My patient described his symptoms to me: fever that waxed and waned for over a week, general body aching, headache, stiff neck and fatigue. He had done his own research on the "Web," searching the best health and medical sites, and had come to a conclusion as to what disease was causing his suffering. He was sure he had malaria.
I thought for a minute and then tried to be diplomatic. "My understanding is that the mosquito that carries malarial infection can't survive this far north in the Rocky Mountains, Tony." He didn't seem to be listening, since he kept looking through articles he had printed from the Internet. "And besides, I have known you for years, and I don't think you've ever traveled east of Omaha, or south of Amarillo."
Tony started shuffling through his articles and handed me a couple. "Read these, doc, they describe my symptoms exactly." I perused them quickly. "Tony, these articles talk about infected people in Africa and Indonesia, not Colorado. The symptoms you describe could be caused by dozens of diseases." But Tony had a theory about how he got malaria. He worked at the airport, and suspected that an Anopheles mosquito had stowed away on a jet from the Congo or somewhere and survived long enough to bite him, injecting the plasmodium parasite. He was ready to go to the University Hospital, so I encouraged him to consider the possibility of other, more common conditions being the cause of his symptoms. How about Lyme disease or Rocky Mountain Spotted Fever? Enlightening Tony on those potential conditions was probably a mistake, since he immediately began looking them up on his iPhone.
I really don't mind when patients bring in articles about their conditions. I don't mind looking ignorant and stupid. When someone brings in an article about the pain associated with their rare familial anemia, I just say, "Wow, how about that!" and change the subject to subluxations or spine stuff.
Speaking of subluxations, I recently had a patient bring in an Internet article describing the dangers of subluxations. "Dr. Hanks, is this what I have?" Since I have treated the patient for more than 20 years, I admitted that she did indeed, at times, have one or two of these things in her spine. I never liked the word and seldom use it. "But Dr. Hanks, this article says that subluxations can suck the Life Force out of me and result in crippling or a horrible death." I might have replied, "Yes Betty, I could not have described it better myself," but that's not what I said. The fact is, I didn't know what to say.
I think some of my patients are getting their information from unreliable Web sites that could probably be called monkeyshineparade.com or wackjobinfo.net or the like. (Those sites probably do exist, but who knows what information they provide?) And yet the Internet is an important tool for patients to "fight back" against the arrogance or worse, neglect, often found in the practice of medicine. Health care providers can also suffer from bias and misinformation.
Heath information is often closely aligned with businesses that will sell you something to fix whatever ails you. One of my favorite Internet ads shows up when one researches "toxicity". This company's ad is for a patch that you wear on the bottom of your feet when you sleep. In you morning, you peel it off and witness the change of color on the patch, which is supposed to be the "toxins" that were drawn out of your body through your feet. If this is true, then I'm going to design a hair net that will draw these same toxins out through your scalp at night. I could be counting the Benjamins ($100 bills) in a few short weeks!
I have asked a couple of internal medical doctors I know about how they receive patients armed with Internet information. One doc, who has been in practice for many years, had a negative opinion. "I think this is a new scheme planned by the government to drive primary care providers into bankruptcy and single-payer servitude!" she said. "I don't have time to argue with patients that bring in all this ...#$%*! They argue about statins, blood pressure and garlic, and the advantages of colonic irrigations, and I can't handle it!"
But my other colleague, a young, new MD, had a different take. "I learn something every day from my patients, and welcome their Web information" she said. OK, I agree. This month I learned a few things from patient research, including Tsutsugamuchi's disease and strangulated hemorrhoids. But, I really do understand. The Web may be a cure for the "white coat" syndrome that keeps some patients from seeking help. People are often intimidated by the complexity of our health care system and the inevitable confrontations that come with it. As one of my stubborn friends puts it, "Why go to doctors? They're just going to find something wrong with you!"
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