Curbside Consult with Dr. Jayne 6/3/24

I use HIStalk as a primary source for healthcare IT news as much as the next person, so I was interested to see the recent Morning Headlines call-out about Google’s AI Overviews. I had seen them pop up in searches, but didn’t think too much about them since the last couple of weeks have been a whirlwind of meetings and deadlines with travel to a conference sandwiched in the middle.

I had a little bit of downtime this weekend and was planning to use it to complete my mandatory Maintenance of Certification questions that I have to do every quarter to maintain status with my specialty board. The online quarterly questions are open book and you’re allowed to use online resources. Normally I use well-trusted sites such as the United States Preventive Services Task Force, various professional journals, and UpToDate to research the answers if I don’t know them outright. This time, I decided to use Google to see what it would come up with.

Due to the honor code involved with the quarterly questions, I can’t share the exact queries that I did during the project, but I’ll share the results of some questions that recently came up related to continuing medical education quizzes and conversations with colleagues.

Asking Google how much calcium I should be taking in each day resulted in the AI overview that displayed the same data that appears on the website of the National Institutes of Health’s Office of Dietary Supplements. It showed values by age range and sex, since Google wouldn’t necessarily know how to define “I” in the query. However, asking it for tips on selecting the best blood pressure intervention for a female patient with a blood pressure of 200/90 didn’t provide an AI Overview. (UpToDate won that one, hands down, with multiple articles addressing the topic.)

The recommendations for breast cancer screening in the US recently changed. I asked Google for the current mammogram guidelines and was greeted with four sponsored results and then a result with a link to the US Preventive Services Task Force site, so that was a plus since it was a direct link to the primary source material. Of the sponsored links, the one from Mercy wasn’t even about mammograms, but rather a promotion for its multi-cancer-screening blood test. Another one of the sponsored links, from a local fitness organization, was last updated in 2020 and provided incorrect information. As a clinician, I was pleased to find that the search for “are COVID vaccines bad” returned two websites from the Centers for Disease Control and Prevention followed by one from Johns Hopkins Medicine.

I then turned to more routine primary care questions, such as “do I need penicillin for sore throat” and was pleased with the information the AI overview provided, including that “antibiotics only help with bacterial infections, not viral infections” and “most sore throats are caused by viruses , such as the common cold, and will go away on their own within a week without treatment.” It went on to suggest reputable home remedies including rest and gargling with salt water as well as links to appropriate articles from UpToDate, GoodRx, and the National Library of Medicine.

I also asked, “what is a sinus infection” and although the information that returned was appropriate, I was thrown by the weird punctuation and capitalization that came with it: “Sinus infections can be caused by a number of things, including: An inflammatory reaction, Allergies, A code that doesn’t get better or gets worse after 7 to 10 days, and Smoking.” Even my Microsoft Word editor function caught that one and didn’t want me to send it along to Mr. H. I was pleased that it got the Oxford comma right, however. The AI Overview blurb also included some solid home remedies, such as reducing stuffiness by drinking lots of fluids, using nasal saline spray, and putting warm wet washcloths on the face.

By this point, I was fairly enthusiastic about some of the responses, since they included basic self-care items that a lot of the patients who come to see me in emergency and urgent care settings don’t seem to know. I see too many patients who present for care without having tried any kind of remedies at home, so I asked a tricky one: “Should I treat my child’s fever?” I see a fair number of parents who don’t give their children any fever-reducing medications when they are sick, under the pretense that they didn’t want to treat it because they “wanted the doctor to see how high it was.” Speaking generally for the physicians in my generation, unless your child is an infant or has one of a few chronic health conditions, we trust your use of a thermometer and want you to give your child some acetaminophen when they have a fever because it will help them feel less miserable.

The AI overview was spot on, advising caregivers to treat a fever “if it’s making them uncomfortable or preventing them from drinking fluids.” It also advised that treatment might not be needed for toddlers and children who are eating, drinking, playing, and sleeping normally. Sometimes I see children who are running fevers, but zooming around the exam room eating Cheerios and drinking apple juice, so this kind of information might have saved parents a $50 or $100 co-pay as well as prevented a couple hundred dollars in overall costs to the healthcare ecosystem. The overview was followed by links to content from UC Davis Health, Stanford Medicine, and Cleveland Clinic, so I felt good about the overall results of the search.

From there, I asked Google for symptoms of abdominal aortic aneurysms, and received an AI Overview. The second item on the list of symptoms, a pulsing sensation in the abdomen, can also be completely normal. The overview then recommended that anyone with the symptoms listed “should see your doctor as soon as possible.” In reality, if someone is having symptoms from this condition, they need to be in the nearest emergency department because it can be a life-threatening emergency requiring immediate medical management and the potential for emergency surgery. I’d give that particular response a D-minus if not an F since the potential for catastrophic consequences is high.

I asked the question again in a different way: “Do I have an aortic aneurysm?” and was told that “many people with aortic aneurysms don’t have symptoms until the aneurysm ruptures” and had to scroll off the screen to see any kind of recommendations for evaluation or care, so on the overall topic of aneurysms I would give Google an F.

In summary, I thought the technology did decently well for basic questions that I deal with every day, although it bobbled a little on the aneurysm question. Given the lack of basic health education in many communities, including how to treat minor illnesses and injuries, Google’s AI Overviews might be a nice step towards improved health literacy. It certainly makes the “finding” health information component easier, especially for patients and caregivers who might not know how to access the website of a local health system or other respected health information organization. It also did pretty well on the board certification questions, although some of them were more specific and therefore didn’t generate an AI overview. I’ll give the tool a solid B-plus as today’s grade but will keep an eye on it to see how it does in the future.

Happy Birthday, HIStalk! Congratulations on officially being old enough to buy a round of drinks. As is fitting for a publication created by anonymous people across the country, I celebrated with pastry for one. Healthcare IT has evolved in ways that I never dreamed it would, and I’m happy to have been along for the ride with HIStalk.

Email Dr. Jayne.