Lost on Route 66

A recent study published in the International Journal of Medical Informatics found that young physicians overwhelmingly turn to Google and Wikipedia when searching for clinical information.  There isn't even a peer-reviewed resource in the top 3.   PubMed, largest biomedical literature database in the world, doesn't even make the top 5.

At first glance, this appears quite frightening.  It conjures images of an exam where your physician stops and says, "Now is this benign or malignant? Let me check Wikipedia first."  As an aside, I wonder how many physicians now have patients telling them, "I'm not sure if this is the best course of treatment. I read on Wikipedia that..."

Regardless, conclusions cannot be drawn from merely looking at resource choice.  Physicians undergo years of rigorous training.  Residency is notoriously brutal.  By the time a physician is in practice, he or she is a walking medical encyclopedia, attached to a neural network with the most advanced semantic and natural language processing algorithms in existence, which has the ability to learn and adapt based on personal and shared experiences.  And, they have taken the Hippocratic Oath, a feature that has yet to be incorporated into any medical decision-support system of which I am aware.

Perhaps these young physicians are simply using the the search tools they find most effective.  In the study, respondants cited accessibility to up to date information and ease of use are primary motivations.  Should a physician be questioned for choosing Google as a search engine, when 72% of the U.S. market does as well.  Additionally, large corporations, academic institutions, hospitals, as well as state and federal agencies use Google search technology.

The more precise question may be, "What is the physician's final source for information?"  Google Search provides links and exerpts, not the information itself.

Perhaps, these physicians are looking for something else.  What do 4 of the 5 top choices for young physicians have in common?  Answer - They foster an online community through enabling contribution and discussion.

That will be the topic of the next post, "The New Triumvirate in Research."

In public health, particularly in pandemic preparedness, dissemination of authoritative, accurate information to the public is a key issue.  The message must be propagated across as wide an audience as possible, while ensuring that the message does not change as it is dispersed.

The most efficient method of dispersing information throughout a community is to relay the message to the key information nodes and allow the information to propagate through the effective channels each community has naturally developed.  This the basis for the Domain Name System (DNS), the Internet's "address book", which is quite robust.  One-to-all electronic technologies, such as RSS and widgets, will work only as long as there is electricity to power connected devices.  Neither technology can cross the digital divide.

As for keeping the message consistent, I recently attended a lecture given by Dr. Robert Provine of the University of Maryland School of Music.  During the Q&A Dr. Provine was asked why lyrics of certain children's songs had not changed over time  He explained that oral traditions are conservative in nature, meaning information is preserved, rather than altered.  In his research he has found that children's songs, as well certain imported sacred traditions, rarely undergo change.

How can this be applied to pandemic preparedness and response?  Perhaps by following the lead of successful HIV/AIDS information outreach programs and actively engaging community information nodes (teachers, religious/spiritual leaders, hair stylists, and servers/bartenders).  State and local public health officials (using accurate, authoritative guidance) can interact with these individuals face-to-face.    They, in turn, will interact face-to-face with citizens.  Allow the message to be propagated into communities through an oral tradition.

What message are they given?  That's a separate discussion.  However, they could teach a song about washing hands and staying home when you're sick...

(to the tune of "This Old Man")
Wash your hands
Cover your cough
If you're sick, take a day off
Go to Flu dot gov or W H O
For the things that you should know

It's kind of catchy, actually.