#EngineerInTheWards is a series based on my experiences and reflections during hospital rotations. I am an Engineering PhD Student in the Harvard-MIT HST Program, which means I take approximately the first year of medical school coursework at Harvard and do 3 months of clinical rotations in addition to engineering coursework at MIT.  When a regular person wants to figure out how to fix their chronic headache, they Google their symptoms, and inevitably end up thinking that they have cancer, or a brain tumor, or both [1]. This is not news. The fact that Googl-ing symptoms causes people to think they are near imminent death has been the butt end of many jokes and memes.

References: (left) http://9gag.com/gag/aEGvXXx/i-don-t-always-google-my-symptoms-but-when-i-do-i-have-cancer, (middle) http-//en.webfail.com/85496262f38, (right) https-//makeameme.org/meme/when-you-feel-8c4g9h

Before my clinical rotations I, too, used to Google symptoms. The top hits would be WebMD.com, MayoClinic.org, MerckManuals.com, or MedlinePlus.gov, which would all regurgitate the same basic information that I found unsatisfying. If I were really on a mission to learn more about a symptom or condition, I would try searching for review articles on PubMed (an expensive resource I am lucky to have access to as a university student). I thought I was pretty good at finding medical information if only I was persistent enough to read papers (something my PhD training had taught me well). My world changed during clinical rotations when I learned about the secret (or so they seemed since I had never heard of them and they never popped up during my Google searches), incredible websites that doctors use. These websites told me exactly what I wanted to know about any condition or symptom accompanied with descriptive photos, reliable references, and trustworthy guidelines for exactly how to treat the condition.
If patients are going to Google their condition anyways, shouldn’t they have access to the same quality information that doctor’s have?
Enter the online world of medical references that your doctor uses instead of Google: UpToDate, DynaMed, Current, and many more. These are medically sound, evidence-based databases that tell doctors most things they need to know to be able to treat just about any patient according to the most up to date guidelines. (Sounds great, right?). My favorite site is UpToDate, which was started by a nephrologist at Harvard Medical School in 1986 as a scrappy startup operating out of his basement (i.e. the New England equivalent of a garage startup. Garages are typically unheated in New England so they clearly won’t work as a startup office for most of the year…). Dr. Rose, the founder of UpToDate, had single-authored an entire nephrology textbook (!) and so the contents of his textbook were the first items to populate the UpToDate website. Over the past 20 years, UpToDate now has information on just about any medical condition and has grown to over 1.1 million subscribers in over 180 countries around the world [2].
garage startups

Sorry Silicon Valley, garage startups aren't really a thing here in New England. No heating you see. Basements (which you don't have) are our next best thing. (Refs: Silicon Valley garage startup www.wired.com/2013/08/coreos-the-new-linux, New England winter en.wikipedia.org/wiki/February_2013_nor%27easter)

For every condition, UpToDate has a “Patient Information” section, which contains more basic information put in layman terms, as well as a “Provider Information” section, which goes into more detail and jargon. Both sections I find have more useful information than WebMD.com or MayoClinic.org have ever given me. And the information is continually updated and curated as new research or medical guidelines [3] come out. It’s a shame that these incredible medical databases are behind hefty pay walls. A one-year subscription costs hundreds of dollars [4]. uptodate_CHF I understand that some of the information contained in these medical databases will be over some people’s heads and has the potential to confuse them. But I think the healthcare system should give a lot more credit to patients than it current does. If patients are going to Google their condition anyways, shouldn’t they have access to the same quality information that doctor’s have? Shouldn’t such information be the first thing that pops up on a Google search? Let me know what you all think. Are there any awesome medical databases you know of that are cheap or free?   Note: If you have the good fortune to be affiliated with universities or hospital systems that give you access to UpToDate or any of the other medical databases I mentioned, I hope you go to these resources when you are trying to research your symptoms or those of a loved one.  

References and Footnotes

1   Google has caught on to this and is now implementing a cool new feature that first lists a symptom’s most common causes (instead of the rare, terrifying ones). Read more at “Google aims to stop terrifying you with its responses when you search medical symptoms” (Washington Post) 2   Watch this 4-minute video of the doctor who founded UpToDate reflecting on the 20-year anniversary of the company: http://www.uptodate.com/home/uptodate-story 3   I hadn’t really appreciated (or given any thought to) medical guidelines before. There are loads of medical associations in the USA, i.e. American College of Cardiology, American Thoracic Society, American College of Rheumatology, American Society of Anesthesiologists, etc. Their job, among other things, is to put out a summary of recommendations of best practices in their field according to the evidence of the time. They put out supplements or revised guidelines every few years as needed to keep up with the research. These guidelines tell doctors exactly how to, for example, treat congestive heart failure patients, treat community-acquired pneumonia patients, treat osteoarthritis patients, or anesthesia guidelines for preoperative fasting in patients undergoing elective procedures. When someone’s life is on the line and you’re in charge of saving them, it’s very comforting to be able to go to medical recommendation guidelines and have them tell you what to do. 4   Though a 7-day subscription of UpToDate is only $19.95   Reference for featured image: http://imgfave.com/view/1518835?c=51029