By DR. Zachary F. Meisel
The medical intern started her presentation with an eye roll. "The patient in Room 3 had some blood in the toilet bowl this morning and is here with a pile of Internet printouts listing all the crazy things she thinks she might have."
The intern continued, "I think she has a hemorrhoid."
"Another case of cyberchondria," added the nurse behind me.
In the end, the patient did, indeed, have a hemorrhoid. She was safe to go home with a treatment plan and some reassurance. But I wasn't so sure if what doctors call the "Google stack" (the printouts listing all the potential and worrisome diagnoses) was really such a problem. After all, her symptoms were scary — she may very well have come to the ER regardless of her Web search. The real problem was with my team: we weren't well equipped to deal with her online homework — and it became a distraction.
Whether the Internet is a useful or dangerous place to get health information is not a novel question. Information overload, biased sources, complicated jargon, conflicting recommendations and stories that always seem to invoke nightmare scenarios are well-known reasons to be wary of Googling your symptoms.
Yet there is no question that patients routinely benefit from going online before visiting the doctor. Recently I saw a patient who came to the ER with a strange rash. She arrived with color printouts that correctly identified her condition. Not only was she correct in her self-diagnosis, but I am not sure I would have considered the right diagnosis so quickly if she hadn't brought in the pictures (it was a common condition with an atypical presentation). I know many health providers who have experienced similar circumstances.
But to debate whether patients should or should not Google their symptoms (which a surprising number of doctors seem to enjoy engaging in) is an absurd exercise. Patients already are doing it, it is now a fact of normal patient behavior, and it will only increase as Internet technology becomes ever more ubiquitous. The average Joe has more health information at his fingertips — both credible and charlatan — than all the medical libraries ever built put together. So the real question is, What can professionals do to translate this phenomenon into better health for their patients and the public?
First, they can adopt strategies in health-care delivery and education that endorse the process of patient self-education. Shared clinical decisionmaking is an influential model for patient care now being promoted by researchers, educators and the federal government as a way to get patients to partner with their doctors to take an active role in making decisions about health care. The ideas behind this model were outlined in the late 1990s by researchers at McMaster University in Ontario, Canada, and were important enough to be included in the language of both the federal stimulus and health-reform laws. This model recognizes that many choices in medical care often involve complicated trade-offs. In this process, patients are encouraged to become informed of the nuances related to a health-care decision in advance of the doctor-patient encounter; and the Internet has naturally become the place where these tools can be found in the form of worksheets, videos and decision aids.
Second, doctors can guide their patients to Internet sites that exclusively present current, peer-reviewed and evidence-based health information. There are select examples of both public and private websites that meet these criteria. Some of these sites are, in fact, set up to facilitate a doctor-patient encounter. This website, for example, from the U.S. government's Agency for Healthcare Research and Quality, is specifically designed to organize evidence-based health information so that it can be printed out in advance and taken by patients to a medical appointment.
Last, doctors and nurses are going to have to shed the presumption that the Internet makes patient care harder. The sanctimony that comes with the eye roll and the cyberchondriac label may be an extreme example, but it's still a problem if doctors continue to walk into the exam room with the belief that patients always need to be disabused of the wrong and sensationalistic information they picked up while trolling the Net.
Doctors are going to have to realize that often patients are doing the absolutely best thing for themselves by going online before the office visit. Clinicians will need to learn for themselves which are the best sources of patient-oriented Internet-based information so that when the patient does go in confused by wrong or poorly organized online data, the efforts can be redirected as opposed to dismissed.
Of course, many patients are going to discover the best online health information way before their doctors do. They, too, have a responsibility: patients will need to signal to their doctor how they conducted their search in a way that was smart, directed and grounded in evidence. Only then will the Google stack be recognized and used in a helpful, not counterproductive, fashion.