Dr. Google, At Your Service
● By Aimee Cormier
By Kari Walker / Submitted Photos
It’s late at night and you notice a freckle on your shoulder looks bigger than last year, so you take action. You type, “what does skin cancer look like?” into Google and after scrolling through a few pages of images, decide what you have is just a freckle and nothing serious. Now, back to scrolling your Facebook feed you go with peace of mind and a sense of pride that your fingertips have the power to instantly diagnose what medical professionals spend nearly a decade studying.
Psychologists have dubbed this behavior as Cyberchondria—the online obsession with real or imagined symptoms. It is estimated over 50 percent of smart phone users have admitted to searching health-related symptoms for their own suspected illness or a family member’s in hopes of either ruling out worst-case scenarios or attempting to confirm a suspected illness is in its advanced stage.
“One may want to look for additional information online if they feel their symptoms are not getting better despite following their doctor’s treatment regimen,” explains Dr. Kelly Cahill Jr., a family medicine doctor all too familiar with patients turning to the Internet for health care advice. “Or, perhaps, they feel they haven’t been heard by their doctor or feel the provider may have missed the mark,” adds Cahill on why after seeking attention at a doctor’s office many patients continue down the rabbit hole of health on the world wide web.
Cahill feels a better approach is always asking your doctor directly the question: “what else could it be?” if you feel the diagnosis is inaccurate. Gaining perspective from your personal doctor who can in return ask you questions about other symptoms you are experiencing is far more valuable than a one-sided Internet search. In fact, the source of the online article you are reading can very well lead to specifically suggestive treatment options—especially when the resource is funded by pharmaceutical companies.
WebMD is one of the top online health symptoms search sites, but has known ties to drug manufactures like its partnership with the Eli Lilly company and paid advertisements suggestive of certain drugs for treatments for searched diseases and disorders. If someone were to search about depression, the page would flood with ads for BRINTELLIX, a prescription medicine used to treat Major Depressive Disorder in adults and is manufactured by Takeda Pharmaceuticals. However, why does this same drug advertisement appear when a mother searches for “how to get rid of head lice?” Certainly the frustrations of dealing with a common childhood pest could send any mother into a brief state of anxiety and depression, but suggestive advertisements for depression medications is a bit much.
Databases called symptom checkers are creating headaches for health care providers because the accuracy of diagnosis is lacking—a recent Harvard study showed WebMD’s symptom checker is only about 30 percent accurate. “The most common thing we see is people enter their symptoms in an online search and inevitably the search engine comes back with a possible diagnosis of cancer,” says Cahill. Many Cyberchondriacs are fearful of this diagnosis and are constantly searching for ways to either confirm or deny the possibility of such serious illness.
“While this can be good motivation for them to see a health care provider, they get very anxious and this can cause great mental stress,” Cahill adds. More often than not when a patient comes to see a doctor after an online search he or she is not diagnosed with cancer on the spot, but rather assessed in person by a trained professional to sort out what is bothering the patient to provide more accurate diagnosing.
However, a reality is health care costs still continue to rise and unfortunately it’s more “affordable” for someone to enter a quick symptom search online and treat what is believed to be a stomach bug or common cold without incurring an office visit and prescription drug costs.
“We have patients who ‘self-diagnose’ and try over-the-counter treatments or get the diagnosis wrong all together,” says Cahill. He has seen a patient with stomach pain whose web search yielded she may have gallstones, which then led her to try an at-home “liver cleanse,” but ended up needing emergency surgery to remove the gallbladder. Skin abnormalities trouble Cahill as well—a patient of his did look at images online and delayed seeking a proper office assessment. Sadly, the freckle was indeed skin cancer.
Dr. Kathryn Strother is another family practice doctor who also has experience with symptom seekers entering her office. “I have had several patients who research a problem, for example, hypothyroidism, and are convinced they have the diagnosis because they have ‘all the symptoms’ listed on the website,” Strother says. Her training and experience lends her the knowledge that sometimes a group of symptoms can be a handful of issues, or possibly no urgent medical issue at all.
“Researching on the Internet has, in some ways, changed the approach physicians have to take to ‘rule out’ conditions or convince patients of what they don’t have,” explains Strother. When patients take to the web for answers, the patient who is convinced of a particular diagnosis is now harder to convince otherwise when a physician disagrees with a symptom checker database’s conclusion.
“Reassurance is often necessary for an anxious patient who has spent too much time researching—sometimes this leads to unnecessary testing. It’s better if a patient comes in and the physician can do a good-ole-fashioned history and physical and really listen so the context of the patient’s medical history, age and symptoms can all be used together to determine next best steps,” urges Strother.
Pew Research Center’s Internet & American Life Project explored who is utilizing online health information in a study finding those most likely to use the Internet to treat health conditions are women, younger people, white adults, those in higher income brackets, and those with some or more college education. In 2000, a similar study by Pew Research Center found eight in ten online health seekers started by using a general search engine for health or medical information—this user statistic remains the same, yet in the year 2000 about 50 percent less adults in the U.S. had access to the Internet.
Despite informing the public about the dangers of online health symptom and treatment searches, doctors understand this behavior will continue as technology advances. Cahill suggests if someone is looking for information online to search a reliable source like Mayo Clinic or Cleveland Clinic as academic-based information sites contain more depth.
Both Cahill and Strother agree there is a place for consumers to research health questions online, but both concur it depends on who will benefit the most from an online search versus seeking in person attention from a health care professional. “It depends on the patient’s ability to understand what they read and put it into the context of their clinical symptoms,” says Strother. “For example, if a highly anxious patient starts to search symptoms about sore throat, he may immediately begin to self-relate with other symptoms listed on the website, which causes him to lose sleep about his sore throat being something terrible like cancer. But on the other hand, many websites do give sound advice about when to contact your doctor, for example, new or worse trouble swallowing or symptoms not improving as expected,” she adds.
The best advice is to never delay care if you believe you or a family member is experiencing something out of the ordinary—if the freckle looks suspicious or a nagging cough won’t go away, get it checked out in person.
“At the end of the day, online symptom checker technology is in its infancy and the algorithms have not yet been refined to be accurate. While exciting technology is certainly on the horizon, nothing to-date can replace a visit with your health care provider,” stresses Cahill.