We GPS love Dr Google as much as our patients

Online advice must be handled with care, but health tech frees doctors to give the human touch

For patients struggling through this long holiday season with a winter cough or cold, the Royal College of General Practitioners’ recommendation to consult the internet before rushing to make an appointment may have provoked some consternation.

Those who recall that, in the notso-distant past, doctors were quick to advise them of the dangers of selfdiagnosis and alternative treatments, may be particularly aggrieved. Patients who arrived at the surgery brandishing a computer printout could expect to be met with raised eyebrows and grim warnings about the quacks and charlatans inhabiting the world wide web.

How times change! It is worth remembering that it took general practice more than a century to get used to the new technology of the telephone. When I started as a GP more than 30 years ago, the phone was considered appropriate only for making appointments and for emergencies. Once scorned as a poor substitute for a face-to-face consultation, it is only over the past decade that the telephone has become a familiar means of doctorpatient interaction.

Over the same decade, the internet, the PC and the smartphone have transformed medical practice as they have every other area of our lives. Few patients – including the elderly as well as the younger generation – now consult doctors without also having recourse to the internet (and we suspect they are often more up front about their symptoms online, too).

The reality is that, today, it offers a rich source of mostly useful information that often assists with diagnosis and treatment. Just as people are wise to the internet when it comes to elections, or “customer” reviews of books or washing machines, they have become increasingly, and appropriately, discerning about the medical advice they find online.

Patients used to grumble that their doctors kept their heads down scribbling notes and prescriptions. If they now complain that their GPS’ eyes are fixed on their computer screens, this is, in part, because, through connections to the internet, these screens provide invaluable information for day-to-day medical practice. I, like many doctors, don’t hesitate to consult Google during a patient appointment, if I need to check protocols and guidelines to ensure they are getting the right treatment. Doctors are not infallible, but whereas in the old days we had to make a trip to the hospital library to look up unusual conditions, or to revive fading memories, now we can readily retrieve such information without getting up from our surgery chairs. While patients are still in the surgery, we can guide them towards appropriate advice on self-managing their conditions, or to sources of support and other services.

Could a robot one day put me out of a job? Of course, but Dr Google is not without faults. Information is not the same as judgment, and doctors still have an important role in helping patients to discriminate between what is valuable and what may be misleading. The internet has a tendency to tilt towards the more serious, the more exotic and the more malignant possibilities. I recall numerous skin rashes, lumps and bumps that patients were convinced were meningitis or malignant melanomas, which, on brief inspection, turned out to be patches of eczema, ringworm or harmless cysts. It is often helpful to remind patients of the old adage, that “common things occur commonly”. Those seeking to selfdiagnose must be prepared to stand corrected.

The RCGP is right to counsel “buyer beware” when patients consult websites: the web is still awash with pseudoscience and quackery. Yet it is better that it is readily accessible and able to be critically reviewed with patients in the surgery. I find it most useful to sit down with a patient and their relatives to look together at reports of new “wonder cures” on the basis of limited early trials, for example, or unsubstantiated claims made on some of the anti-vaxxers’ websites.

Patients visit their doctor as much for the human interaction as for the clinical interpretation of their symptoms. Conversely, then, as healthcare technology continues to advance, doctors may be freed up to make consultations more personal.

So Dr Google is here to stay, and it has gone from foe to force for good. But I fear it will not reduce demand for GP appointments, as the chair of the RCGP hopes. The experience of NHS Direct shows that, at a time when health-related anxieties are running high and a culture of risk-aversion is pervasive, remote encounters fail to reassure. Telephone contacts often lead to further consultations in GP surgeries and A&E departments.

Patients now want the information offered by the internet in addition to the expertise and reassurance provided by human contact with their GP. The challenge to the NHS is that patients want both Dr Google and their own GP.