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

smaley's picture

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:

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

Comments

Anne's picture

Internet > Doctors

There's a lot of crap on the internet. Lots of anecdotes from unscientific people who assume their problems are caused by X, without evidence, and then conclude that X will therefore cause the same problems in everyone else.

But you know what? There are a lot of crappy doctors, too.

The majority of times I've been to the doctor in the past 10 years were a complete waste of time. I got more useful information from the internet than I did from the doctor. They just want to guess at your problem, prescribe some pills, and push you out the door.

One "good" experience was with a GI doc who diagnosed me with "probably IBS" and recommended I "eat more fiber". Armed with the Google keyword "IBS", I found that IBS is actually *aggravated* by insoluble fiber, and I had been causing my own misery by trying to eat more of it. Reducing insoluble fiber and increasing soluble fiber fixed me right up. So the doctor's visit was helpful... in the sense that he got me to look up good information on the net that contradicted his bad information.

A study found that "31% of doctors believe that the Internet complicates their relationship with patients and undermines their credibility." I say "good". Keep them on their toes.

Kwarlizzle's picture

A great resource, but never a replacement

I agree with most of what has already been said on here concerning doctors and the internet. The internet is a great tool: it makes puts information in our hands and make us more ready to take our health in our hands and challenge our doctors (and not take their every opinion like it's sacred) - and that is always okay. One might even say it's long overdue.

But I do not for one second think that doctors should be replaced with the internet. It's not okay. It's like going to a mechanic or something. A lot of the times, we can diagnose what is wrong with our own cars and fix it if we have some manual, or know other people who have had similar problems with their cars and how they fixed it. A lot of the other time too - a small problem with the car is often about a bigger problem we have no idea about. Going about the business of repair wrongly causes even more damage. Illness is like that too. There are lots of things we can diagnose ourselves for, with the help of the internet, common sense, and our own experience. But there is also a frightening number f things that can go wrong and of things that are relatively little but can easily become life-threatening. Doctors/nurses/healthworkers are trained to handle that reality and one is more likely to have a better outcome dealing with them than dealing alone.

knorrell's picture

Personally, when I use WebMD

Personally, when I use WebMD during an illness I look at it before I go to a doctor to figure if my symptoms even warrant a visit to the doctor.  I think that in certain cases it could be a good idea to look at health sites, such as WebMD, so that you, personally, don't have to waste a trip to the doctor to find that you have something that will clear-up on its own in a couple of days.

I also understand that many people take health sites to seriously and do not think of the individualistic aspect of their illness.  While somethings start out with symptoms similar to the common cold they could lead to something much worse.  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.

adowton's picture

Medicine on the internet

 I think this is a really interesting issue. On the one hand, many valid assertions were made about the benefits of sites such as Web MD and the mayo clinic website. People without health insurance at least have some avenue to turn to in the event of ailment (although, if a person without health insurance is truly ill, needing critical or chronic care, I doubt the efficacy of self-treatment via the web), it is a beneficial resource for people to investigate diagnoses presented to them by a real live clinician, it might perhaps provide people downplaying their illness with an incentive to be see etc. So yes, for these reasons I think such sites can be beneficial. I also think they have the power to be harmful. The issue of self-medication came up in class and I am still vehemently against it. I think that the one downfall of these online medicine sites is that they are not always correct, and people can end up doing themselves great harm as a result of diagnosing themselves on Web MD, and then purchasing  medications for it online. 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.

 

lbonnell's picture

I think the internet is

I think the internet is useful for doing research before and after visiting the doctor. Patients are able to make their own conclusions based on the information they find on the internet. Then, when they visit the doctor they are able to see if their conclusion is the same as the doctor's and if not, why. 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. The patient's conclusion is still valid and I don't think the doctor should ignore the patient's ideas because the patient does not have formal training. In an ideal situation, there should be discourse that allows the patient and doctor to reach the same conclusion. 

