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From Web-Savvy Patient to Cyber-Chondriac - WSJ.com
By BENJAMIN BREWER, M.D.. Wall Street Journal
JULY 19, 2005
Recently a patient contacted our practice after convincing herself, based on some Internet research, that her child had Attention Deficit Disorder.
She wanted us to start the child on a medication typically used for seizure disorders, instead of a more commonly used medication approved by the Food and Drug Administration for ADD. In addition, could we call a prescription in to the pharmacy for her today without examining her child?
No. Not on this planet. Not today or any other day.
The proliferation of medical information over the Internet has helped people take more responsibility for their health. Patients are able to educate themselves in ways we never thought of several years ago. It seems that individuals affected by nearly any medical condition have a Web community to turn to for support and education. The Web lets patients help each other and takes some of the work of patient education off of the doctor's hands.
As a physician, I'm not troubled by the autonomy of the informed patient. What troubles me is the proliferation of the partially informed patient and, frankly, the misinformed patient -- the patient who crosses the line from Internet-educated patient to cyberchondriac.
My impression is that people believe more of what they read than what I tell them. It seems that traditional Western medicine based on scientific evidence is less and less trusted by the general public. Meanwhile, some dubious theory from the Internet will be swallowed hook, line and sinker nine times out of 10.
When a patient comes to me with a set of symptoms that is concerning them, I apply my skills in history-taking and my years of experience in evaluating similar problems, and I formulate a list of possibilities. Doctors call this process developing a differential diagnosis.
It takes about five years of daily medical training to get good at developing and narrowing down the list in an efficient manner. The average patient doesn't have this background and sifts through the possibilities they read about without the benefit of experience as a filter.
The challenge with self-directed online medical investigations is that similar symptoms can be triggered by multiple diseases. Your sore throat could be a symptom of the common cold (very likely), strep throat (possible, but less likely), or something like leukemia (rare).
Rare and serious diseases seem more common and prominent on the Internet. The mundane and non-threatening illnesses are not as popular. There is a Leukemia Society and an American Cancer Society, but not a Common Cold Society, as far as I know.
He was unaware of a possible increased risk for developing lymphoma (a type of cancer) with the drug until I told him about it. I learned about it from reading the package insert-downloaded off the Net, of course.
Another adult patient became anxious about the redness and discomfort in his eye. After reading about red eyes on the Internet, he was convinced that he had a herpes infection and worried that he could lose his vision. It took me about five minutes to rule out herpes or another serious problem and another 10-15 minutes to convince him that the redness was due to the start of a common cold.
Unproven therapies and sham treatments that are well marketed look even more impressive than the real stuff. Throw in a few patient testimonials and make some vague reference to the secret treatment that the "mainstream medical establishment" has been suppressing, and you have a viable alternative medicine business plan based on the placebo effect.
Some patients research their conditions and buy their medication online to avoid the "hassle and expense" of going to the doctor. Some are getting real medication. Some are undoubtedly getting ripped off.
My Google search for "buy Vicodin" turned up 705,000 references. Vicodin is a potent, potentially addictive narcotic pain medication that can be bought online from some Canadian and overseas pharmacies against FDA regulations.
When I first started my practice, I dealt with a number of drug-addicted patients looking for a steady source of narcotic pain medication. I don't see nearly as many now. I suspect that part of the reason is that they are buying online.
Autonomy? Perhaps. Progress? No way.
By BENJAMIN BREWER, M.D.. Wall Street Journal
JULY 19, 2005
Recently a patient contacted our practice after convincing herself, based on some Internet research, that her child had Attention Deficit Disorder.
She wanted us to start the child on a medication typically used for seizure disorders, instead of a more commonly used medication approved by the Food and Drug Administration for ADD. In addition, could we call a prescription in to the pharmacy for her today without examining her child?
No. Not on this planet. Not today or any other day.
The proliferation of medical information over the Internet has helped people take more responsibility for their health. Patients are able to educate themselves in ways we never thought of several years ago. It seems that individuals affected by nearly any medical condition have a Web community to turn to for support and education. The Web lets patients help each other and takes some of the work of patient education off of the doctor's hands.
As a physician, I'm not troubled by the autonomy of the informed patient. What troubles me is the proliferation of the partially informed patient and, frankly, the misinformed patient -- the patient who crosses the line from Internet-educated patient to cyberchondriac.
My impression is that people believe more of what they read than what I tell them. It seems that traditional Western medicine based on scientific evidence is less and less trusted by the general public. Meanwhile, some dubious theory from the Internet will be swallowed hook, line and sinker nine times out of 10.
When a patient comes to me with a set of symptoms that is concerning them, I apply my skills in history-taking and my years of experience in evaluating similar problems, and I formulate a list of possibilities. Doctors call this process developing a differential diagnosis.
It takes about five years of daily medical training to get good at developing and narrowing down the list in an efficient manner. The average patient doesn't have this background and sifts through the possibilities they read about without the benefit of experience as a filter.
The challenge with self-directed online medical investigations is that similar symptoms can be triggered by multiple diseases. Your sore throat could be a symptom of the common cold (very likely), strep throat (possible, but less likely), or something like leukemia (rare).
Rare and serious diseases seem more common and prominent on the Internet. The mundane and non-threatening illnesses are not as popular. There is a Leukemia Society and an American Cancer Society, but not a Common Cold Society, as far as I know.
He was unaware of a possible increased risk for developing lymphoma (a type of cancer) with the drug until I told him about it. I learned about it from reading the package insert-downloaded off the Net, of course.
Another adult patient became anxious about the redness and discomfort in his eye. After reading about red eyes on the Internet, he was convinced that he had a herpes infection and worried that he could lose his vision. It took me about five minutes to rule out herpes or another serious problem and another 10-15 minutes to convince him that the redness was due to the start of a common cold.
Unproven therapies and sham treatments that are well marketed look even more impressive than the real stuff. Throw in a few patient testimonials and make some vague reference to the secret treatment that the "mainstream medical establishment" has been suppressing, and you have a viable alternative medicine business plan based on the placebo effect.
Some patients research their conditions and buy their medication online to avoid the "hassle and expense" of going to the doctor. Some are getting real medication. Some are undoubtedly getting ripped off.
My Google search for "buy Vicodin" turned up 705,000 references. Vicodin is a potent, potentially addictive narcotic pain medication that can be bought online from some Canadian and overseas pharmacies against FDA regulations.
When I first started my practice, I dealt with a number of drug-addicted patients looking for a steady source of narcotic pain medication. I don't see nearly as many now. I suspect that part of the reason is that they are buying online.
Autonomy? Perhaps. Progress? No way.
