Where to obtain medical advice: A Doctor, or the Internet?

Biology in Society Senior Seminar

Bryn Mawr College, Fall 2010

Session 5A
 

Where to obtain medical information: A Doctor, or the Internet?

• Why did medical websites first appear? How popular are they? How accurate are they?
• Do they replace doctor’s visits? Or do they just supplement them?
• Do they lead to better-informed patients? Or do they lead to misinformed patients?
• Are some websites better than others? Are there different “classes” of sites?

Examples of current medical websites:

• http://www.webmd.com/
• http://www.mayoclinic.com/
• http://www.healthline.com/
• http://www.health.com/
• http://www.healthfinder.gov/

Case report

“A university student in her 20s registered with a general practitioner complaining of a two-year history of frequent mood swings, each lasting a few weeks or months, and requested to be referred to a psychiatrist. She described depressive episodes characterized by low mood, tearful spells, social isolation, poor sleep and appetite with weight loss. During these periods of being in 'a dark pit' she had seriously contemplated suicide several times. A few months later she would then report feeling 'too good', in an ecstatic mood associated with irritability, hyperactivity, racing thoughts, excessive spending and disinhibition. These episodes had caused a deterioration in her social and academic functioning. While in college she had discovered a 'Depression news group' while on the Internet which she then joined and exchanged mail with members. Occasionally she came across the phrase 'manic-depressive' which she assumed to be a very severe form of depression. While reading frequently asked questions on depression on a web-site, symptoms of manic-depressive (bipolar affective) illness were described which she immediately recognized as what she had been experiencing over the past two years. Through electronic mail (e-mail) facilities she discussed her symptoms with a 'psychiatrist' in America, who enlightened her about the possible nature of her disorder and advised that she sought a psychiatry consultation. The psychiatric assessment was facilitated by the knowledge she had acquired of her disorder, medication and side-effects, which she had also printed out. She had also prepared questions for clarification. The diagnosis of a rapid cycling bipolar affective disorder was made and lithium was commenced as the most appropriate treatment. Following treatment, her condition stabilized and she resumed college without further major disruption. Initially, her condition had not been helped by the negative attitude of her family who were bewildered by her behavior. From the Internet she printed out information pages for her family members who now have a better understanding of her unstable behavior as an illness and this has improved their relationship.”   Ayonrinde, O.

Opinions:

• "Often we spend time basically discrediting inaccurate information they read online before they got to the doctor's office," said Dr. Jim Starman, a resident in orthopedic surgery at Carolinas Medical Center.

People need to be aware the information they're getting may not be objective and it may not be complete, and it's no substitute for talking with their doctor." Charlotte Observer, September 22, 2010

• “It is estimated that 70 million Americans have used the Internet to acquire health-related information … [Doctors] also worry that patients who turn to Web sites for information may not consult a doctor when serious health problems occur.” Anderson, J.G.

• ''Those who are using 'Dr Google' should only do so for background information. The information on the internet is not made on the basis of an individualized specific condition.'' Sydney Morning Herald, September 26, 2010 

Site Classifications: 

There are so many sites today and the landscape is changing so rapidly that it would take an encyclopedia rather than a newspaper to list them. But they can be grouped into five broad, often overlapping, categories:

GENERAL INTEREST Sites like WebMD (webmd.com), Discovery Health (health.discovery.com) and The New York Times (nytimes.com/health) provide information about disease, news and lifestyle advice, as do medical institutions like the Mayo Clinic (mayoclinic.com).

MEDICAL RESEARCH SITES offer access to the published work of scientists, studies and a window into continuing research. Examples include PubMed (ncbi.nlm.nih.gov/pubmed) from the National Library of Medicine; clinicaltrials.gov, which tracks federally financed studies; psycinfo (apa.org/psycinfo), with its trove of psychological literature; and the National Center for Complementary and Alternative Medicine (nccam.nih.gov), the government’s registry on alternative medicine research.

PATIENT SITES for groups and individuals are booming — so much so that they are increasingly used by researchers to find patients for studies. These include the Association of Cancer Online Resources (acor.org) and e-patients (e-patients.net), as well as Patients Like Me and Trusera (trusera.com), which provide a bit of Facebook-style social connectivity for patients, along with the ability to share their stories in clinical, data-laden detail.

