We have a significant number of patients who google their complaints as a first port of call, especially over the past few months since we have been in lockdown.
Sometimes in the appointment, patients sheepishly admit they have already used Dr Google, as though it is a bad thing and we will thoroughly disapprove of their computer habits!
But what does Physiotherapy think of “Dr Google”?
Physiotherapy Assessment
In our Physiotherapy Assessment we always begin with a “Subjective assessment”. This is where we ask:
- About your complaint
- When and how it started
- How the pain behaves during the day, if it affects sleep
- What movements make it better and worse
- We learn about your family/exercise/work demands
- If you are taking any medication for pain
After this in depth conversation, we have narrowed what the problem is, to a couple of possibilities eg:
A pain in the buttock could be caused by:
- Lumbar disc irritation
- Lumbar joint sprain
- Gluteal Tendinopathy
- Proximal Hamstring Tendinopathy
- Active Extension posture where the spine is held too rigidly
Then we perform an “Objective assessment”:
We put you through your paces to examine your posture, joint movement, trigger points and muscle strength. We use this physical examination to finalise our diagnosis as different injuries will affect the body in slightly different ways.
Dr Google is very helpful to get to this point.
Google is an expert at detecting key words and there is so much information on the internet that is free and convenient to access from our lounge room. It is impossible to resist looking for a diagnosis and in the process you can learn a lot about medical conditions.
We know people use “Dr Google” (even if they pretend they didn’t!). Therefore, we always ask our patients “what do you think is going on”. This is a vital way establishing our starting point. Naturally if our patient has some previous knowledge of their injury, the treatment starting point is more advanced.
It is a benefit to use “Dr Google” if it means you have a greater understanding of your body and your problem.
We actually wish more people would google the medication they are taking.
However Google then has its inherent limitations.
“Dr Google” doesn’t have clinical reasoning.
Physiotherapists are not technicians who just provide a recipe for an injury. We put together a treatment tailored to individual circumstances based on best practice as demonstrated by research combined with complex clinical reasoning requiring highly developed problem solving skills and pattern recognition
“Dr Google” does not understand that the same injury does not elicit the same pain experience in different people.
Pain and how you feel is influenced by so many individual factors including:
- Emotional Factors
- Pain related fear
- Depression, anxiety, worry
- Social Factors
- Work, family, stress load
- Cognitive Factors
- Fear of pain, belief of what is causing the pain
- Life Style
- Sleep patterns, sedentary behaviour
- Physical
- Tired, fatigued, sudden change in activity
- Other medical problems
- IBS, psoriasis, fibro myalgia, diabetes, rheumatoid arthritis, hypermobility
There are so many things that influence pain and it means something different to everyone. An office worker who hurt their shoulder at cricket is going to have a very different experience of their treatment than a builder who has the exact same injury.
“Dr Google” cannot ask clarifying questions back to you
We had a patient with neck and shoulder pain that was stiff one morning and then became progressively worse over the day. He was on strong medication from the doctor and he had severe neck spasm and discomfort. During the discussions over treatment, we determined his brother had recently been diagnosed with cancer and which started with some shoulder pain. Through human conversation, we were able to clarify that although he had irritated his neck and developed “joint stiffness” the severity of his pain was being driven by his worry about cancer.
In Summary
Technology has enabled the prolific use of “Dr Google” to make our own diagnosis. Indeed learning more facts about your body and injuries is very helpful. However relying on a search engine and key words is not a good place to end your investigations. Google is a search engine for facts only. Physiotherapy will overlay basic facts with clinical reasoning, research and your individual circumstances. So when you have pain, start with key words to learn more. Then follow up with Physiotherapy to interpret individual aspects of your pain and how it affects your life, which is vital to developing successful treatment.
