Does Googling your own symptoms to self-diagnose help you or your doctor?

If you’re one of those who have searched their symptoms before going to the doctor, you’ll know how the more frightening articles get more of your attention

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Doctors are concerned that health apps and fitness trackers are creating more ‘worried well’ than ever before. But is that really the case?

In recent weeks there has been a spate of articles arguing, as Dr Des Spence wrote in the BMJ, that health apps and fitness tracking devices such as the Fitbit and the Apple Watch are ‘untested and unscientific’, and that they could create “extreme anxiety” in a new generation of the “worried well”.

I won’t dispute that some technology companies talk about their health gadgets as if they’ve reinvented penicillin, but these are the sort of companies that will hold a huge event to announce a slightly improved phone as “a shining jewel”; they talk about everything as if they’ve just reinvented penicillin. But I would argue that health apps are, for the most part, fairly simple and genuinely useful.

Google’s list of the 10 most popular health apps of 2014 includes nine that track walking, running or healthy eating, and one for tracking periods. They all work in the same way, recording data about you and then presenting the results in an intelligible way. They give you facts on how much you weigh, or how much exercise you’re getting, how much alcohol you really drink, or when you’re likely to be most fertile. Facts on their own don’t tend to make people anxious unnecessarily. Ask anyone who’s taken a course for fear of flying, and they’ll tell you it’s mostly just learning interesting facts about air travel. Uncertainty, on the other hand, is great at making you anxious.

Dr Richard Harkness, a Durham GP who writes about technology for GP magazine, confirms it’s not so much that there’s been an increase in Worried Well patients, but he does say that the sources of anxiety are changing. “It used to be 'I read in the paper' but increasingly patients have heard [about an illness] on TV, websites and Google”, says Dr Harkness. Other results back him up: of the 300 GPs polled for the Astellas Innovation Debate in January, 76% reported a ‘marked increase’ in patients self-diagnosing from the internet in the past year.

Is this necessarily a bad thing? The Googling done by Dr Harkness’ patients may fuel a certain amount of hypochondria, but in other cases it’s about gathering facts and saving time. “People are using online tools to score symptoms, and they are the exactly the same scales we use as doctors. A good example of this is the PHQ 9 score for depression.” Some have even successfully treated themselves: “One patient I saw correctly diagnosed themselves with vertigo after Googling their symptoms- they read about vestibular exercises, performed them and quickly resolved the problem. They came to see me because the vertigo had returned, so they very sensibly came to check they were doing the right thing.”

 

The combination of ubiquitous smartphone cameras and increasingly clever image searches is also become a force for good in the GP’s surgery. “Patients are using their phones to capture rashes or document changing lumps and bumps”, says Harkness. “As smartphone cameras improve, this is increasingly helpful.”

Harkness reports that patients also learn from each other through support forums. “They can present with a narrative that they have read online which led to a diagnosis after a long and involved pathway, and use this to avoid the same experience. Sometimes these aren't always appropriate for them, but it opens a dialogue about how we can help.”

There is definitely no denying the anxiety that Googling your symptoms can cause. If you’re in the 30% of people who have searched their symptoms before going to the doctor, you’ll know how the more frightening articles get more of your attention. Attention is the main factor search engines use to decide which page goes to the top of your search results – just as attention-grabbing health scare headlines help decide who sells the most newspapers – so the process feeds a kind of crowdsourced anxiety. But while certain editors are unlikely to give up front-page splashes about statins, Google is taking steps to make symptom-searching less scary by adding sensible medical advice, written by its team of doctors, above search results for common illnesses. This is currently being trialled in the US, but you’ll see it in you search results soon.  

If anyone has a reason to worry about the growing influence of technology on your visit to the GP, it’s your GP. While gadgets like the Apple Watch excel at providing information, you still need a qualified practitioner to interpret it, and that will mean more work for doctors. “There is a tidal wave of medical data coming our way”, says Harkness, “and most doctors will know little or nothing of the devices it has been generated by. To my knowledge there is no guidance on how to deal with this new wave of patient-generated content.”

For health tech to genuinely change things, the huge technology firms providing the means for people to generate this giant increase in medical data must also help doctors to interpret it. If they can – and, by the look of programmes like Apple’s HealthKit platform, they’re certainly spending a lot on trying – then apps may undergo an upgrade from generally useful to genuinely lifesaving.

Will Dunn is the editor of Stuff magazine. To see Stuff’s recommendations for wearable and health-tracking technology, click here.

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