Crash Cart – Should patients go to Google before physicians?

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REAL PHYSICIANS DISCUSS RECENT HEALTHCARE HEADLINES

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Study shows Googling symptoms helps patients interact better with doctors


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William Sullivan, DO, JD

Informed patients are great. Misinformed patients can sometimes drain the life blood from your soul. Unfortunately, I’ve seen probably an order of magnitude greater of the latter than the former. Google directs people to some support group for an issue that it tangentially related to their symptoms, patients then read that someone’s Uncle Sally had those symptoms and had to see five different doctors before they caught his neck cancer, then the patients come to the ED demanding an MRI of their spine to rule out metastatic disease.

Off the top of my head, I can recall one patient pitching an absolute fit (as in we needed to call security) because a pimple on her kid’s leg looked like bedbug bite on a random Google picture and all medical providers in the ED were idiots because we couldn’t tell what a bedbug bite looks like. She was escorted out with her kid in tow waving a cell phone picture and yelling through the waiting room. I recall one patient who stopped taking her blood pressure medication and Googled “high blood pressure” before demanding that we do a test for a “peeocycromida.” Or the 26-year-old with obvious musculoskeletal neck pain who demanded a cardiac workup because he read on Dr. Google that neck pain is a symptom of heart attacks. Then there’s the patient with a rash on her elbow who self-diagnosed herself with psoriasis based on a Google search and wanted a prescription for one of those cool psoriasis medications she saw on TV. She didn’t believe me when I told her she didn’t have psoriasis. To humor her, I mentioned that those drugs cost nearly $1,000/month – maybe she should start with some OTC steroid creams. She then told me to just call the Medicaid department and get the expensive drugs pre-approved.


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Despite discussions about why their Google searches were incorrect, in each of these cases the patients left upset and thought I was a horrible doctor because I didn’t concur with their presumptive Dr. Google diagnosis. I can’t recall any instances in which Dr. Google has saved the day. Makes me wonder if Google and Press Ganey have some kind of secret pact. Oh, and that last part of the study where about 40% of patients admit to being “worried or anxious” about the results of Google searches just tells me around 60% of the participants either had poor memories or weren’t being entirely truthful. If they weren’t worried, why did they come to the emergency department instead of following up with their PCP?

Nicholas Genes, MD, PhD

We should welcome motivated, curious patients who sought to educate themselves before seeking our expert opinion. Glad to see this study confirms that — at least, in Australian patients. The vast majority of respondants said searching in advance of the ED helped them communicate more effectively with their provider, and helped them understand what care and instructions were delivered. The only problem comes when Googling takes someone down the wrong path and 40% of subjects said Googling symptoms made them anxious. A small subset of patients clearly ‘anchors’ on the worrisome diagnosis Google suggested and no amount of reassurance or expertise seems to help. It’s these few patients that have instilled a fear of Google, among EPs.

Seth Trueger, MD MPH FACEP


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Better informed patients is a better situation for everyone. Unfortunately a lot of information online talks about what the worst case scenario is for every symptom, and seems to increase patient anxiety — maybe enough to throw patients into a fib, which their Apple Watch will catch, and now I have something to treat. In all seriousness, I’m generally impressed with the insight a lot of patients have about their symptom-googling. “I know I’m not supposed to search online about this… and now I’m nervous about X.” I’m still an optimist: as Bill implied, it implicitly reinforces *why* we’re here. If Google could tell you the answer, you wouldn’t be in the ER. I’ve had a lot of positive experiences assuaging patients’ googling-related concerns and it can be a good springboard to demonstrate our expertise. There have always been and always will be unreasonable patients with unreasonable expectations.

Paul DeKoning, MD, MS

Informed patients are a good thing. I find it most helpful to ask what it is that patients who Google are worried about. It’s often some form of cancer. They usually have something in particular they are concerned their symptoms represent and when we can talk about THAT then we are really making progress.

