|LETTER TO THE EDITOR
|Year : 2014 | Volume
| Issue : 4 | Page : 531-533
The physician and the patient: Biting the bytes
PK Satpathy, PM Diggikar, Anunay Agarwal, Gaurav Bachav
Department of Medicine, Padmashree Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India
|Date of Web Publication||25-Jun-2014|
P K Satpathy
Department of Medicine, Dr. D.Y. Patil Medical College, Pimpri, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Satpathy P K, Diggikar P M, Agarwal A, Bachav G. The physician and the patient: Biting the bytes. Med J DY Patil Univ 2014;7:531-3
Medicine has been on a never-ending journey from a starting point of no-technology to the current location of higher and higher technology, more and more intruding into human touch and care. Even some patients impressed by the advent of latest innovation request the physician "Just put me in such a machine that will show all the defective parts and also tell the disease."
However, they are right!! Trusting machine more than the humane humanity. Nothing has greatly changed medicine more fundamentally than one recent advancement - the internet. Miniaturing the personal computer attributes to its portability to every possible nook and corner of the world; and has become a great boon to both the physician and patient as compared with all other medical technologies, which are accessible only to the medical fraternity. Taming this "wild horse" is a formidable task. Later part of the 20th century could forecast this concern.
"With the star or specter - as you will - of the computer hanging over us, the student might be led to think that the importance of clinical method is receding. There is a saying in the computer world - "garbage in, garbage out." If a machine is really going to suggest diagnosis to us, it will only do so usefully if it is first fed with accurate information suitably standardized and coded." 
The web contains innumerable information to inform and educate doctors. Useful search engines such as Google and Yahoo! offer portals to primary data published in peer-reviewed journals, slide shows, video procedures and guidelines from professional societies. Patients are increasingly proficient with the internet and frequently use the above search engines for medical information. 25 million people in the United Kingdom were estimated to have web access in 2001 and searching the health information was one of the most common uses of the web. 
Most physicians use the internet daily in the search of diagnosis. In 2006, two Australian physicians tested the diagnostic accuracy of Google searches by entering symptoms and signs from 26 published case records of 1 year (2005) in New England Journal of Medicine.  The search revealed the correct diagnosis in 15 cases (58%, 95% confidence interval 38-77%). Internet searching was more effective for conditions with unique symptoms and signs; complex diseases with non-specific symptoms or common distresses with rare presentations were less likely to be diagnosed this way.  In Googling for a diagnosis, "garbage in" must be accurate to get a correct "garbage out;" for example if liver enlargement is missed in a jaundiced patient, the diagnosis will be totally different. The web also provides immediate access to current information, including primary source data. Journal articles can be obtained within seconds and evidence based analysis are readily available on the sites of professional societies and in compendiums such as UpToDate and Zynx. 
Enquired by patients about novel therapies, physicians have to resort to internet searching for details. Primary physicians now have easy access to many guidelines whose reach were previously limited to specialists and could reduce the volume of referrals to some type of specialists.
Patients consult the internet in search of self-diagnosis. Doing so leads them to seek medical attention very fast and to suggest what turns out to be a correct diagnosis. However, the web is perilous for its hypochondriacs. The differential diagnosis for backache, for example, led one patient to think that he had an abdominal aortic aneurysm. With a normal examination and repeated reassurance, the backache resolved. Other patients whose diseases have no ready cure are drawn to chats and websites that may make more false claims such as assertions that macrobiotic diets cure lymphoma, acquired immune deficiency syndrome can be treated with hyperbaric oxygen and many more fallacious claims. Falsehood are easily and rapidly propagated on the internet: Once you land on a site that asserts a false rumor as truth, hyperlinks direct you to further sites that reinforce the falsehood.  One woman with recently diagnosed Lupus tells "I really don't want to read what's on the internet, but I can't help myself. Half the time, I just end up scaring myself." 
Many medical centers have secure web portals that allow patients to view their laboratory, radiology and pathology results remotely without consulting their physician. This technology is efficient, avoids the need for multiple phone calls and mailing of information and is welcomed by many patients. One man saw a report of neutrophil count 78% and highlighted in red. He took this report as Leukemia and passed a sleepless night before he could be reassured as non-significant. Patients increasingly seek information about selecting doctors online. "Dr." followed by a name gives a plethora of rating sites, whereas a search for the same name with "M.D" at the end yields scholarly publications as well. Information obtained in web searches of physicians is not always accurate.
Beyond providing broader, speedier access to information, the web in profoundly changing communication between doctors and patients.  Many patients E-mail not only their own doctors but also specialists around the world. Many doctors also E-mail their patients of test results - an efficient practice. However, sending E-mail is quite different from speaking with a patient face to face, can't observe grimaces, tears, looks of uncertainty, tone of voice, confidence; those are essential in building up a strong patient-physician relationship.
Physicians are endeavoring out how best to use this technology in the interests of patients and themselves. Although the internet is reshaping the contents of the conversation between doctor and patient, the core patient-physician relationship should not change. A patient recently asked "What can you possibly learn from your doctor that is not available on the internet?" What a radical sentiment! Knowledge is said to be power. However, information and knowledge do not equal wisdom, wisdom always stands before knowledge. Physicians are in the best position to weigh information and advice patients based on their training and experience. The doctors will never be optional and redundant. 
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