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Dr. Zach’s Guide to Dr. Google

BT Montreal | posted Monday, Mar 27th, 2017

Dr. Google — Using the Internet to improve your health


Unlimited information available at the click of a button.

People are getting informed about their health.

One in every 20 Google searches is health related

Pew research ctr:  80% of ppl have looked up health info online


Internet has info about conditions, health maintenance advice, and even programs that will try to diagnose you.


Self-diagnosis? Regarding online symptom checkers – Harvard study reviewed 23 symptom checker sites and found that they are not good at triaging or diagnosing — they err on the side of caution (can’t say it’s nothing if it’s something) and they only got the right diagnosis 34% of the time.  23 websites, 45 vignettes half common.

BMJ 2015;351:h3480 doi: 10.1136/bmj.h3480

Conclusions Symptom checkers had deficits in both triage and diagnosis. Triage advice from symptom checkers is generally risk averse, encouraging users to seek care for conditions where self care is reasonable.


So be careful about symptom checkers.  At best they can give you a list of possibilities.


Knowledge is power.  Good to be a partner in your healthcare — better to be active than a passive recipient.  The doctor has a limited time to explain. More info empowers patients — doctor as guide




Is the information real or “fake news”?  Who is writing it?  Who is paying for it?  What is their motive?

—-Be careful of miracle cures that cost money


Another problem is that we tend to search out things that we agree with or want to believe and dismiss the rest


So where do we go for valid information:

–Governmental (eg/ health Canada, Canadian public health agency), sites that end in.edu, .org

–Mayo, harvard



In some countries they’ve curated bona fide health info to pop up with searches eg/ Australia

What about online forums?  They are good for support, community (you are not alone) but careful to make sure they relate to you.

Dr. Zach’s Guide to Kidney Stones

BT Montreal | posted Tuesday, Mar 14th, 2017

I am a 50 year old man who experienced my first kidney stone last week.  The pain was excruciating.  The doctor sent me home with some pills and a follow-up but I want to know — will the stone pass on its own and will this permanently damage my kidneys?

Kidney stones are very common, with a lifetime prevalence of 12% in men and 7% in women.  The risk is higher if you have relatives with kidney stones.  They are known to cause very severe pain which often requires a visit to the ER to control.

In general, kidney stones are not considered to be a common cause of kidney failure.  The risk of kidney stones causing kidney failure is higher in people with diabetes, only one kidney, pre-existing kidney disease, and polycystic kidneys.

Most kidney stones (85%) pass on their own.  The chance of passing depends on the size (less than 6 mm have a better chance of passing), shape, and orientation of the stone.  In the ER the doctor gives medication to control the pain and checks to make sure that the kidneys are functioning well and that there is no infection.  If the stone cannot pass on its own then a urologist will determine the best way to help it do so.  Methods include lithotripsy (using electromagnetic shock waves to break it down), ureteroscopy (using a scope to remove it), or percutaneously (through the skin).

What is important if you have kidney stones is to have follow-up with a doctor after the acute episode, for two reasons: first, the doctor can determine what kind of stone you have and recommend ways to decrease your risk of recurrence.  In general it is wise to drink a lot of fluid and, for calcium (the most common type) stones have a low protein and low salt diet.  In addition, the doctor can check your risk factors for kidney disease and control them early.  This will protect your kidney function for the future.