desired. In his humility, Solomon asked for an understanding heart, so that he would be able to wisely lead such a great people (I Kings 3:9,10).

When we look at knowledge, it is simply a group of facts— blocks of information that need to be assembled into some sort of coherent pattern. Wisdom and understanding are the tools with which we make sense of the knowledge that we have acquired.

Wisdom lets us judge the accuracy of the sources of “knowledge” as well. It helps us to ask the question, “Is this person trying to sell me something? Do they actually have any scientific studies that indicate that what they say is true?”

These are two questions that I ask when I look at a website. Are there links to products that are being sold to me, and is the advertising clearly separated from the articles? More than that, are there links to studies that support what is being claimed? If there are, how big were those studies? If a study has only 12 people in it, it is not large enough to give accurate information.

Robert Harris made an acronym CARS, that helps sort out whether information on a website is valid. Credibility, past Accuracy, Reasonableness, and Supporting information are all important to look at to see if we should value the information on a website.²

Unfortunately, many people who claim to have the answers to living long and healthy lives are actually trying to sell books, supplements, and a variety of other products. One prominent doctor who promotes better health through the use of supplements (that he sells) has managed to accrue enough money through the process that he stated in a 2017 affidavit that he was worth in excess of 100 million dollars. This doesn’t mean that he has nothing to offer, but it does say that he has some bias towards recommending things he is selling.

The American Medical Association has guidelines for doctors to sell products out of their offices ethically. Those guidelines say that the products should serve a particular urgent need (say, crutches at an Orthopedic office), have scientific validity for their use, and that doctors should offer information about other ways that patients can get the same products elsewhere.³ More than that, doctors should reveal to their patients any financial interest that they have in the product that is being offered to the patient.

Confirmation Bias

Most of us read in order to confirm the things we already believe. I see this when people read the Bible— somehow, people can read the Bible and completely ignore Scriptures that contradict their behaviors in terms of political involvement or modesty of dress but believe that they are following all things of the Scripture.

In the same way, each one of us can find stories and information that reinforce our beliefs about doctors and medicine. If we believe that doctors are simply after money and are unethical and prescribe medicines that are toxic to patients, we can find articles that confirm that. On the other hand, if we look for stories that tear down alternative medicine theories, we can find those articles too.

The important thing is that we approach the question looking for real answers and understanding that science doesn’t know everything.

As an example, we do not have good treatments for people who have Long COVID symptoms. That doesn’t mean that many people who suffered through COVID months later aren’t suffering from things like mental fog and fatigue, but it does mean that there is not a single medication that has done better than sugar pills in studies to get rid of those symptoms.

In the absence of scientifically proven treatment plans, many clinics have developed their own treatment courses, using a mixture of supplements and even hyperbaric oxygen treatments. Are these helpful? I don’t know, but I do know that those marketing them will confidently claim that they have an extremely high success rate in curing people if they are simply willing to follow (and pay for) the treatment plan.

More than that, when people are researching their symptoms, they tend to choose what diagnoses they think are likely based on their underlying personality types. Some people are prone to catastrophize— that is, they immediately believe the worst possible outcome of any given scenario they are presented with. These people will type in their symptoms and will come to the conclusion that they have cancer with only days or weeks to live. As God told Hezekiah, it is time for them to set their house in order.

On the other hand, there are plenty of people who have optimistic personalities. They type in their symptom list and come to the conclusion that they have a mild viral illness and will feel better in a few days.

The whole point of having a medical provider review things is that the practitioner can (hopefully) sort out the likely things from the unlikely ones. They don’t deal with the emotional overlay that patients do, so they can objectively decide how many tests to order and what type of tests to order in order to come up with a diagnosis.

Doctors Can Identify Dangerous Situations

I remember seeing a patient years ago who came in to see me with what she thought was a sinus infection. She was in her 20s and said that she had a pounding sensation in her head and a lot of pressure.

She didn’t really have any drainage or fever and none of the typical symptoms of a sinus infection, but sinusitis seemed like the most likely diagnosis that she could come up with.

I took one look at her and didn’t like what I saw. For one thing, she was extremely pale. For another, her pulse rate was quite fast – 130 beats a minute at rest. When I examined her, I found nothing that indicated that she had a sinus infection.

“Jenny,” I told her. “I need you to go to the hospital and get a stat blood count. I’m afraid you are really anemic— although I don’t know why. Wait at the lab and I will talk to you once I get the results back.”

It was perhaps 20 minutes later that I got an urgent call from the hospital laboratory. “Dr. Waldron,” the voice on the other end said. “We have a critical lab result for you…”

Jenny’s hemoglobin was 4.6 (normal is between 12 and 16), and she ended up getting a transfusion. What she didn’t get was treatment for a sinus infection.

