Dr. Kirtan Vyas (M. S.- Obs/ Gyn)

Asst. Professor

P.D.U. Medical College, Rajkot

# 98254 07702

KNOWS ALL

Dr. Kirtan Vyas(M.S.-Ob/Gy)•Gujarat Uni. First-Gold medallist

•Gujarat Public Service Commission(GPSC) first

•Fellow in Gynec Endoscopy(Mumbai)

•Fellow in Ultrasonography(FOGSI)

•Publications in various International Journals

•Presented Scientific Papers and Chaired Sessions at State and

National conferences.

•Faculty at State and National Conferences

•Local Joint Secretary of SOGOG 2015-Gujarat State Org of Ob/Gy

•Organising Secretary for the First Rajkot Obstetrics and Gynec

Society Annual Conference 2015 and Committee Member at State and

National conferences

•Organizing secretary for the West Zone Yuva Fogsi 2016, Rajkot

Scientific Committee member at Mid Term SOGOG 2016, Diu

At present working as an Assistant Professor at P.D. U. Medical College

and Hospital, Rajkot

WHO IS DR. GOOGLE?

• Most famous doctor on the planet

• Your Major Competitor

• Almost every one of your patients consults with Dr. Google before they contact you

• Dr. Google only performs house calls and is open 24/7/365

4

DR. GOOGLE

CONSULTATION HOURS: 24 X 7

• When patient get sick, she visits the doctor

• Proper Check-up & medication

• She will take the prescription to the Pharmacy

• Then she hopes the medicine will have a fast effect on her

• Patient surfs anything that pops-up in her head

• Helps her find information, or give her a “pathfinder” to trace the information

• Dr. Google offers many ways to cure her needs

• Let’s find out which will work

WHO’S DR. GOOGLE?• Consultation at home

without fees

• Advice changes every time on surfing

• Never pinpoints what is wrong

• Patient Guesses and self-diagnoses

• Patients trust what Google says and they are not seeing doctors because of the same 6

SELF DIAGNOSIS

Dr. Google will never know a

patient nor care as much as a

physician will do

DR. GOOGLE DOESN’T KNOW

THE PATIENT

• can’t see or talk with the patient

• can’t hear patient story

• can’t smell

• can’t touch

It doesn’t have intuition or gut feelings

about patient

THE INTERNET BREEDS CYBER

CHONDRIA IN SOME AND FALSE

REASSURANCE IN OTHERS

• The more complex the problem, the more likely your self-diagnosis is wrong

• ovarian cancer with expert consultation diagnosed as a uterine fibroid

• Opposite may be true, and you could use the Internet to convince yourself that there is nothing wrong when you actually do have cancer

GOOGLE INCREASES THE RISK

OF CONFIRMATION BIAS

• This bias occurs when a patient comes in looking for evidence to support a pre-conceived opinion, rather than actually listening for information that might prove her wrong

• “I know that I have an ovarian cyst, so there is no reason for my doctor to ask me any other question. He’s not listening to me, I know that I have an ovarian cyst”

• Unfortunately, patient stopped listening because Dr. Google says she has a cyst, and she is looking for confirmation

DR. GOOGLE CAN SOLIDIFY AN

ANCHORING BIAS

• When a physician settles on a diagnosis too early and then disregards other important clues that don’t fit that diagnosis

• The patient can also have an anchoring bias when they know what’s wrong with them, so they leave out important details and dispute any information from the physician that doesn’t fit their diagnosis

DR. GOOGLE IS WRONG 59% OF

THE TIME

• According to the Pew Research Center’s

Internet and American Life Project, 35% of

respondents had researched a medical

condition in 2012 and of that group only 41%

of patients who diagnosed themselves online

said a medical provider confirmed their

suspicions

In the exam room, your story matters

more than your research

• Don’t let Dr. Google

get between you

and your patient

• If patient has already decided on treatment

and the physician disagrees, then she may

set up an adversarial relationship

Patient is only two clicks away from

garbage medical advice and junk

science

• Who is behind the “expert” Internet advice?

Being a celebrity does not make you a

medical expert

• NIH, ACOG,

• RCOG, PUBMED-Reputed

DR. GOOGLE DOESN’T REALLY

CARE ABOUT PATIENT HEALTH

• The Internet will never replace human interaction

• It can’t show the patient compassion, empathize with them, give them a shoulder to lean on, hold their hand, rejoice with them or grievewith them

“Just because

someone says

something, we

should not

believe its true”

Always Ask “Where is the Evidence ?”

Evidence Based Medicine is an Evolving

Science…...Life-long Self-directed learning……..

“The conscious, explicit & judicious use of current the best available evidence in making decisions about the care of the individual patient.” *

Standardized care in Scientific way

Improves patient safety by eliminating unsound practices

Keeps knowledge up to date

*Sacket DL, Evidence based medicine; BMJ 1996;312:71-2

EVIDENCE BASED MEDICINE

Improves understanding of research

and its methods

Confidence in managing clinical

situations

Better communication with the

patients

Prevents wasteful practices

Improves computer literacy and data

searching skills

Allows group problem solving and

teaching

Improves our reading habit

Goal of EBM

Active management of the

third stage of labor(Ω)

Antibiotics for asymptomatic bacteriuria in pregnancy(π)

Single dose antibiotic prophylaxis for caesarean section(€)

Magnesium sulfate for eclampsia(∑)

Early initiation of oral fluid and food after caesarean

section(√)

EFFECTIVE EBM

×Pubic shaving, Enemas (∞)

× Routine episiotomy (£)

× Multiple micronutrient supplementation

during pregnancy (@)

× Micronised Progesterone for

threatened abortions (*)

× Tocolytics for Preterm Labor (©)

× Abuse of Oxytocin (®)

× Excessive use of Ultrasound, BT (Ø)

PRACTICES - NEED TO BE ELIMINATED

Clinical research is constantly producing new findings that

may contribute to effective and efficient patient care

Putting them in to practice is vital *

Without current best evidence , practice-risks becoming

rapidly out of date , to the detriment of patient $

* Grimshaw. Oxford handbook of public health

$ Sacket 1996

Clinical decision should be based on

best available scientific evidence,

informed by epidemiological and

biostatical reasoning

(Ω) Maughan KL, Am Fam Physician;2006:15-73,1025-8

(π) Varma R Eur j Obstet Gynecol 2006,Jan 1:124-1

(€) Hopkins l, Cochrane Database 2000,(2): CD001136

(∑) Duley Cochrane Database Syst Rev2001;(1);CD002960

(√) Mangesi L Cochrane Database Syst Rev 2002,(3): CD001136

(∞) WHO, C57-C76: August 2006

(£) Cochrane Database syst Rev 2009,(3): CD001136

(@) Merialdi M, RCT,J Nutr 2003;May 133:1626 s-1631 s

(©) Sanchez-Ramos L, Clin Perinatol 2003, Dec; 30(4),841-854

(Ø) J Ultrasound Med 1988 Sep;7(9 Suppl):S1-38

REFERENCESREFERENCES

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