Facebook might make MRIs a lot faster

William Sullivan, DO, JD

I don’t know enough about how the AI will be applied to make MRIs faster, but rest assured that Facebook is NOT undertaking this endeavor out of the goodness of its hive-mind. It WILL assimilate the data it gains into some already-existing database it has about you. With trillions of dollars spent each year on health care, after receiving your Facebook-enhanced MRI, look for targeted advertising suggesting orthopedists to fix your torn rotator cuff, cancer centers to treat your peeocycromida, and the latest and greatest $1,000/month medications to treat your cardiomyopathy. I’ll just sit in the MRI machine a little longer and pass up the Facebook enhancements, thanks.

Nicholas Genes, MD, PhD

Kudos – I guess? Maybe Facebook is trying to repair the damage to their reputation? This is one of those out-of-left field applications — like Google developing autonomous cars —  that will probably make more sense in retrospect, when Facebook starts using MRI scans to optimize advertising.

Seth Trueger, MD MPH FACEP
I suspect this is a scheme to ultimately get eye-movement-controlled Facebook screens into the MRIs for the patients to browse while they are stuck in MRI…

EpiPen expiration dates to stave off shortage

Nicholas Genes, MD, PhD

This story pits three major forms of pharmaceutical industry BS against each other — which will prevail? First, as we’ve covered before, EpiPens are outrageously expensive. Despite jacking up the price and lining their leadership’s pockets, however, Mylan and Pfizer still can’t reliably make the drug available — another shortage! So much for the invisible hand, and the genius of our market system. Thankfully, the third form of BS — the expiration date — can be relaxed, so anxious patients can hold onto their supply a little longer. I do worry that pharma will learn a lesson from this, and start moving up the expiration dates on other drugs, to goose profits. It sounds shameless and wrong, but also entirely consistent.

William Sullivan, DO, JD

Sing it, Nick. Expiration dates are such a crock. All they do in 95%+ of the cases is force medical providers to throw out perfectly good medications. So now, because of some perceived emergency due to shortages on a decades-old drug, the FDA waves its magic wand and *POOF* one subset of a specific drug suddenly has a longer shelf life. Can that be applied to the epinephrine in crash carts as well? Nope. Or how about future EpiPens once this manufactured “shortage” has resolved? Or *gasp* could the FDA extend the shelf lives of other drugs as well? Of course not. You want to solve this whole drug shortage and expiration date farce quickly and easily? Make two laws: Any drug that experiences a shortage in more than 5% of the market immediately and irrevocably loses its patent and can be mass-produced by any entity. Second, if any medication expires and is returned to the drug manufacturer, it must be replaced by the drug manufacturer with an equal amount of unexpired medication at no cost.

Paul DeKoning, MD, MS

What’s even worse is when you look at what the actual remaining shelf-life is of pharmacy-stocked EpiPens. A couple of my residents did just that by surveying pharmacies across the country. Virtually none had the full shelf-life remaining; some only a couple months before they expire, if that’s even a thing. No wonder patients are ticked—crazy expensive drug that docs tell them they need to have in their glove box, with the school nurse, under the pillow, in their purse/backpack/man-satchel and buried in the back yard. But don’t worry, it may only have two months left before it expires and they’ll ‘need’ to buy replacements.

Tyler Armstrong, MD

Expiration dates are honestly just built in job security for the FDA and pharmaceutical companies. If they were actually needed we’d have evidence supporting the practice.  Instead, what you have is a perpetual cycling of medications that not only forces the consumer/hospitals to continue to purchase the product but also keeps FDA employees busy. It’s yet another tool in the arsenal of big pharm to line their pocketbooks and support exorbitant pricing.. which although likely stems from greed, some could argue is a byproduct of the US consumer subsidizing medication research for the rest of the world (ever wonder why the same drug in Canada is so much cheaper than in the US and more importantly the consequences if that were to change?).

1 Comment

  1. I think people Googling their symptoms can be fine and even helpful, as long as they can be rational about it, and are willing to set aside their “Google PhD” and listen to what the doctor says.

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