What Happens When Dr Google Is a Prime Referral Source

Dr Google has become a very reliable referral source for my practice. In the early days of internet medicine, patients would often come in telling me what they had after having done their own research. With full disclosure, they were sometimes right. More recently, though, I have seen a change in the tone of our conversations in which the Google search done for chest pain, left fingernail color change, or hair falling out is combining with this global anxiety brought on by the global pandemic. Now I am seeing much more fear and anxiety about what the various symptoms could be; often the fear runs to serious diseases, such as cancer, that are extremely unlikely.

Dr Google contains a lot of truth (and some fiction) but is not always accurate. The distance between truth and accuracy can be a wide gulf, especially for patients who are at low risk for serious illness. I recently saw a patient who was in tears after 2 days of a vague chest wall pain. I've learned the subtle (and not-so-subtle) signs that indicate that my patient is convinced an ominous diagnosis awaits her. My usual approach is to ask what they know or what they've learned and what they think is going on. This question generally leads to confession-like revelations that they searched Google and found out that it could be caused by pancreatic cancer, a stroke, a brain tumor, an ectopic pregnancy, and so on.

After getting to whatever they fear is the problem, I calmly and gently try to neutralize fear by explaining that almost any symptom could theoretically be caused by cancer, but it is almost never the cause. I discuss their specific risks and the things I am hearing in their history and seeing on their exam that argue against a serious diagnosis. When, after the history and exam, I too harbor a suspicion that this could be cancer, I still adopt the approach that it is always possible but there are many other possibilities, and the best next step is to get a for-sure answer as quickly as possible. I usually leave the conversation by advising my patient that this is not enough of a worry that they should lie in bed at night thinking about it. Because even the breast lump in a 60-year-old woman or the blood in the stool of a 75-year-old man is still usually not cancer.

We are living in an interesting time as we use the internet and public discourse to learn, educate, debate, inform, argue, and convince about all things COVID-19. It is logical that there is carryover into other health topics, especially as the different beliefs about COVID-19 have directly challenged the trust we place in science, medicine, health institutions, and physicians. Dr Google is here to stay, and part of our job (the part we weren't necessarily trained on in medical school) is to help our patients navigate an increasingly complex, confusing trove of internet information that is filled with truth — sometimes accurate truth, but also misinformation and disinformation.

Dr Google doesn't threaten my profession. In fact, Dr Google emphasizes the importance of a physician and a patient coming together to discuss a medical concern and arrive at a solution that is specific to that patient, accurate, and evidence-based.

What are your tricks for referrals from Dr Google? How have you advised your patients to navigate the various levels of quality information found on the internet?

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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Jennifer Frank. What Happens When Dr Google Is a Prime Referral Source - Medscape - Jan 13, 2022.