Query for article: The Internet as diagnostictician

[snapp]

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Hey folks,

I'm a Philly-based freelance journalist who last wrote a big-ish feature for The Verge and spent most of my time here in the local Philly press. Since I don't know a ton of GPs (and because Margaret Talbot of The New Yorker got her interviews for this story by posting on an internet forum originally), I figured I'd ask SDN if they could help me out.

I'm interested in how physicians are relying on patients' own internet research to help them make their diagnoses, and to what extent patients are now essentially diagnosing themselves and ordering physicians to give them tests or drugs, particularly when their symptoms are nonspecific. I recently saw my GP the other day and presented with some symptoms, and one of the first questions he asked was, "Have you read anything on the internet that you think this could be?" Is this common? Is there a sense that, because patients spend more time thinking and researching their own health than their doctors, that the collective wisdom of internet boards and Google may be a useful tool in assisting physicians in the initial workup? Broad strokes for now, but let me know if this rings a bell or at all sounds like something you've seen.

Thanks for any help.

edit: apologies for the typo in the subject line

 

[deleted87716]

If I ask a question like that (i.e., "is there anything in particular you're worried about"), I'm not asking the patient for help. I simply want to make sure I address their concerns.

 

[samsoniter]

In my experience it is a double edged sword. I am a huge advocate for patient education and have some patients who research their symptoms in a manner that augments the encounter and increases efficiency simply because there is less explaining to do. However, many of the medical sites geared toward the layperson emphasize the most dreaded and severe diagnoses. This leads to problems because I have patients come in with non specific symptoms (fatigue and loss of appetite) and outright demand ridiculous exams such as a full body MRIs and tens of thousands of dollars worth of lab tests.
These are often the patients who feel, because they spent 20 minutes googling something medical, they possess a superior knowledge and diagnostic prowess, which inevitably leads to disappointment and possibly distrust when I try to explain the tests that are really indicated.

 

[PTPoeny]

I'm only a student, but one thing multiple attendings have told me is that if a patient comes in worrying about something like a brain tumor because they had a headache yesterday, they will keep worrying and likely go see another doctor unless you specifically say "I don't think this is brain cancer because of x, y and z". If you just don't mention brain cancer and only talk about the common causes of headaches the patients will worry that you didn't consider the possibility.

It also isn't a new phenomenon. It is more common with the internet, but you will also have people coming in saying "my brother had a headache and it turned out to be cancer and it killed him". This has always happened.

 

[link2swim06]

Unfortunately a lot of medicine is consumer satisfaction. Tests get ordered all the time for 'social reasons' to just calm the patient. Even when there is no scientific indication the test is needed.

You could deny the test or scan but 99% of the time the patient will find a new doctor who will order the test.

 

[deleted87716]

You could deny the test or scan but 99% of the time the patient will find a new doctor who will order the test.

And, this is a problem why...?

Unless you enjoy collecting demanding, unreasonable patients, that is.

 

[dpmd]

I think there is zero benefit and a lot of harm for most patients who try to self diagnose instead of just seeking medical help. Perhaps in a patient with persistent symptoms who is already undergoing a workup some internet research may point out some obscure etiology, but it is just as likely that the problem is not due to that obscure etiology so unnecessary testing or worry would happen. The problem is that there is so much bad info out there, and it can be difficult for the layperson to identify the good and the bad. I prefer to know if the patient is doing their own research though, because then I can undo any damage this has caused and point them to reputable sites for the future.

 

[deleted87716]

Information ≠ knowledge.

http://www.infogineering.net/data-information-knowledge.htm

 

[survivordo]

I recently saw my GP the other day and presented with some symptoms, and one of the first questions he asked was, "Have you read anything on the internet that you think this could be?"

He may have been asking this to see what perspective you were coming from. It is important to get an idea of the patient's agenda for the visit. "I think I have celiac disease and I want to be tested" is a lot different from "I am having vague abdominal symptoms and don't know what it could be"

Survivor DO

 

[J-Rad]

Closing.