In the span of twelve hours (in the past 18), I read two separate things that struck me… well, they left me… dumbfounded, really. Coupled with a third recent habit (can you couple to make three?), I find myself at a loss to express, let alone explain, all that I think of them except to say, “It’s a conundrum.”
1. Photoshop
Over the past 8 weeks, I took a class on the basics of graphic design. We covered basic principles of design, as well as how to use the Adobe products, Photoshop and InDesign. I learned a lot, including a gained (and unexpected) awareness of how often pictures that appear in magazines, websites, ads, etc. are manipulated. It happens so often, I now note, that I find myself questioning what the heck is real in any of these images anymore. It’s one thing to draw or paint a picture of a setting and throw an extra tree in to make it look nicer. There’s an expectation of interpretation in some artistic disciplines. I’m not sure that everyday photography carries with it the same.
Examples: I sit in a committee working on redesigning my library’s website. We’re looking for images to use in our rolling banner. We’re looking at other pages for other departments and come across a really lovely picture of the quad with students on it, having lunch, studying away. It’s on the department’s homepage, the one visitors will look at and say, “Ooh, how nice.” After a few seconds, someone in the group asks, “Were there ever any trees there?” And we all look closer and then we feel… well, what do we feel?
A few trees added to make the quad look nicer (nicer than it’s ever looked, but…). No harm, no foul. It’s like the three hamsters in tea cups. I mean, it’s pretty easy to tell it’s the same darned hamster copied and pasted three times over. It’s cute. It’s fun. It’s a joke. So the department’s website is a joke, too? You tell me.
2. Wikipedia
People trust Wikipedia. There are have been stories and interviews ad nauseum on the topic of its credibility. I regularly see medical students with a page from Wikipedia open on the PC in front of them as I walk through the library. Not a big deal, I guess, if you’re looking for some basic info or perhaps a nice diagram. I recently had some surgery and one of the best diagrams of the artery involved in my surgery, I found on Wikipedia. It made it easy to share with family members or friends who wondered what and where the celiac artery was. In fact, there was a nice, condensed version (questionably lifted from an uncredited source) of the condition I had. Again, I had several very good journal articles from reputable society publications that I could pass along to others, but Wikipedia was a lot easier and just the right amount of information to share.
However, here’s a little snippet from an interview with the singer-songwriter, Lisa Hannigan, that I read last night before going to sleep:
Not everything is “perfect” in Hannigan’s world – her Wikipedia page, for one. “There’s so much misinformation about me there,” says Hannigan, sweetly. “Especially, all the stuff about me and Damien [Rice]. There was all this speculation about us after I left his band. [Hannigan sang with the singer-songwriter from 2001-2007. They also had a romantic relationship.] And all these supposed bad feelings and broken hearts. It was weird, but we sorted it out ages ago. Anyway, I wanted to change all the stuff about that on my Wiki page. But my page lady said, ‘Oh, it’s a conflict of interest for you to write your own stuff. And besides, the amount you want to change is too much!’ So, I’m stuck with all this stuff that isn’t true. Yes, my reign of terror against them has just begun.
Lisa Hannigan: Road Songs, by Peter Gerstenzang, Nov/Dec 2011 Issue, American Songwriter
You tell me, what do you do with these two examples? How can you reconcile them? How do you teach the credibility of sources? I’m still working out how I’m going to bring this example into my next lecture on such for a group of students. And I will. In the meantime, I’d love to hear others’ thoughts.
3. Google
I refuse to go into any diatribe, pro or con, about the role and place of Google in our information searching behavior. I’m done with that. I simply want to present here something I read this morning in the book, Every Patient Tells a Story, by Lisa Sanders, M.D.
I picked up a copy of this book and had the author sign it when she spoke at the Annual Meeting of the North Atlantic Health Sciences Libraries a couple of weeks ago. Physician, professor, author, oft-sought-after speaker, and technical advisor to the television show, “House, M.D.”, Sanders’ book is an expansion on a column she’s written regularly for the New York Times Magazine over the past several years. (For more on Sanders, see this NPR story.) I’m only a few chapters into it, but it’s a good read. And she was a good speaker. But here you go… page 12:
Hsia (a first year resident at Yale) posed the question to the team. Neither had heard of such a syndrome. So, after the team had finished seeing all the patients they were caring for, Hsia hurried to find a computer. She went to Google and entered “persistent nausea improved by hot showers.” She hit the enter key and less than a second later the screen was filled with references to a disease Hsia had never heard of: cannabinoid hyperemesis – persistent and excessive vomiting (hyperemesis) associated with chronic marijuana use (cannabinoid).
