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How to Outsmart Dr. Google

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Google is not a doctor and so we don't complete (just a clarification regarding the title given to me by the conference organizers). Presentation at the annual convention of the Philippine Society of Nephrology, 27 April 2019, EDSA Shangrila Hotel.

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How to Outsmart Dr. Google

  1. 1. H O W T O O U T S M A RT “ D R . G O O G L E ” I R I S T H I E L E I S I P TA N M D , M S C Professor 3, UP College of Medicine Director, UP Manila Interactive Learning Center Chief, UP Medical Informatics Unit
  2. 2. NOTHING TO DISCLOSE I give consent for the audience to tweet this talk and give me feedback (@endocrine_witch). Feel free take pictures of my slides (though the deck is at www.slideshare.net/isiptan).
  3. 3. D O Y O U H AT E “ D R . G O O G L E ” ? H A S G O O G L E A LT E R E D T H E M D - PAT I E N T R E L AT I O N S H I P ? H O W C A N W E S U P P O R T PAT I E N T S W H O G O O G L E ?
  4. 4. Pei-Li Teh & Marc Yates (2013) researchpartnership.com
  5. 5. Pei-Li Teh & Marc Yates (2013) researchpartnership.com Nine in ten had accessed the internet looking for healthcare information, with almost 3/4s having done so in the last month.
  6. 6. GENERAL HEALTHCARE WEBSITES ONLINE HEALTH FORUMS HEALTH COMMUNITY WEBSITES DISEASE WEBSITES CLINICAL WEBSITES PHARMACEUTICAL WEBSITES WIKIS E-NEWSLETTER FACEBOOK % 0 25 50 75 100 HEALTH INFORMATION SOURCES EVER USED Pei-Li Teh & Marc Yates (2013) researchpartnership.com (Philippines)
  7. 7. Do cultural variations exist in patterns of online health information seeking? Song et al. Trusting Social Media as a Source of Health Information: Online Surveys Comparing the United States, Korea, and Hong Kong. J Med Internet Res 2016;18(3):e25) US Hong Kong Korea
  8. 8. HEALTH INFORMATIONSong et al. J Med Internet Res 2016;18(3):e25) Expertise-based information produced by medical professionals Experience-based information laypersons’ subjective first-hand experiences of health & illness
  9. 9. HEALTH INFORMATIONSong et al. J Med Internet Res 2016;18(3):e25) Expertise-based information Americans showed a stronger preference for WebMD & CDC Experience-based information Asians showed more trust in blogs, online support groups & social networking sites
  10. 10. Internet-hostile Clearly uncomfortable with, and sometimes seem to feel offended by patient’s attempts to learn more online Image by Niklas Hellerstedt http://www.flickr.com/photos/niklashellerstedt/2414448568/ Tom Ferguson, MD & the e-Patients Scholars Working Group (2007) “e-patients: how they can help us heal healthcare”
  11. 11. “[Most doctors] really do like to think they have ALL the answers. This will never change, I am afraid.” Pew Internet Project e-Patient Survey Image by caricaturas http://www.flickr.com/photos/caricaturesbynelson/2031107541/
  12. 12. WHY DOES SELF-DIAGNOSIS ANNOY DOCTORS? http://www.endocrine-witch.net/2015/07/05/why-does-self-diagnosis-annoy-doctors/ #Bloggys2015 Blog Post of the Year
  13. 13. Online health INFORMATION resources push information out to the patient Online health ENGAGEMENT resources promote sharing of information and support/interaction among patients Collins S & Lewis DM. Clinical Diabetes 2013
  14. 14. Potential to transform the pursuit of health by allowing people to share what they know PEER-TO-PEER HEALTHCARE Fox, S. https://www.pewinternet.org/2011/09/18/medicine-2-0-peer-to-peer-healthcare/
  15. 15. Collins S & Lewis DM. Clinical Diabetes 2013
  16. 16. … the average person with diabetes spends no more than 0.1% of their time in the course of an entire year discussing health matters with a medical professional. Hernandez M. Diabetes Manage. 2013;3(3):203-205 “
  17. 17. D O Y O U H AT E “ D R . G O O G L E ” ? H A S G O O G L E A LT E R E D T H E M D - PAT I E N T R E L AT I O N S H I P ? H O W C A N W E S U P P O R T PAT I E N T S W H O G O O G L E ?
  18. 18. Crowd-sourcing Harnessing collective intelligence Image from antigone78 http://www.flickr.com/photos/antigone/457089364/
  19. 19. Image by judepics http://www.flickr.com/photos/judepics/2059494008/ Physician as INTERMEDIARY: gatekeeper of health information
  20. 20. APOMEDIATION Less reliance on traditional experts Image by migclick http://www.flickr.com/photos/migclick/2535570629/
  21. 21. Image by WebWizzard http://www.flickr.com/photos/webwizzard/3931165028/ The Well The Acutes Facing a new medical challenge The Chronics Chronic but stable illnesses 3 Categories of e-Patients* from Cain, Sarasohn-Kahn & Wayne (2000) “Health e-People: The Online Consumer Experience” * Includes caregivers
  22. 22. Internet Access from Tom Ferguson, MD & the e-Patients Scholars Working Group (2007) “e-patients: how they can help us heal healthcare” The Well every few months The Acutes everyday The Chronics several times a month Image by iwd http://www.sxc.hu/photo/1129780 60- 65% 5- 6% 30- 35%1 32
