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We rely on the Internet to get the latest news, stock quotes, and sports scores; conduct online banking; and purchase goods and services from vendors worldwide.
We rely on the Internet to get the latest news, stock quotes, and sports scores; conduct online banking; and purchase goods and services from vendors worldwide. Thanks to e-mail and wireless Internet connections, we’re never out of contact for too long; in fact, many of us now stay in touch with our offices and even our patients 24/7.
The Internet allows us to access CME (continuing medical education) on demand—including live streaming video—and use knowledge-based medical information services, such as Micromedix, PubMED, and UpToDate. Vast amounts of medical information are available on the Web, enabling us to look up clinical articles and information on drugs and clinical syndromes.
Our patients do the same thing, often using the ever-popular and highly productive search engine Google. Google was created by two Stanford students, Larry Page and Sergey Brin, who in 1996 developed BackRub, a search engine that analyzed back links (the number of Web links that point to a particular website). From there they introduced the unique concept of ranking pages based on how many other pages link to it (when you do a Google search, the pages with the most links pointing to them are higher up in the results list). With an investment from Andy Bechtolsheim (a founder of Sun Microsystems, Inc.) and others, Google, Inc. was founded in September 1998.
Since then, the company has steadily improved on its search engine technology in an effort to streamline the search process and ensure search queries return the most relevant and useful information (for example, if you think Bechtolsheim’s name is misspelled, just check for yourself; in fact, try misspelling it, and Google will correct you).
Start Your Engines
Search engines are arguably most valuable because they enable users to quickly find information on a variety of medical and non-medical topics. Many of us have slipped into the habit of using Google as a medical search engine to identify drugs, find articles, and even point patients toward references for their own edification. More often than not, when prescribing a new drug or making a new diagnosis, I will ask my patient if he or she is Web savvy and then send him or her to the Internet for a quick review of the literature prior to a return visit to initiate therapy. It saves time, informs the patient, and is generally reliable; hardly ever are you confronted with bad information that takes the patient off track and takes extra time to explain.
It is also not very difficult to locate a colleague almost anywhere in the world for consultation, referral, or communication using
Google or any other popular search engine. In fact, it is downright scary to realize how much information is available on the Web. Just recently, one of my colleagues from the west coast required a formal letter from me inviting him to participate in a CME program. It took only seconds to Google him and find his e-mail address and phone number, and to find out what he has been up to and what transitions have occurred in his career.
If you really want to give yourself a wake-up call, open up Google and type in a few-word description of yourself and your specialty. Did you realize there was that much information about you online?
Much like the original Google, Google Scholar provides a simple way to rapidly search for information, but narrows the target information to include only scholarly literature. From one place, you can search across many disciplines and sources: peer-reviewed papers, books, abstracts, and articles from academic publishers, professional societies, preprint repositories, universities, and other scholarly organizations. Still in beta testing though very robust, Google Scholar identifies the most relevant information across the world of scholarly research. It “aims to sort articles the way researchers do, weighing the full text of each article, the author, the publication in which the article appears, and how often the piece has been cited in other scholarly literature.”
The most relevant results will always appear on the first page. Use Google Scholar to “search diverse sources from one convenient place; find papers, abstracts, and citations; locate the complete paper through your library or on the Web; and learn about key papers in any area of research.”
Google Health is Google’s newest directory, providing up-to-date products, medical reviews, and access to overall health information listed by category (eg, Men’s Health, Addictions, Weight Loss, etc). Google Health lists related Web pages in Google’s typical page-rank fashion, by total number of hits per page. Google Health takes your standard search and breaks it down into more precise categories, until you have an exact match:
> Conditions and Diseases
> > Cancer
> > > Breast
> > > > Organizations
> > > > > Susan G. Komen Breast Cancer Foundation
A recent article in Healthcare IT News explored why the company recently decided “to improve the information that comes up in a Google search on health information.” At the Fourth Health Information Technology Summit, Google Vice President Adam Bosworth said “a large percentage of all Google queries are searches on health issues” and fall into one of four categories: symptoms; treatment for a specific illness; experts in treating a specific illness; and coping advice. Although Google searches retrieve the most popular health information, the company has been working to identify the most reliable healthcare information and has reconfi gured its search engine to display that information at the top of search results.