So this admission wasn’t the first for this patient. She’d seen multiple doctors, received multiple diagnoses, and been given a plethora of treatments over the previous twelve months, all to no avail. Her chart was thick. The resident read all of it first. Maybe all of the doctors who saw the patient before had done some credible research on the case. Maybe not. We don’t know. All we know is the pattern of information searching by the doctor presented in this paragraph. All we know is that she went to Google and in less than a second had the right answer that had eluded everyone else up to that point.
Again, or perhaps for the third time, what to do with this? As a practitioner, consumer, producer, and teacher of how to seek, find, evaluate and use information, I’m left right now with only one really definite feeling – “It’s a conundrum.”
blahg, blahg, blahg... 
I’ll bite. Here are a few anecdotes to help you comfort yourself with the direction you find the world going:
1. Photoshop
Photos, especially online ones, are a reproduction of the real world. In the case of a website banner, particularly corporate ones, you’re trying to evoke a certain emotion. But try capturing the warmth of a small room covered in frescoes with a photograph–especially if you don’t have professional photographic lighting or a wide-angle lens. Especially in visual media, our brains can easily misinterpret information, and sometimes it’s necessary to correct this in order that the information is perceived as the real thing would.
Similarly, a university campus’ quad may not have trees in it, but it may still have a vibrancy and fresh, crisp air that you can’t reproduce literally in a photograph. Is the photograph saying “our campus is great because it has trees,” or are the trees merely a symbol for something less tangible?
2. Wikipedia
Wikipedia entries are very important for public figures, even small-scale local ones, because often hosts at an event will just print off the Wikipedia article for the person’s introduction, and any minor incident that’s overrepresented in the article will carry over to such occasions. Here are three approaches I’ve used with or suggested to various local public figures:
a) Go through it with a Wikipedian who has lots of experience, and therefore credibility, and make it clear in the explanation field that you are correcting errors in consultation with the subject of the article. Supplement with c)
b) Remove the most offending errors in the typical Wikicrat fashion—by suggesting in the explanation field that the claims are uncited. Ideally, before doing so, search the web to confirm that there aren’t any credible references to support the false claim, or better yet, some true claims that contradict the error. If you do find erroneous references, you can try taking it up with the publisher of that content, and/or find something that raises doubt with the false claim reference, such as a comment on a newspaper article page claiming errors in the article.
c) The guidelines as I recall them (though I haven’t been very active on Wikipedia for a few years) discourage the subject editing his/her own article, I don’t think there’s anything wrong with that person listing the erroneous claim on the discussion page, and leave it up to the resident Wikipedians to determine the best way to resolve those issues. If they remain unaddressed after a while, that might make it fair game to change them yourself.
Removing erroneous information–especially unsourced claims–is much less controversial than adding correct/true information–especially if no reference is provided (which the subject of the article is unlikely to produce).
3. Google
I think much has been written about how learning these days is no longer about memorizing a bunch of trivia, but about learning how and where to find the relevant information. It’s not a doctor’s job to necessarily know every single condition and be able to diagnose it instantly, but to be able to discern truth from fiction–and to know enough about you to determine whether a diagnosis actually fits. I’d expect my doctor to look up the drug she’s about to prescribe me, to make sure it doesn’t conflict with another medication or condition, and to explain to me the implications of taking it improperly (e.g. if you miss a dose). I don’t expect my doctor to know from memory these details for every combination of medication and condition–if she does, then she probably doesn’t know very many of them and is seeing every symptom as a nail that fits her hammer.
– RG>
Thanks, RG. I really appreciate you taking the time to offer some thoughtful comment.