Chest pain is a classic symptom that can point to an underlying heart condition. At the same time, it could simply indicate esophageal reflux (acid in the esophagus) or inflammation in a rib or muscle. I probably see a couple of patients every day who have this symptom.

The majority of them need a simple treatment, but a few of them need to be sent urgently to the hospital for a complete heart evaluation. I don’t know how an online search engine will know which direction to indicate for a person to seek after reviewing their symptoms.

At best, an online resource will refer a user to seek emergency services or their local doctor.

Not All Doctors Are Equal

Roughly 50 percent of doctors finished in the bottom half of their Medical School class. Just because someone didn’t have top marks in Medical School doesn’t mean that they don’t have adequate knowledge to treat an ailment. Perhaps the most important knowledge that a doctor needs is to know when he doesn’t know.

It is still challenging for patients to know whether they are dealing with someone who will help them. When you meet a doctor, you tend to judge them based on their “bedside manner.” Most of us look for someone who exudes confidence and seems to know what they are doing.

Confidence does not equal competence, and there are many doctors (and people in other fields) who have high levels of confidence in themselves but are not really competent to take care of the situation at hand.

Here is where doing some research can help. First, your doctor has online reviews, and those reviews will indicate something about the level of care they provide for patients. Second, if what your healthcare provider tells you seems really odd, it is easy to do a little research on the condition that you are supposedly dealing with and see if the symptoms line up and if the treatment seems reasonable.

It is important to realize that humans are not like vehicles. What I mean by that is that there is no scan tool that healthcare providers can hook up and generate all of the error codes and then fix the things that generate those codes.

Even if healthcare providers are certain of the diagnosis, some patients do not respond to the first or even the second treatment that is available. That doesn’t mean that the diagnosis or the treatment was wrong, but that people are not clones of each other and some respond better to one type of treatment than another.

Maybe someday we will have some type of genetic testing that tells us right off what the perfect medication or treatment plan is for a given illness, but that day seems a long way off.

A final thing to mention is that good doctors will not feel threatened by their patients asking questions or doing research. There are times when a patient will ask me about a new treatment that I am not familiar with, and I need to do my own research.

Those scenarios are not upsetting for me but rather a learning opportunity. “I’m not familiar with that,” I will tell my patient. “Let me do a little research and talk to some specialists that I trust, and I will call you later this week and let you know what I find out.”

Sometimes I investigate and find that the treatment is expensive and seems to provide mixed or little benefit, but sometimes it is an improvement over the past ways of doing things. Doctors need to learn and adjust their style of practicing medicine as we learn new things about diseases and how the human body responds to them.

Humility is Needed

The longer I practice medicine, the less I feel that I know. It isn’t that I have developed dementia, but rather that I realize that there are numerous diseases that we don’t have good treatments for. The human body is amazingly complex. There are 36 trillion cells in the human body, and normally, they all work together perfectly; the problem is figuring out what to do when they don’t.

The Dunning-Kruger Effect is something that affects many fields in which people with limited knowledge and skill significantly overestimate their abilities in that field. Studies have shown that 65 percent of Americans believe that they have above-average IQs.⁴ Statistically, this isn’t possible. Fifty percent of any group of people will have above-average IQs, and the other 50 percent will be below-average. That’s how the IQ scale is set up.

While this effect is present for doctors, it is also present for patients. “Doing your research” is not the same thing as spending four years in Medical School, another three years in a residency training program, and continuing to stay abreast of developments in medicine through a variety of educational courses. We all would do well to listen better and realize our limitations.

The fact that your mother’s cousin took milkweed extract and felt much better from similar symptoms to yours is interesting. Whether the milkweed extract helped them get over their illness, whether there was a placebo effect, or they were just going to get better anyway, regardless of what they took, is up for debate.

True Wisdom

I have mentioned wisdom already, and I would finish with that. True wisdom is realizing that healing comes from God. Psalms 103:3 says of God, “Who forgiveth all thine iniquities; who healeth all thy diseases.”

Healing doesn’t come from antibiotics or chemotherapy. It doesn’t come from taking the right supplements or even eating a healthy diet. Healing comes because God touches us, right down to the tiniest parts of our cells and immune system, and makes things whole again.

I do believe that sometimes He works through medicine, but other times He works through the effective, fervent prayer of righteous men and women. (James 5:16)

With all of our knowledge, it is easy for us to get puffed up with pride and believe that we need no one else. We live in a world that is teeming with knowledge and a world in which wisdom has taken a back seat.

We must choose the source of our information carefully and realize that we don’t know everything. Maybe the reason why the fear of the Lord is the beginning of wisdom is because it is the first step to us laying aside our pride and realizing that we are a tiny part of Creation. Only then, can we humbly listen and learn and receive healing.