Why does self-diagnosis annoy doctors?

This picture has circulated in my Facebook feed since last month. It didn’t feel right but I decided not to say anything as I saw some colleagues sharing it. I was wary of offending someone. However, there was one post in particular recently where I simply could not in good conscience keep quiet. And I said –

I am a physician and I find this picture offensive.

So what happened? The person who posted the picture deleted my reply! That’s what made me decide to write this blog post.

Our patients have used Google for quite sometime now to look up symptoms and find more information about their health. Yes, these are Filipino patients. I’m seeing more of them. And no, I don’t have Philippine data to substantiate this – but it doesn’t mean it’s not happening.  Googling may lead to self-diagnosis which can sometimes be correct and sometimes not. The doctor is the one who can confirm the diagnosis. The doctor should not be annoyed that a patient has gotten a self-diagnosis off the internet. Obviously, if the patient was satisfied with what Dr. Google had told him, he would not have still gone and seen the doctor.

Years ago, I was talking with a patient for about 45 minutes explaining her thyroid problem. She had read something on the internet and aside from explaining the usual things, I had to spend more time with her to discuss a few misconceptions. She was my last patient for the day. After she left, my secretary at the time said Doctor, I wanted to charge her above your usual rate for taking so much of your time. Thankfully, she didn’t. I wasn’t annoyed as much as I was tired. I also felt that patients needed guidance on how to look for reliable health information. Eventually, I discovered the HON (Health on the Net Foundation) code and shared this with my patients.

This is not to say that patients have never annoyed me. They have! I am not a saint after all. But bringing information from the internet isn’t one of those things that annoy me. 🙂

Are you an internet-friendly MD? I wrote this post in 2011 and you can read here what the HON code is all about. I had delivered a presentation then at the Philippine College of Physicians annual convention on what to do when patients surf the net before seeing the doctor.

I’ve had patients stop their diabetes medications because their neighbor recommended boiling guyabano leaves or eating okra instead. I’ve found these events to be more common than patients being harmed from acting on information found online. If your experience is otherwise, please feel free to leave a comment. The slide below is old data but I think it’s still true that doctors can overestimate the hazards of imperfect online information.

Crocco et al (2002) did a systematic review published in the Journal of the American Medical Association – Analysis of Cases of Harm Associated with the Use of Health Information on the Internet. They only found three cases. A quote from their abstract –

The search yielded 1512 abstracts. Of these 186 papers were reviewed in full text. Of these, 3 articles satisfied the selection criteria. One article described 2 cases in which improper Internet searches led to emotional harm. The second article described dogs being poisoned because of misinformation obtained on the Internet. The third article described hepatorenal failure in an oncology patient who obtained misinformation about the use of medication on the Internet.

Recently, I found this tutorial from the National Library of Medicine – Evaluating Internet Health Information. It’s 16 minutes long and I hope to do a Filipino version someday. Please let me know if you’d like to help with that.

Update: This post was awarded Blog Post of the Year at #Bloggys2015.