Colette's picture

                The internet

                The internet can be a great resource; however, it is most definitely not a solution to all problems. On the other hand in matters of health professionals such as doctors, nurses, etc. might not have all the answers either. People could use both as a check and balance system. It is risky to trust everything online because of the uncertainty of the array of advice given (professional and non-professional). For minor colds, the web is a useful resource and there doesn’t seem to be much of a difference between googling for information and going to a pharmacy store and reading the back of boxes for symptoms a person may have. With our expensive healthcare system, unfortunately people have to really save for terrible situations and I think designated internet sites could be very helpful. For more serious problems, I would however most definitely advocate seeking professional help.

            This summer I shadowed a doctor and one of her patients had done research on the symptoms he was experiencing. I think the web was slightly detrimental in this situation because it was difficult to convince him to stay for observation. He was right for trying to figure out what was wrong with himself. Much of the day may seem tedious to doctors, however, so  I think an  informed patient informed patient challenges doctors to stay on top of their game. Therefore, I would have to disagree with a point that someone made about “the internet taking away from doctors’ precious time during evaluations and getting in the way of their work.” I think that 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.

            Another point that I was perplexed about was the comparison between pubmed and webMD. I am lost as to how one could even compare these sites when trying to diagnosis a person. WebMD I believe was created for the purpose for self-diagnosis however pubmed was created as a database for research, two entirely different types of medical applications. Yes, they are related, but I highly doubt any doctor would recommend pubmed for a diagnosis. Maybe once a person has an idea about their sickness or about a drug they are on, but to understand their ailments, a doctor probably would give them a handout or refer them to a regulated site that would better explain.

            When you don’t know what is going on and you need information, you look for a reliable source. The more critical the need for the information, the more important it is that the information is reliable. The medical professional is regulated—standards are set, and adherence is checked and enforced. There is a performance threshold.

If the information is not so critical, patients are allowed to do it themselves. Fortunately for everyone a lot things get better on their own. If you make a mistake you just suffer a little more a little longer

 

 

mlhodges's picture

 For most Americans, online

 For most Americans, online medical websites are a supplemental resource, not a replacement, for physicians. However, as we discussed in class, using a medical website to “the extreme”, is, of course, a problem. (Ex: diagnose yourself in your own home, without professional tests, and buy “treatment” through the internet)…

All new technology introduces advantages and disadvantages in to society. In this case, the benefits of the technology outweigh the negatives. As I mentioned in class, I think medical websites are a fantastic resource for the educated youth. Some personal issues, such as questions about sexually transmitted diseases, sexuality, drug use, or abortion may be very difficult topics for people to discuss with a physician. A person may feel more comfortable exploring these topics in the privacy of their own homes. It’s safer (for everyone’s sake) that the knowledge is at least accessible to all. Hopefully, if he or she needs help physically treating a problem, and not only learning about a problem, they do eventually see a physician, but this is at least a step in the right direction.

Furthermore, 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?

 Internet knowledge is power - as long as it’s questioned and taken with a grain of salt - just like any other resource we use for our education.  

 

dfishervan's picture

Doing the research

  In our discussion on “Doctor Google,” it was mentioned that we view those who utilize the internet in attempt to gain some insight on their ailments as dumb. I found our disdain towards these “Doctor Google” patients interesting when you take into consideration our biases. As a group of pre-med students, I understand why there is a tendency for us to look down on those seeking advice from the web as we believe doctors to be one of the highest authorities on health related issues. However, as science students, I would think that we would condone society’s use of “Doctor Google.” We are encouraged to use the internet for outside research prior to coming to class and applaud those classmates who utilized “Google Scholar” in order to enhance their understanding of a topic. As consumers, we are also taught to do our research before making a purchase (and by going to a doctor, we are making a medical purchase and buying into the doctor’s description). However, just because I support the idea of people using fairly reliable WebMD-esque sites, that does not mean I am in favor of replacing doctors with the internet. 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.

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