It is safe to assume that most, if not every provider has encountered a patient that has come into the office with a laundry list of laboratory or radiologic tests that they have requested after self-diagnosing themselves using an online medical website.
The nature of the Internet has allowed mankind to explore vast online health websites without limits to aid them in their conquest to diagnose their own symptoms. A simple Google search using the term “rash” can bring up more than 1,000 explicit and overwhelming images that can be scary for most patients.
Online health information can be falsely misleading and may lead to patient anxiety. It can also prompt patients to seek out health-care providers who will order unnecessary laboratory and radiologic tests that can be expensive and even harmful.
Concern is growing about the overwhelming increase in the number of CT scans being ordered. For instance, take a simple case of a young patient who may complain of a dry cough for a couple weeks and request a CT scan based on their fear of lung cancer. The patient’s online information source does not disclose that the radiation from a CT scan can be equivalent to almost 100 x-rays.
We as providers have an obligation to be conscious and evaluate the risks versus benefits of such scans. Generally, we overestimate how much patients know and underestimate how much we should disclose. I’m not sure whether this is attributable to a fear of being sued, or a lack of confidence in our physical examination skills.
Working to strengthen the foundation of patient education may help solve this problem. As non-physician health-care providers, we have the advantage of being able to utilize our skills and time to properly educate patients on their health.
In the instance of the patient with the cough, we can explain our logic in evaluating various differential diagnoses, such as acid reflux, post nasal drip, reactive airway disease and so forth. We can then coach the patient through a sequential and logical health plan that does not illicit fear and is cost-effective.
Not all online health information is bad. Blogs can enable people to share their experiences with cancer, loss of a loved one, depression, etc. The Internet can also facilitate support groups, enable patients to share information on important resources and assist health-care foundations in establishing relationships with patients. For example, the Celiac Disease Foundation shares helpful information regarding the disease, gluten-free home recipes and maps out gluten-free restaurants on it’s website.
The Internet can be an incredibly useful tool, but it should be used with caution when researching health conditions. Online information is simply a reference, and should never be relied upon to make a diagnosis. The health-care provider and the patient must work together to determine the most appropriate diagnostic tools necessary to determine the best treatment and care.
Lauren Gorence, MPAP, PA-C, practices family medicine full time in Santa Monica, CA. She has also been a senior consultant and student affairs expert for Certified Physician Assistant Consulting since 2011.