Friday, January 28, 2011

Diagnosis and the Internet

A recent article in Time Magazine discussed the issue of patients taking the initiative to look up symptoms online prior to visiting a physician and then using the information collected online to suggest possible causes and treatment regiments. The article author argued in favor of this behavior using a single cherry-picked example where a patient’s research had shortened the diagnosis process.

Sadly such simplistic examples are consistently used as backbones to these types of arguments. The author goes on to suggest that any debate surrounding the issue is absurd because patients are already performing research in an attempt of self-diagnosis before visiting a physician. This argument is flawed because the position taken is, that if a group of individuals are engaging in a particular task one should not question whether or not they should engage in that task; that conclusion makes no logical sense. However, regardless of that initial argument the author misses the most important element in the discussion regarding the use of the Internet in self-diagnosis.

While the author does suggest that patients should be given the tools and resources to better understand their condition and the potential treatment options, he neglects to identify the issue of neophyte-expert. The principle reason most physicians get annoyed by patients engaging in self-diagnosis using information from the Internet is that people can look at expertise as an issue of information instead of information and interpretation. Regardless of whatever tools are made available to these patients, they are still neophytes when it comes to using that information to accurately determine whether or not a particular condition is a reasonable cause for their symptoms.

Unfortunately there are a number of individuals that value their inexperienced opinion at the same weight versus the experienced opinion of a practicing physician, especially when it comes to probability arguments. Based on this mindset there are patients that will demand a specific test to rule out a one-in-a-million probability disease when a much more likely and common candidate is available; this testing demand spawns specifically from simply learning about the existence of the disease rather than understanding the disease. This neophyte element is clearly demonstrated by the ‘stack of papers’ which characterize these patients, they bring every possibility not the most likely possibilities.

The ease at which the author, a physician in his own right, dismisses the experiences of medical school and medical residence is almost insulting to the medical profession when suggesting that patients should familiarize themselves with the best sites to extract diagnostic information. Any belief that patients would develop diagnostic abilities similar to licensed physicians by simply viewing information from reputable sites alone is stretching the imagination. This nonchalance is especially troubling when considering that issue that it is highly likely that more patients will focus on end stages for a potential condition over the probability of actually acquiring that condition in the first place making more believable diagnosis more difficult.

However, this attitude is subjectively prevalent throughout the article. Taking an objective observation at a WebMD ‘analysis’ of a given group of symptoms should demonstrate that it is very easy for an inexperienced individual to become mislead by superfluous information even from a reputable site. A big error in analysis made by the author is the belief that most individuals are rational and logical actors when it comes to their health, thus research is always suitable.

It is understandable that patients want to have some measure of control in not only their medical care, but also what condition may trigger the need for that care; however, these patients must also understand that their expertise is lacking compared to the treating physician. A patient may attempt to come to reasonable conclusion regarding his/her condition, but must understand that the physician has the experience to more effectively determine the most probable cause from the available information and that the opinion of the physician should supercede the opinion of the patient. Without this understanding patients will not be ‘doing the absolutely best thing for themselves by going online before the office visit’, but instead will more than likely simply be complicated their office visit.

However, it also must be noted that physicians must understand that they are fallible as well and if the patient has information which contradicts their conclusions a more accurate diagnosis should be developed. While physicians are fallible it is important for patients to realize that in the web community rarely do message board posters and chat room participants report physicians being right in the diagnosis, instead they simply carp about those instances when their physicians were wrong and their own personal research assisted in deducing the proper diagnosis. In these web communities physicians are frequently treated like the CIA in that you rarely hear about their successes, but frequently hear about their failures. Physicians may not have superior intelligence all the time, but they do have superior experience and patients need to respect that experience. Overall physicians must work hard to be cordial to the questions of their patients and in return patients must not be argumentative to the answers or conclusions provided by their physicians.

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