Paging Dr. Google? 

By: Emmeline Tran, PharmD, BCPS and Anne Kim, PharmD, MPH, MIT

“Just Google it.” Popularity of the internet search engine, Google, has resulted in its designation as a verb. Widespread use of and accessibility to the Internet has made it a fundamental tool in navigating the day-to-day, including health-related information. A survey in 2013 found that 59% of adults used the Internet within the past year to search for health information and, of those individuals, 80% started with a general search engine (GSE). In alignment with general Internet use trends, these numbers are expected to increase. 

The “just Google it” mentality has extended into the academic and clinical setting. When crunched for time, and recognizing the limitations of gathering information in this manner, we have been lulled into the usability and functionality of these resources to address immediate needs. Drug information purists may be appalled by this behavior. However, given the extent to which the Internet has grown and the value placed on accomplishing more with less, are we doing learners a disservice by prohibiting use of GSEs as drug information tools or resources and in not teaching learners how to properly use them? Are there situations when GSEs are appropriate to use in the clinical setting?

Power of convenience

GSEs have designed features to target speed and efficiency. Best-matching answers and summaries or quick previews of information are provided (e.g. Google featured snippets, Google knowledge panel, Bing Q&A). Information enclosed within these areas are curated via algorithms, which studies show have varied or lacking quality, accuracy, and completeness.^{1, 2} 

Drug information questions should not be answered solely using GSEs; however, they have features that promote convenience such as quickly defining unknown terms to acquire a general understanding of topics (e.g. disease states or outcome assessment tools) to further narrow down a search strategy or finding and obtaining relevant articles.^{3 4} The volume of information available to providers and patients can influence patient care practices. Providers have rapid access to information to facilitate diagnoses or treatment plans, and patients can more readily engage in their healthcare. However, information provided may be inaccurate, outdated, or biased. Clinicians are faced with providing optimal care while balancing time and resource constraints. Consequently, the ability to correctly navigate, assess, and apply available information is crucial. Development of efficient search strategies and utilization of resources that require a subscription may be sacrificed in lieu of convenience. Thus, conducting medical literature searches via GSEs may be a compromise. 

If you can’t escape it, embrace it

Given the ubiquity of the Internet, there is a natural inclination to gravitate towards the use of it in a manner society has always used it—a quick means to satisfy an inquiry. Instead of prohibiting the use of GSEs, the answer to these questions above may lie more so in teaching learners the differences between search engines (e.g. PubMed versus Google or Bing), advantages and disadvantages of each (Table 1), and how to optimize search strategies within them.⁵ 

Table 1. Examples of advantages and disadvantages of different types of search engines^3-5

Search Engine	Advantages	Disadvantages	Comments
PubMed	Sorts results via various parameters Extensive indexing and quality control	Training often needed to obtain best results Only indexed journals included	Sorts results in reverse chronological order Retrieves published literature
Google Scholar	Retrieves more types of literature Orders results by relevance	Lacks advanced search features Does not identify sources it has or has not indexed	Sorts results in chronological order Retrieves published and unpublished literature
General*	Ease of use Familiarity	Too much information Results provided can be manipulated Lack of transparency of content

*includes, but is not limited to, Google, Bing, and Yahoo

 Pharmacists are the most accessible healthcare professionals and with increasing use of the Internet for health information, exposure to GSE results can help gather what patients are finding in their searches. If discrepancies are found, appropriate materials to replace or supplement the information can be developed. A discussion with patients, addressing information found, can promote more informed decision-making.

Regardless of how information is obtained, the drug information mantra “verify and validate” should be implemented. Criteria have been developed to evaluate Internet resources. Exercises in which learners utilize each search engine or alternative resource to answer drug information questions may help them practice “verification and validation,” identify distinguishing features amongst these resources, and reconcile information found for patients. These exercises can be organically implemented in experiential education settings and may help retrain learners to rely on alternative methods for answering inquiries rather than “just Googling it.”   

Are learners at your institution taught how to navigate the various GSEs? What are some ways you have found the use of GSEs helpful with clinical workload?

References

1. Nguyen C. The accuracy and completeness of drug information in Google snippet blocks. J Med Libr Assoc. 2021 Oct 1;109(4):613-617. https://doi.org/10.5195/jmla.2021.1229
2. Scull A. Dr. Google Will See You Now: Google’s Health Information Previews and Implications for Consumer Health. Med Ref Serv Q. 2020 Apr-Jun;39(2):165-173. https://doi.org/10.1080/02763869.2020.1726151
3. Shariff SZ, Bejaimal SA, Sontrop JM, Iansavichus AV, Haynes RB, Weir MA, Garg AX. Retrieving clinical evidence: a comparison of PubMed and Google Scholar for quick clinical searches. J Med Internet Res. 2013 Aug 15;15(8):e164. https://doi.org/10.2196/jmir.2624
4. Nourbakhsh E, Nugent R, Wang H, Cevik C, Nugent K. Medical literature searches: a comparison of PubMed and Google Scholar. Health Info Libr J. 2012 Sep;29(3):214-22. https://doi.org/10.1111/j.1471-1842.2012.00992.x
5. Steinbrook R. Searching for the right search–reaching the medical literature. N Engl J Med. 2006 Jan 5;354(1):4-7. https://doi.org/10.1056/nejmp058128

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Author Bio(s)

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Pulses is a scholarly blog supported by a team of pharmacy education scholars