Cyberchondria « Family Webicine

Finally, someone gave it a word: Cyberchondria. The number of people who research or attempt to self-diagnose their medical problems over the Internet is exploding. Could it be because over 40 million Americans do not have health insurance? Could it be that the cost of providing even the most basic medical care is astronomical? Could it be that doctors are often too busy to listen? Yes.

A few minutes ago, I got a call from my automobile mechanic. It is not going to be good news when they ask you if you are sitting down first. I should have been a little suspicious when three of them jumped on my car this morning; one under the hood, one with a computer, and another checking my tires, as part of my “free” 48 point inspection. Needless to say, they found a few things that they would like to fix. Please keep in mind that I dropped off my car because the gas gauge was not working. I am not comfortable just guessing how far I can drive without running out.

Humm…maybe medicine should have a 48 point inspection. A person comes in with a sore throat, we can check them out head to toe, tell them what we found, recommend some expensive tests, refer them to specialists, remove a few suspicious moles, etc. Let’s use up that expensive insurance!

The friendly mechanic said that they will not have my car ready by 1 PM like they promised. They will need to keep it overnight – the automobile equivalent of being admitted to the hospital. They wanted me to bring the car in with a near-empty gas tank so they would not need to drain it to fix the fuel sensor. Again, when your gas gauge does not work, this is not always possible. They found a transmission leak, so it will need a new seal/gasket. They would like to flush my transmission fluid, too. This is an expensive procedure that the mechanic described as “similar to a kidney dialysis“. I didn’t want to share with him what I did for a living.

Apparently my transmission fluid (urine) is too dark (not drinking enough?) and needs to be replaced for about $375. Now, I am not an auto mechanic, but I think I will shop around for a better price. I have no idea if there is a car equivalent of WebMD that I could have diagnosed my mechanical problems and perhaps, fixed this myself. The “check tires” light on my dash has also been bugging me. Apparently, the car’s computer was not aware that I bought some new tires two months ago. The mechanic said that my tires were fine and did not recommend that I replace the air in them. Oops, there I go on a tangent again.

Hypochondriacs are a part of any medical practice. We also call them the “worried-well” – people who are basically well, but feel they are sick; usually with cancer or some sort of rare disease they read about or heard on ER. People with good insurance tend to abuse it sometimes by coming in with very trivial, quasi-medical complaints.

“I woke up this morning, and my hair does not seem to be a shiny. Do you think I have a scalp cancer?”

“No, I think you just need to wash your hair.”

Of course, I say this on the “inside”. On the outside, I try to be respectful of their concerns and offer them as much reassurance as I can, short of doing an MRI on their hair.

It is not unusual for modern hypochondriacs to bring in some articles that they found on the Internet. One mother brought me some information that she found on WebMD’s ENT board regarding her teenager’s on-going vertigo and asked me what I thought about it. She was convinced that her vertigo was due to the power lines near the home; or perhaps from some toxic mold hiding in the walls.

“It seems accurate to me,” I said. “I wrote it.”

At first, she thought I was kidding. Then she compared my picture on the web site to the guy sitting in front of her. She was both embarrassed and thrilled at the same time to meet me. Unlike the usual people who post on the advice boards, at least I had the opportunity to examine and treat her daughter first-hand. By the way, her daughter had labyrinthitis, a common, self-limiting viral infection that involves the inner ear.

Cyberchondriacs are particularly worried and fearful of cancer (carcinophobia). The Internet has made leaps and bounds over the last 15 years or so, but the Internet will never replace a hands-on medical examination. Until I can literally “reach out and touch someone” through cyberspace, the Internet will always have its medical limitations. Perhaps, the future will tie in computer robotics that will prod and probe areas at our command, but what about those important senses of touch and even smell that cannot be simulated? I doubt that a robot will ever be able to recognize the smell of strep throat or give a therapeutic hug.

Perhaps because I practice a little cyber-medicine, I am not turned off by worried patients who present with Internet-based references. I am turned off, of course, if those Internet references are not from legitimate, mainstream medical sites. Web sites are becoming quite clever in disguising themselves as legitimate, so people must always be on guard for against cyber-charlatans. There are more snake oil salesmen on the Internet than there ever were traveling from town to town in medicine shows. Hypochondriacs are magnets for quacks selling unproven, bogus cures.

In defense of people’s rights to participate in their own medical care, the Internet has indeed saved lives. When people, for whatever reason, cannot seek medical care, the Internet can be an invaluable source of life-saving information. I have had people come in with a picture of a melanoma that they found on-line, and then point out a similar lesion on their leg.

Busy physicians often tune-out people who bring in print-outs and medical reports, but I love this type of participatory patient. Often, the patient themselves will give me some valuable clues as to their elusive diagnosis by their independent research. However, I have to admit that sometimes the information that is collected is not that helpful; even dangerously wrong.

Medical providers have to remember that even hypochondriacs get sick, and like it or not, sometimes the patient is RIGHT!

It’s like the epitaph on the hypochondriac’s grave: “I told you I was sick!”