DISEASE-SPECIFIC SITES focus on a particular condition and are often sponsored by major organizations like the American Heart Association (americanheart.org), the American Cancer Society (cancer.org) and the American Diabetes Association (diabetes.org). But smaller groups can put together extensive resources as well, with sites like breastcancer.org and Diabetes Mine (diabetesmine.com), which calls itself the “all things diabetes blog.”

WEB TOOLS These sites help people manage their conditions — for example, sugarstats.com for diabetes, Destination Rx (drx.com) for comparing drug prices, and YourDiseaseRisk.com, a service of the Washington University school of medicine that helps patients determine their risk for various problems.

NY Times, September 29, 2008

Class session discussion summary (kendra)

The beginning of class started with a case report on a female who self diagnosed herself through the internet.  It was stated that it was ridiculous that the general practitioner did not refer the, afore mentioned, female to a psychiatrist.  Then we started to focus on the pros and cons of “google-ing” symptoms.  One problem brought up with “google-ing” symptoms is the issue of a prescription.  Self diagnosis followed the discussion of prescriptions.  You can get pills/medicines from the “Black Market” or offline.  But, the ability to check symptoms online makes medicine less elite.

Then we discussed the actuality of self diagnostics from internet sources.  It is easier to diagnose a physical ailment then a psychological ailment.  Many physical ailments are clean cut.  But even then, all online diagnosis, or any diagnosis for that matter, should be taken with a grain of salt.  People start to identify with the diagnosis and refuse to believe their doctors when they are told that they are wrong.  Many online symptoms “mislead” people into thinking that they have a problem when they just have some of the same symptoms. 
It was brought up that checking symptoms online doesn’t only have to be a before the doctor or instead of the doctor action.  People can use the internet to check behind the doctor or understand to a better extent the ailment that they have.  Even if the information questions the diagnosis it is the doctors job to belay any fears that the patient has and to inform their patient of why they believe that this is the most probable ailment.   Which led to, if you are uncomfortable with a medical question you have the ability to look it up online instead of having to suffer with embarrassing questions to family members or doctors. 

The competency of patients was the next topic.  That it is OK to replace the doctor with the internet as long as the person was competent and willing to take responsibility for their actions.  Then, refuted that it was not OK for the doctor to be replaced by the internet because most people are not competent and will try to find someone other than their selves to take the blame.

The final topic discussed in class was the difference between going to a doctor and self diagnosis.  Any material read about the set of symptoms online tends to treat the person as a group instead of treating them as an individual with individual problems.  Doctors are also able to give patients test for illnesses and the internet cannot give a physical test.   But, then it was mentioned that doctors give to many irrelevant test.  Doctors give differential diagnosis like the internet; countered with: doctors only see one person at a time. 

Conversation and Implications To Date 

By replacing one professional authority figure with the internet, society will have to begin considering what real life authority figures should not be swapped out with internet resources. Just because online articles and lectures are available to students does not mean that society should do away with professors. dfishervan

In a sense, medical websites encourage us to think in-depth. Instead of a doctor laying out the facts, we get to play doctor - we collect and synthesize information, rule out what seems erroneous, and work through the puzzle to determine the cause. Are medical websites teaching us to think critically? mlhodges

People need to be advocates for themselves. It is a doctor’s job to help his/her patient, and that includes answering questions to help clarify things. Colette

Doctors do the  same thing as the patient- they are also making a conclusion based on information and observations, but their conclusions may be the result of different information. Doctor's may rely on results of testing and other medical knowledge to reach their conclusion. ... In an ideal situation, there should be discourse that allows the patient and doctor to reach the same conclusion. lbonnell

I know that some people are saying that doctors are not always correct either, and this is true. However, I think that physicians are taught how to take a history, perform a physical exam, and look at the whole picture for a reason: this works! I firmly believe that typing the symptoms you believe to be important into a web search is not as comprehensive of a workup as is needed in some medical situations. adowton

People should not completely rely on the internet for medical advice and should go see a doctor.  It is fine to question the doctor with the internet (or another doctor) but as a non medical practitioner people should not try to self diagnose.  It is dangerous. Kendra Norrell

• Individuals should not rely solely on the internet, and should instead use it to augment the information and advice received from a doctor
• Society needs to be careful about allowing individuals to replace their doctor with the internet
• Doctors need to use the internet to their, and their patient's, advantage, instead of viewing it as their opposition