Friday, March 4, 2011

Internet research and the Doctor-Patient relationship Part 2

Having discussed some of the reasons why patients use the Internet to learn about their health, I’d like to discuss one of the most contentious issues regarding Internet-usage: self-diagnosis. This again is a source of friction between doctors and patients, and part of the reason that some docs don’t want patients using the Internet. Indeed, I admit that I’ve had some difficulty with this as well, which I’ll presently explain, but I’ve come up with some solutions to this challenging issue that I’d like to share. I want to make clear at the outset that I intend to grapple with this as a fact of our modern existence, not try to fight with it to make it go away – whether or not we doctors like it, this is something patients are doing, and this article is intended to educate both doctors and patients on how to work with this fruitfully.

As a naturopathic doctor, I sometimes see patients whose chief complaints are diagnoses they have found on the Internet. In my clinical experience, one of the primary issues around self-diagnoses is that they can negatively affect patient reporting, making patient outcomes poorer. Here’s what I mean: as a doctor, it’s my job to make a diagnosis based on signs, symptoms and other information gathered from a patient, and then to formulate a treatment plan based on that diagnosis. The part of this process that is most frequently disrupted by self-diagnosis is the patient’s symptom reporting. Self-diagnosis based on Internet research can result in patients being less attuned to their symptoms. In all honesty, diagnoses given by trained medical professionals can have the same result. In both cases, instead of reporting symptoms, patients report the ‘diagnosis’. When I have patients whose primary complaint is a diagnosed problem, I consider that as a primary possibility, but also want to explore other possibilities, just in case. When the patient has either found or received a diagnosis, the situation I sometimes run into is one where patients are able to speak at length about a given disease, but have a dearth of symptoms to report.*

The point for this section is this: If you are going to use the Internet to explore self-diagnosis, don’t lose sight of those symptoms that lead you to ask questions in the first place, and keep an eye out for new symptoms that emerge along the way. Bring all possible information to the doctor’s visit. Bring your hypothetical diagnosis, but make sure you bring your symptoms too. This will help you and your doctor come to the most accurate diagnosis possible, as well as aid the both of you to understand how you as an individual are manifesting your illness. The diagnosis is not the be-all-and-end-all. Your experience of life is the most important factor in seeking health. Your doctor can throw on all sorts of treatments that are shown to be effective for your diagnosis, but unless you are happy and healthy, your doc hasn’t done their job.

As doctors, I think we need to recognize that this is a phenomenon that is happening, and that we should learn to work with, rather than dismiss. When patients come in with self-diagnosis, we shouldn’t be irritated by it, but rather take it as another piece of information. Even if it does not turn out to be the correct diagnosis, there are almost certainly very real reasons why the patient came to the conclusion that it was the diagnosis. These should be clues for us to follow – we can only gain information from them.

Hopefully this has been informative for both professionals and consumers. This is certainly a contentious issue, but it doesn’t have to be one that divides us or causes opposition in the doctor’s office. Patient education is one of the primary callings of the physician, and this topic provides plenty of opportunity for that. As stated in part one of this series, our goal should always be to strengthen the doctor-patient relationship, through education and honest communication.

*A note on under-reporting symptoms: In situations like this, it is frequently challenging to help, as there is little to go on. Without know what this patient’s symptoms are, it’s hard to know what body systems to target, how physiology has been altered, or what to follow up with. All of that information is gathered in the reporting of symptoms. Most naturopathic doctors would agree that a diagnosis alone is not enough, for we individualize treatment based on the unique ways that a patient is manifesting their illness.