Bosworth mentioned that although doctors may not always agree on which course of treatment is best, “consumers deserve to be armed with the most—and best—information possible.” He also identifi ed several types of important information that is currently difficult to find online—including information about how many times a particular doctor has performed a given procedure, mortality rates, and guidance on interpreting this information—and noted that Google is working on finding ways to make this information available.
Hide and Seek
Let’s return to the subject of how much and what kind of information is available online to patients looking for information about their physicians. We mentioned before just how easy it was to use Google to find personal information about a colleague. Having all that information out there for anyone to see makes the concept of being “on call” take on a whole new meaning, doesn’t it? And this was merely a case of one professional colleague who wanted to contact another. Just think who else might be looking up our information—it could be anyone from our patients, to our high school classmates,
to our bill collectors, or even the occasional stalker! This raises an important question: “Are you Googleable?” And if you are, is that necessarily a good thing?
One of the main reasons patients will research a physician online is to fi nd contact information in order to try and schedule an appointment. Looked at in one way, this a benign use of the Internet to acquire information, but from the perspective of most primary care providers (PCPs), who needs more business? Most practices are overrun, so who needs another patient searching for a PCP? Besides, the search for contact information may possibly also turn up all sorts of other information about a physician, including his or her home address, phone numbers, e-mail addresses, and other information.
Do you want your patients knowing what lectures you have given, your employment history, other areas of interest, and any additional ways in which you have applied your expertise (at least since the dawn of the electronic era)? And this applies only to information that you yourself have more or less directly generated. What about information generated by others, such as opinions expressed about you in online chat rooms and other forums, comments on blogs, etc? As the Internet expands to accommodate greater use of social media and other information-sharing applications, the amount of information online will also expand.
So, can you “control” the information available about you online, at least to some extent? Not really. But you can provide an ideal platform for the presentation of most of the information about yourself and your practice for which patients are searching. Most professional societies now off er their members the opportunity to subscribe to some kind of home page or portal that gives them both the opportunity to link to their professional affiliations and the capacity to provide their patients with access to the practice. Some are quite sophisticated and serve as your front desk. Many of our readers might already be familiar with the likes of Medfusion, which partners with the American Academy of Family Practice. Visit the Medfusion website to learn more about the custom website development solutions offered by the company. Practices can create secure patient portals that enable patients to pre-register for appointments, schedule appointments, request prescription renewals, conduct “virtual office visits” to receive minor-acuity and non-emergent care, assess their symptoms, pay bills online, and find out lab results. Practices can even use the service to off er an “Ask a Doctor” secure e-mail feature.
If you are in the market to develop a patient portal, plenty of additional vendors exist, and a simple Google search of “patient portal” will return enough information to provide you at least an hour’s worth of browsing. To give you an idea, on the day I performed that search, I looked at results one through 10 of about 2,490,000.
Off the Grid
On the other side of the equation are those select individuals who remain “unGoogleable.” This can occur either by intent or just from lifestyle choices alone. “Ungoogleables don’t post online, blog, publish, or build web pagesusing their own names,” says Wired News. “They’re careful about revealing information to businesses, belong to few organizations that can leak personal data, and never submit online resumes—all common ways that Google captures your data.” Wired News offers this tip: “If you don’t want to be found on Google, don’t use your given name if you participate in chat or newsgroups, and for all of your e-mail addresses, don’t use any part of your true name and have an unlisted phone number.”
It can be difficult for physicians to achieve this level of anonymity, given that many of us have faculty information Web pages on the websites of the universities and/or health centers and hospitals with which we may be associated. Many physicians have also coauthored papers for peer-reviewed journals, spoken at conferences, or performed any of a dozen other actions that likely resulted in at least some information about them being published and preserved somewhere online. At the very least, online Yellow Pages and other directories make it easier than ever to fi nd home and practice addresses and phone numbers.
The volume of information available online is expanding at an ever-increasing rate. Companies are developing increasingly sensitive and sophisticated search engines to aid in sifting through the horde of information available online. Any tool such as Google that is easy to use, points you in the right direction, seems to understand your needs, and corrects your spelling in a very kind and gentle way is ideal for quickly uncovering information on just about any subject or any person. Go ahead: Google yourself or Google any one of the Editorial Board Members on the MDNG masthead, and see what shows up. The search engines, the opportunities, and the challenges appear to be almost endless. Kind of like 1 followed by 100 zeros…