I started practicing as a pediatrician in 1982 and retired in 2021. So, Google, which became commonly used around 2000, has been with me about half of my practice lifetime. Those two halves were startlingly different.

Before Google, I gave new parents and parents-to-be lists of books I recommended, I stocked my waiting room and exam rooms with brochures and handouts on wide ranging topics like breastfeeding, circumcision, discipline, immunization, and childproofing. Parents expected me to be a source of reliable advice and information. And I was. Parents saw me as an expert with valuable knowledge from my 7 years of training as a pediatrician. My standard baby shower gift for friends was a copy of The Academy of Pediatrics’ wonderful book Your Baby’s First Year.

Between 2000 and 2005, things changed. Smart phones could text both words and photos, while Google traffic increased exponentially. Parents of my patients started to sound different.

“Doctor, I read on the internet that you can toilet train babies starting at 6 months.”

“Google says vaccines can be harmful.”

“I’ve been reading about mono, and I think my child has it.”

Just Hold Your Child Up to the Phone

Night call started to change as well. In the 1980s and 90s, we pediatricians joked about nighttime calls involving rashes. Parents are uniformly terrible at describing rashes, so the calls used to go like this.

Them- “Doctor, Suzie has a rash. What should I do?”

Me- “Well, what does the rash look like?”

Them- “It’s just really rashy.”

Me- “Pink, red, purple? Big bumps or little bumps? All over or just in one spot?”

Them- “I don’t know, it’s just really rashy.”

I was always tempted to say, “Just hold them up to the phone and show me!” A joke in the 1980s, this was a real possibility by 2006. I loved it when parents could send me photos. But I didn’t love it when the phone call was accompanied by, “The internet says it might be smallpox!” Reassuring a worried parent that smallpox has been eradicated worldwide never held a candle to the power of the internet.

Eventually, Google became a verb, (Added to the Oxford English Dictionary in 2006) and searching the internet prior to calling or going to see the doctor became ubiquitous. I learned to expect parents with a list of questions, possible diagnoses, and tests they wanted, based on what they had read on the internet.

Your 15 Minute Google Search or My Seven Years of Training?

How did we doctors react to this sea change? In varying ways, based on ego, level of stress or fatigue, attitude of patients, and a host of other factors. I began to see cute/snarky coffee mugs in the hospital break rooms, saying “Don’t confuse your Google search with my medical degree.” and “Is it a headache or cancer? Let me just Google that.” I know some doctors who, on bad days, may have said such things to patients. It never helped.

Once I became a hospitalist, most of my patients had worried parents who had been Googling for a while before their child was admitted. They always had a lengthy list of questions and fears, usually worsened by the internet. If they were told a diagnosis in the emergency room, by the time their child was admitted and I met them in their hospital room, they’d had a good hour to furiously Google the new diagnosis. I learned to enter the room with a disarming smile, introduce myself, and say, “Have you had a chance to get really scared by Dr. Google yet?” They always said yes. It wasn’t all bad. I found it tremendously helpful for parents of a child with a new diagnosis, to have had a chance to read and start to get their head wrapped around it. It gave us a starting place. I learned to have a list of reputable websites for the more common conditions I dealt with in the hospital and steer parents to those, suggesting they ignore other unreliable websites.

What’s a Valve Cover Gasket?

You know, access to information is a powerful tool. But information is not the same as knowledge. You must have a context for the information, or it is not helpful. Here’s how I think about it. I know extraordinarily little about how cars work. If I take my car to the mechanic because it is making a funny noise, and he tells me I have a cracked valve cover gasket, I don’t know if that is a $20 part, or if I’m going to need a whole new engine. In the same way, if a parent reads that their child’s persistent fever and rash could be sepsis (which is life-threatening), Henoch-Schoenlein Purpura (which can cause kidney failure), or a minor viral illness, they have no way to put that information in context. That’s what I’m here for. If they had an extensive list, I said, “Good, a list. Hmmmm. The good news is, a lot of the items on this list don’t exactly fit what’s going on with your child. Here’s what I am most focused on; let’s go from there.” If they were still worried about the entire list, I told them about my car’s valve cover gasket. It seemed to help.

No Good Deed Goes Unpunished

Now, things have taken another turn. In 2021, a new law, the 21st Century Cures Act went into effect, mandating that patients have access to the information in their electronic health record “without delay”. There are a host of unintended consequences because of this law. Now, when I’m in the hospital, my patients will have blood drawn at 6 AM, and the results will hit the medical record by 9 AM or so. I may not see that patient until 1 PM, but the parents have had plenty of time to see the results. And Google. And worry. I know that a sodium of 146 instead of 145 doesn’t really matter, but they don’t; the computer has flagged it as abnormal. They have now read a scary list of potential causes of elevated sodium, none of which are pertinent for their child. I have to peel them off the ceiling. They were worried about nothing. Much worse is when their child has an MRI first thing in the morning, and try as I might, they see the results before I get to their room. If it is bad news, this can be awful.

I saw another side of this with a friend recently. She got called back for a repeat mammogram after the first one looked suspicious. Done on a Friday afternoon, the results would not be on the chart until Monday. She was a wreck, trying to figure out a way to get the results on the weekend. I wondered, was it better to wonder all weekend, or get information that she might have breast cancer on Saturday, sitting at her computer at home? How many people now find out horrible news by looking at their electronic medical record? Would it be better to learn it in a phone call or visit with your doctor?

No Looking Back

Would I go back to pre-Google times? Not by a long shot. I love the access to information for my patients and for myself. The ability to go to Google Scholar and access scientific medical publications in the blink of an eye is seductive, efficient, and makes me a better doctor. My patients are usually better-informed. There’s no going back, only forward.

Soon (probably already), AI will tell you your lab results, what you should think about them, and which specialist in America is the best one to see. Shoot, it might even schedule the appointment, deliver your medicine and file the insurance claim. It’s a bold new world!