“I CAN guarantee that you have not got prostate cancer now and that you will never develop it in the future,” I said.
“But how can you be so certain?” my patient asked. “I‘ve been on the internet and all my symptoms point towards prostate cancer.”
The individual’s partner nodded in agreement and emphasised that the problems passing urine were identical to those detailed on the various websites the two of them had visited. “Also we have been eating a lot of sardines recently and one site said that this is an extremely important risk factor for developing prostate cancer.”
“The reason I can be so confident is that women do not have prostates. Wombs – one, ovaries – two, but prostates – none,” I explained.
Cyberchondria is the one diagnosis patients tend to miss in their health-related internet searches. Funnily enough, the search engines don’t throw it up very often. It’s the term that has been coined for those individuals who are otherwise well but develop unfounded anxiety brought on by regular visits to medical websites.
One individual developed cyberchondria after seeing a fox darting across his driveway and finding out, from the internet, that some wild animals in his local area were carrying rabies. Even more helpfully, the search brought up references to people contracting rabies from infected animals’ saliva and bites. Soon the sufferer was unable to open the door of his house through worry that the fox might have licked the door knob.
Over recent years, I have encountered individuals concerned that they have problems ranging from scurvy (Vitamin C deficiency) to bubonic plague (the Black Death), not to mention conditions so obscure that I have to resort to Google myself. No wonder doctors are warning that self-diagnosis sites risk turning us into a nation of online hypochondriacs.
According to recent research, cancers top the list of conditions wrongly diagnosed using the net, followed by high blood pressure, asthma, arthritis, depression, diabetes and thyroid problems. This can lead to unnecessary – and sometimes risky – investigations and treatments. I have found that it can be particularly difficult to convince a patient who has trawled the internet that their migraine is not due to a brain tumour.
Unfortunately the only solution – in many circumstances – is to arrange a CT scan that entails a high dose of radiation which, ironically, actually increases their risk of brain cancer.
One key factor in the growth of health-oriented websites is the rise in the use of smart phones, tablet computers and apps. Another, however, is undoubtedly people’s inability to get to see an experienced GP promptly and at convenient times via the NHS.
The major patient concerns that precipitate a web search are not clear-cut problems such as coughing up blood but more subjective symptoms like headaches, fatigue and stomach cramps.
The difficulty with these is that they will, on many occasions, remain unexplained and it is the task of the GP to explain this to patients while carefully ruling out a few key conditions.
Nine out of 10 of all the patients I see with headaches will never be given a clear-cut diagnosis and the same applies to those with fatigue or tummy pains. In many cases the symptom disappears as quickly as it began, often being simply down to the normal stresses and strains of daily life.
This process of sifting symptoms is complex and takes time and experience – commodities which are being steadily eroded by the NHS management’s current priorities. Moreover, having decided that pharmacists, nurses and physiotherapists are just as adept at advising on symptoms irrespective of their particular areas of expertise, it is no great surprise that the Department of Health are now also promoting self-assessment online using their own “symptom checker”.
There is no doubt that there are some excellent websites and online resources out there, but it is often extremely tricky to separate the wheat from the chaff. For assessing cancer risks there are a raft of online resources to choose from but I often direct individuals to one in particular – www.yourdiseaserisk.wustl.edu – which I have found to be the most useful.
As a GP, I would argue that a consultation with a doctor is always an essential element of assessing a health-related worry. But whatever clinicians might feel about self-diagnosis, to me it represents a valuable way for patients to raise a concern – provided that we, as family doctors, then take the time to listen.
Perhaps the best health-related use for the internet in the future will be to combine reliable and accredited sources of information together with an online conversation with an experienced GP – ideally via an instant messaging system or Skype. Hopefully that might then keep this rampant cyberchondria in check.
Dr Nick Summerton is a GP in East Yorkshire.