This op-ed first appeared in The Hartford Courant.
By Dr. David W. Wolpaw
“Doctor, I think I have cancer.” the young man said to me.
His throat had been sore for a few weeks and, when he looked in the mirror, he thought he saw a growth in the back of his mouth. An internet search of his symptoms told him it could be oral cancer.
He was in his 20s and did not use tobacco or drink heavily, so he had no risk factors for this sort of cancer. His exam was completely normal and, after I reassured him that it was only a minor cold, he went on his way.
These cases are not as rare as you might think. As a primary care doctor, I frequently have patients come to see me for a second opinion after getting a “terminal” diagnosis from “Dr. Google.”
I don’t mind. It’s helpful to me as I conduct an examine if they tell me their concerns. Even as I reassure them, I make sure they will call me if their symptoms persist.
Other doctors tell of similar experiences. A rheumatologist colleague of mine described a patient with a suspicious red rash on her face who was worried she had lupus — a serious but relatively rare autoimmune disease. The patient had found a Google image and was 100 percent sure that the rash she had looked exactly like a lupus rash.
Oddly enough, the rash occurred suddenly after a day at the beach. Can you take a wild guess what it really was? The doctor told her about the many other symptoms of lupus, aside from a facial rash, and told the patient she had a simple sunburn.
I understand the urge to use the internet to self diagnose. Health care is expensive so, if the internet can give you reassurance that what you have is benign, maybe you can avoid a costly visit to the doctor. The internet is also quick and convenient. Although there are potential problems, I have useful advice for those using the internet to learn more about their health.
Be careful when searching for symptoms or diseases. Websites want to attract “clicks,” and some of them do this by catering to your worst fears, which are, more often than not, totally unfounded. Sites can look trustworthy even when they post information not supported by scientific evidence. Perhaps the best example is Lyme disease, a major concern for Connecticut residents. There is so much misinformation about Lyme disease on the web that even some doctors are fooled by legitimate-looking websites.
Another approach is to Google “Symptom Checker,” which brings up a number of legitimate sites. You enter your symptoms and get a list of possible diagnoses. I have tested these sites, and the results they produce make some sense. The problem is that amid all the likely benign diagnoses, there are inevitably one or two very unlikely but dangerous ones. For this reason, these sites can lead to misunderstandings and often do not provide the reassurance people are seeking.
I’d suggest trying one. Type in any symptom or combination of symptoms and see what you get. If you enter “headache,” you may see stroke or brain cancer on the list, even though these are very rare causes of headaches. If you enter “joint pains,” don’t be surprised if you are told you have Lyme disease, even though it’s more likely the ordinary joint pains we all get from activity and age. And if you enter chest pain you will be told you might be having a heart attack or pulmonary embolism. Needless to say, none of this is at all that reassuring, which is what most people are seeking in the first place.
The web does have good medical information but it is often hard to distinguish the accurate from the false or misleading. The more you know about a given subject beforehand, the better you are equipped to weed through it. But the more complicated the subject, the harder this is to do. I know next to nothing about auto mechanics, so I wouldn’t expect I could figure out what was wrong with my car through an internet search.
Needless to say, people shouldn’t expect a website to replace their physician. Primary care physicians work through four years of medical school and three years of residency, which is then augmented by experience and continuing education. Furthermore, your doctor knows you, your medical history, family history, risk factors, etc., much better than the internet, which helps immensely in arriving at a correct diagnosis and treatment plan.
Nevertheless, if you are determined to explore the internet for medical information, I have found WebMD.com and MayoClinic.org to have generally reliable information. They offer useful, understandable material. Also, CDC.gov is an excellent resource for information about a variety of topics especially cancer prevention and vaccines. There are other good sites, so ask your doctor for a recommendation.
If you do gather information from the internet, be forthright with your doctor. Bringing in a printout from the site that has you concerned will allow you to review it at your appointment. Your doctor can say whether the information is accurate and to help you understand it in the context of your individual situation. The doctor-patient relationship is, after all, a partnership.
David W. Wolpaw, M.D., is a primary care physician at Hartford HealthCare Medical Group in Manchester.