Paging Dr. Google

We’ve all seen it. Patients feel ill and the first place they turn is WebMD. They get their diagnosis from Dr. Google, do their research, and come in prepared to discuss their options based on the print outs from online forums and other websites.

The thing is, we’ve also done it. It doesn’t matter if I’m pre-med, I have used WebMD to soothe my worries about certain symptoms. I get an idea of what I’m dealing with and whether I feel I need to see a professional to be treated. I have the advantage of being able to distinguish between certain diagnoses because of my medical knowledge and experience. The layman does not.

Doctors, nurses, and other healthcare professionals have a tendency to mock patients for this. I would be lying if I said I hadn’t participated in teasing patients about Dr. Google. Unfortunately, by doing this we alienate our patients. Fear is a major factor in illness. Patients don’t (usually) go to medical school. They become ill and afraid. They hear scary stories on the news or horror stories from friends and family. Their solution to conquer their fear is to do their research. Fear of the unknown is lessened when armed with knowledge.

Instead of ridiculing patients who advocate for themselves, we should be praising them. Many patients could choose to ignore their symptoms and problems. They can refuse to be educated (as many of us have experienced). Instead, they choose to learn and understand. By refusing to acknowledge their efforts we are setting the patient against us. Think about it. Do you like to be told that you’re wrong?

I feel the best way to address this with patients is first to acknowledge them.

“I appreciate that you’ve taken the time to do your research.”

“I think it’s great you take this so seriously.”

Then address the problems with self-diagnosing through the internet. Take it a step further by providing with the appropriate resources.

“Unfortunately, the sources you’re using aren’t very reliable. Here are some resources you can use to get a better idea of what’s going on.”

The biggest issue arises with a misdiagnosis. I’ll use myself as an example. When I lived in China, I developed severe abdominal and back pain. Multiple visits to the ER, even a CT scan, yielded no answers. Frustrated, I took to the internet and found a diagnosis to consider – pancreatitis. At that time, I wasn’t involved in medicine. I didn’t know it was unlikely that I had pancreatitis. I just knew that the symptoms sounded right. So I booked an abdominal ultrasound (since you don’t need physician orders in China, just the money to pay for it).

The ultrasound technician found the problem immediately. My gallbladder was filled with stones. I was, of course, surprised. I barely knew what the gallbladder was, let alone that it could be filled with stones. I accepted my diagnosis gracefully and followed the doctor’s instructions.

Some patients may not be as willing to let go of their diagnosis. They may have made their own differential diagnosis or gone through tests before without answers. Again, acknowledgment is the answer. Acknowledge their concerns. If their diagnosis is very unlikely, explain why they might have been misled and why you don’t believe they have this illness. If you don’t have a diagnosis yet, explain how the testing may rule out the patient’s diagnosis. Patients don’t understand the process behind your decisions. Keeping them informed eases their anxiety and builds trust between you.

I sound like I know what I’m talking about, but of course I’m not a practicing physician. I don’t get to put this into practice as much I’d like. The idea came to me after reading In Shock, which focuses on speaking to your patient with respect and compassion. Dark humor and making fun of people become common to deal with stress, but at the end of the day patients deserve to be treated with respect. I’ve been trying to adjust my attitude and the way I deal with patients to reflect that. It takes time, and it is difficult to avoid joining in to the general attitudes of other healthcare employees.

How do you deal with patient who rely on internet research? Are you guilty of belittling patients for googling their symptoms? Do you disagree with my suggested approach?

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