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Computer says ‘yes’ but doctor says ‘no’

Katrina Delargy at TIYGA Health looks at how ‘Dr Google’ can be used to the advantage of patient and practitioner

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We first heard of Dr No in the 1962 James Bond film, and the phrase “Computer says no” became a catchphrase after being used in the Little Britain television series in 2004.

“Computer says no” was a frequently used response to a perfectly reasonable question and became a national catchphrase.

Both came to mind today when discussing an article entitled “4 tips for doctors who see patients already diagnosed by Dr Google.” The article raises the question:

“How can doctors deal with patients who come to the appointment with printouts of diagnoses found online or ready-made lists of prescription drugs? And what to do when a patient starts trusting Dr. Google more than their doctor?”

The four tips are themed as:

  • Listen, explain, educate
  • Use Google to achieve therapeutic goals
  • Leverage the power of Google to strengthen your authority
  • Discuss the information found by the patient on the internet

So often we hear doctors complain about patients arriving to consultations with their own internet research on what their symptoms could be caused by or cured with, and many doctors do not like this happening. Likewise, we hear patients who are unhappy that their ideas or efforts have not been given due consideration. The result can often be 

  1. a waste of precious consulting time – a digression from the expected process 
  2. a sense of mutual frustration – arising from lack of trust and shared understanding
  3. delay in arriving at a shared decision on the best next steps 

A time problem?

At one level, this becomes a time management problem. The scheduled consultation does not go according to plan, there is even more to digest, distil and discuss. Maybe the result is that the whole schedule gets out of kilter, or an extra consultation is needed and maybe tests, prescriptions and referrals happen later than they could do.

Sometimes, however, the combined knowledge and experience of doctor and patient might lead to a better outcome that would have otherwise happened. Consultation times often feel too short, patient waiting times are becoming longer and  more new data, information, and knowledge becomes available on the internet every minute. 

How can a doctor keep up with all their duties and read all new sources of knowledge and be fully equipped for what each patient needs at the time of the appointment?

Patients may be able to dedicate a lot of their time, together with that of family or friends, to researching diseases so it is reasonable that they might find and combine sources to achieve a credible conclusion.

I recall listening to talks in a Rare Disease Forum and one doctor spoke eloquently about how a family arrived with the same diagnosis as he was planning to give. They had worked it out, he was relieved he had got there too. 

A trust problem?

At another level, this is a trust problem. Do both parties trust the other’s sources or summary of relevant details?

The doctor knows that the internet has a huge volume of information and that the quality is variable, they see examples that they truly feel is unhelpful but must also recognise that there are many very trustworthy sources of medical knowledge readily available to the public.

They know that what appears at the top of the search may be determined by marketing and search engine optimisation strategies rather than medical credibility. This is true. But is it the whole truth, and nothing but the truth? 

However, it is also true that many of the world’s most prestigious healthcare organisations, whether research or delivery, also post their latest findings online and often they are written in a style that is consumable by most patients.

Patients may invest many hours in finding, reading, comparing, and discussing such content – especially if motivated by direct real-world experience.

The wisdom of lived experience, combined with community debate and openness to questions and new sources, can very powerfully focus on specific cases and arrive at insights or conclusions that may be clinically valid. In rare diseases, this may often be a faster track to diagnosis. 

A better way?

There must be a better way. How far are medical professionals trained to receive information from patient research? Are they trained to arrive at shared decisions where a significant contribution comes from information provided by the patient? Do they understand when the wisdom of the crowd might be worth listening to? Sometimes we need to “cut a long story short”, to distil the results on an enquiry into something the recipient can digest quickly – and believe.

Perhaps we need some tools whereby patient research or even patient-generated data is somehow processed and validated before the doctor sees it – could it be submitted through a tool that assigns some scores based on the credibility of sources? Would it help doctors if the data was presented in a more familiar standard way rather than in a very ad hoc individualised way? Maybe some automated summarisation or prioritisation process is needed? 

One thing is certain, the number of patients will always exceed the number of doctors and the amount of time allocated to a consultation time may always seem too short for complex cases.

It seems rather unlikely that Dr Google will retire or change the search rules to suit doctors, although maybe the searches will get so much smarter that trusted medical sources always come top.

In the UK, if someone has read NICE guidelines or NHS websites or those from leading research organisations or charitable bodies, the information will be highly authoritative. There are a great many sources of credible and consumable health information online, patients may be happy to be guided to them. 

Undoubtedly, machine learning and artificial intelligence have a role to play. But surely it is not unreasonable for doctors to find ways to guide patients towards sources they are more likely to trust. This may vary by location and by population segment served, but certainly there must be a win-win where patients can find out what sources or methods of presentation their own doctors will be more likely to find helpful. 

Real world data – problem or opportunity?

Similar arguments can be made for patient-generated-health data, where the patient presents the data, they have captured using one or more devices to see a pattern or trend or a response to intervention. If the data was not captured on a medical grade device, with gold-standard peer-reviewed RCT references, can it be trusted? Healthcare professionals are not always trained to interpret or include such data – yet more patients are capturing similar data themselves, even more so since COVID-19 started circulating freely. 

Long Covid is just one example of where the medical profession can learn from the lived experience of patients. Fig 1 is a summary for the high scoring and continuing symptoms from one individual, over a six-month period – the relative impact on different body systems varies from person to person and different pathways might be chosen.

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Figure 1: Summary of main body systems affected by long covid for one patient

TIYGA has been enabling Long Covid patients to report in real time on more than 40 symptoms and a similar number of self-management options together with the opportunity to add free text notes explaining the context. This can be used to summarise their day-to-day experiences for any healthcare professional who needs such data. This saves time and allows a better overview of the progression of this complex illness and the problem that brain fog can make it difficult for them to recall the sequence of events.

We need to use technology to condense and present daily lived experience into a format that enhances the patient-doctor relationship and the short time available for consultations. By giving a heads-up to healthcare professionals, they have a better opportunity to identify trusted sources of guidance for their patients and to overcome some of the frustration arising from being presented with whatever the patient has found on the internet. 

Time is your greatest asset; the clock is ticking for all of us whichever side of the argument we sit on. Let’s not waste time rejecting patient sources of data and knowledge but find a way to present and summarise it so that we can empower the patient-doctor relationship. 

  • Katrina Delargy is founder and CEO of TIYGA Health

@tiygahealth 

www.tiygahealth.co.uk

www.tiyga.health

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