A couple of my thoughts in reply:
I appreciate the idea of using commercial photography to evoke a certain emotion. It’s certainly valid. I am concerned, however, with the pervasiveness of it, particularly as it’s passed off as realistic. The easiest example I can think of is the use of it in fashion and/or modeling. Does the shaving and toning and reshaping of men and women’s bodies into ones that are humanly impossible to attain, over time, produce negative effects on a societal understanding of a healthy body image? Do we begin to create and pass of “realities” that aren’t real at all? It’s a concern. Again, trees and hamsters… okay. But there’s something bigger at risk, I feel.
The fact that Wikipedia entries for public people are so important is exactly why I was taken by the incident shared by Hannigan. She’s a public person and if she herself cannot easily make right the content of her own Wikipedia page, it makes me question the editorial process and subsequent credibility of the source in its entirety.
As for docs and Google, as a health sciences/research librarian, this bothers me on many levels. Like you, I do not expect my doctor to know and/or have memorized everything. However, the point for me and this topic is the pattern of how a professional goes about finding credible information. It’s why I said that I don’t know that this was her first attempt at finding a diagnosis, but it was certainly presented that way. What this says to me is that here is a highly educated individual who has gone through K-12 education, received a four-year undergraduate degree, and completed 4 years of medical school, and somewhere/somehow along the way she never learned and/or never adopted any better habits for finding and retrieving information than the quickest and easiest tool. And more, the tool with secret and customized ranking algorithms. Yes, in this instance it worked out (or so we’re led to believe) and yes, in some cases the mystery is so great that you go for big, wide open search tools to find the answer. Cast a wide net, so to speak. But I can guarantee you that this resident (because she was at Yale) and more than likely your own doctor, has access to a myriad of better quality, more effective, and more efficient information resources. We pay a huge amount of money for them annually, not to mention have professional staff to help docs and other healthcare practitioners utilize them. It’s not their job to know everything, I agree, but it certainly IS their job to know where best to look for the information.
Beth beat me to it, but succinctly: for every person* trying to remove false information from their Wikipedia entry, there’s another one trying to remove true information.
(*and corporations are people, too!)
Cheers,
– RG>
I think that this is a very interesting topic and I’ve been thinking and pondering about the question of “authority” and what exactly does that mean when we are teaching about different sources to use.
Wikipedia
The whole Wikipedia thing to me is interesting and I’m not quite sure what to make of it. I think that Wikipedia can be great for some topics, and I would say that’s true for some medical topics. One of our oncologists knows the people who maintain a Wikipedia page and he feels confident in that page and the information because he knows who is policing the page (sadly, I don’t remember which one it is). But maybe that gets back to the authority issue, and he feels he knows the people supplying the information and trusts them. I can’t say that I know the people who maintain any Wikipedia pages to vouch for their authority. The example I always like to use is the drug companies that have been found out to delete adverse effects of their drugs from their Wikipedia pages. I think it serves as a cautionary tale and still surprises some of the students. I just hope we’re doing a good job showing them better (I’d like to think) and more viable alternatives that if I end up being their patient, I have confidence they are relying on more than just Wikipedia.
Google
Something that we talk about to our third year med students ties with a few articles–Googling for a diagnosis–Use of Google as a diagnostic aid: internet based study http://www.ncbi.nlm.nih.gov/pubmed/17098763, and then a later article based on this initial one–Effectiveness of the use of internet search by third year medical students to establish a clinical diagnosis http://www.ncbi.nlm.nih.gov/pubmed/20505913 .
The first article looked at case reports in the New England Journal of Medicine, and the authors searched using 3-5 terms in Google to see if a correct diagnosis showed up (maybe on the first page? I don’t quite remember). They received a correct diagnosis 58% of the time. For the study with 3rd yr med students, they followed the same method and received the correct diagnosis 44.7% of the time. So you “can” Google a diagnosis and get the correct one…but both of those percentages to me are still not even a passing grade, and we point out to the students that if/when I am their patient, I hope that they are not basing their clinical diagnosis on something that it correct 45-58% of the time. We then highlight some of the tools we have that they could use to answer those types of questions.
Thanks, Beth! Thanks especially for the links to the articles and describing how you use them in your teaching. We can benefit from this.