  23. 23. e-patient & Empowerment From Von Knoop at al of Boston Consulting Group (2003) “Vital Signs: e-Health in the United States Accepting Informed Involved In control Severity of Condition Attitude Toward Physician High Moderate Low Godlike Partner Supplier
  24. 24. Accepting Informed Involved In control Doctor- dependent & uninformed Doctor- dependent but informed Junior medical partners Autonomous patients Rarely go online for health information Go online before or after MD visit Prefer to make joint decisions but defer to MD Make their own decision even if MD disagrees From Von Knoop at al of Boston Consulting Group (2003) “Vital Signs: e-Health in the United States 1 32 4 Image by iwd http://www.sxc.hu/photo/1129780
  25. 25. “Paradoxically, a patient’s interest in knowledge may not always accompany an interest in the medical decision making process.” Gerber & Eiser, Journal of Medical Internet Research 2001 Image by nightRPstar http://www.flickr.com/photos/ninjanoodles/1586212326/
  26. 26. Physician-Patient Encounters Gerber & Eiser, Journal of Medical Internet Research 2001 Informed decision-maker Knowledge-acquirer Image by Kurhan http://www.sxc.hu/photo/1314902
  27. 27. The Knowledge-Acquirer Provides some personal values to the physician Image from carbonNYC http://www.flickr.com/photos/carbonnyc/3440688097/ Interested in learning more about the treatment decided on by MD Gerber & Eiser, Journal of Medical Internet Research 2001
  28. 28. http://www.flickr.com/photos/72341818@N00/4555752947/ The Informed Decision-Maker Possesses both preference and knowledge Extra time to discuss what patient knows Avoid frustration of not being the sole source of information Gerber & Eiser, Journal of Medical Internet Research 2001
  29. 29. D O Y O U H AT E “ D R . G O O G L E ” ? H A S G O O G L E A LT E R E D T H E M D - PAT I E N T R E L AT I O N S H I P ? H O W C A N W E S U P P O R T PAT I E N T S W H O G O O G L E ?
  30. 30. WHO runs or created the site or app? Can you trust them? WHAT is the site or app promising or offering? WHEN was its information written or reviewed? WHERE does the information come from? WHY does the site or app exist? http://nccih.nih.gov/health/webresources
  31. 31. Unproven Therapies. American Diabetes Association. Diabetes Care 2003; 26(suppl 1):s142. UNPROVEN THERAPIES Tend to be developed/promoted in isolation from established scientific facilities/associations
  32. 32. Unproven Therapies. American Diabetes Association. Diabetes Care 2003; 26(suppl 1):s142. UNPROVEN THERAPIES Contain misapplication of data from scientific literature Provide exaggerated or unrealistic claims
  33. 33. Unproven Therapies. American Diabetes Association. Diabetes Care 2003; 26(suppl 1):s142. UNPROVEN THERAPIES Often have the potential to be financially profitable to those who have developed, promoted or endorsed them
  34. 34. Unproven Therapies. American Diabetes Association. Diabetes Care 2003; 26(suppl 1):s142. UNPROVEN THERAPIES Generally communicated outside regular channels of scientific and clinical communities Details of therapies often secretive
  35. 35. Unproven Therapies. American Diabetes Association. Diabetes Care 2003; 26(suppl 1):s142. UNPROVEN THERAPIES Their proponents discourage or refuse consultation with or review by reputable physicians or scientists
  36. 36. Unproven Therapies. American Diabetes Association. Diabetes Care 2003; 26(suppl 1):s142. UNPROVEN THERAPIES Developers/promoters often claim a medical/ scientific “conspiracy” against them
  37. 37. http://nccih.nih.gov/health/webresources Are you reading news or advertising?
  38. 38. Endorses a product. Only quotes people who say good things about the product. Presents research findings that seem too good to be true. Contains links to a sales site. Includes only positive reader comments. You can’t add a comment of your own. ADVERTISEMENT NOT NEWS nccih.nih.gov/health/webresources
  39. 39. Collins S & Lewis DM. Clinical Diabetes 2013 Assess patients’ use of online resources and level of health literacy
  40. 40. The Internet Prescription Recommend websites to the patient Patients will likely seek a “second opinion” on the internet Gerber & Eiser, Journal of Medical Internet Research 2001 Image by Charles Williams http://www.flickr.com/photos/charlesonflickr/3926259585/
  41. 41. Building the Bridge from Office Visit to Online Interaction: Time-Saving Approaches Solicit and review recommendations. Collins S & Lewis DM. Clinical Diabetes 2013
  42. 42. Collins S & Lewis DM. Clinical Diabetes 2013 Create a list of credible online resources to proactively share with patients during office visits.
  43. 43. DOK BRU #PARASABAYAN www.dokbru.endocrine-witch.net
  44. 44. D O Y O U H AT E “ D R . G O O G L E ” ? H A S G O O G L E A LT E R E D T H E M D - PAT I E N T R E L AT I O N S H I P ? H O W C A N W E S U P P O R T PAT I E N T S W H O G O O G L E ?
  45. 45. @ E N D O C R I N E _ W I T C H I R I S T H I E L E I S I P TA N M D , M S C Professor 3, UP College of Medicine Director, UP Manila Interactive Learning Center Chief, UP Medical Informatics Unit

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