Confessions of a Quackbuster

This blog deals with healthcare consumer protection, and is therefore about quackery, healthfraud, chiropractic, and other forms of so-Called "Alternative" Medicine (sCAM).

Wednesday, October 05, 2005

What's up, e-doc?

What's up, e-doc?
Patients 'diagnosing' themselves online are headache for physicians.

By Shari Rudavsky

The patient walked into Hamilton County physician Matthew Nelson's office, announced he had looked up his symptoms online, determined he had Lyme disease, and demanded specific antibiotics to treat the malady.

Nelson, with years of medical training, could only sigh. He's all too familiar with patients who go online to self-diagnose.

"In the past, we actually looked at your symptoms and tried to diagnose you," says Nelson, an internist and pediatrician at Riverview Hospital with a practice in Carmel. "Now I have to de-diagnose the patient and say these are probably the reasons you don't have this."

With more people turning to Dr. Internet, experts urge caution in consulting the Web for medical or health information. While many sites offer sound information, just as many sell a product, promote a controversial view of an issue or provide outdated or wrong information.

Still, that doesn't stop people from looking.

A study published earlier this year found 41 percent of 2,007 people interviewed in a telephone survey -- and 56 percent of those who used the Internet -- had searched for health or medical information in the past year.

Seventy percent of those surfers asked about a specific problem, according to the study, which appeared in August in the International Journal of Medical Informatics.
Since surviving a heart attack last January and discovering that she had diabetes, Mary Margaret Wisner goes online often to learn about her conditions.

Some days, Wisner, 57, visits Irvington Internet, a cafe her son co-owns, to search for tips on what to eat or alternative products to take, information her doctors have not given her.

Still, she always checks with her doctor or pharmacist.

"I don't just take it as the gospel truth, but I don't do that with the doctor either," says the Indianapolis resident. "I wouldn't know anything if it were up to my doctors; 95 percent of what I know as to how to take care of myself, I learned from the Internet."

Physicians, however, need not worry about the Internet supplanting their expertise, the study found. Of those who looked for health information on the Internet, 55 percent contacted their physician afterward.

"Health-care information online seems to be an adjunct to health care; people are using it as one tool among many," says Michele Ybarra, an author of the study and president of Internet Solutions for Kids, a nonprofit in Irvine, Calif.

People between the ages of 40 and 60 relied on the Web the most as a health information resource.

Because that age range has the most caregiving responsibilities -- for their kids and their parents -- it's not surprising they're the most likely to look for such information, Ybarra says.

Patients go online to check out a drug's side effects, to learn more about a condition they already have, to find others who share their disease or to try to diagnose themselves.

So does the Internet make a doctor's job harder or easier?

"I think it does both," says Dr. Lisa Richter, a doctor at Speedway Family Physicians, a Westview Hospital clinic. "It definitely gives patients another avenue, but sometimes it makes them too aware of things."

Laypeople have always been able to go beyond what their doctors have told them in the search for more medical information, checking out books or journals aimed at professionals. The Internet has made the practice that much easier and -- with its rash of Web sites -- much more complicated.

"It takes a lot more work to wade through the information to sort out the good from bad," says Dr. Michael Weiner, a scientist with the Indiana University Center for Aging Research and the Regenstrief Institute. "We know most Americans have access to health information. Whether they're good at sorting it out remains to be seen."

That's why some professionals, such as Dr. Matthew Surburg, have taken matters into their own hands. Surburg, a family medicine physician with Hancock Family Practice in Greenfield, hands patients a form letter advising them how best to use the Internet to answer medical questions.

Others, such as Dr. Patrick Rankin, a family medicine physician in Fishers, will log on to a professional site in the exam room to provide the patient with immediate information. Rankin also takes the time to discuss information patients have found to make sure they understand its implications.

"Misinformation, that's our biggest concern," says Rankin, a doctor at Olio Road Family Care, part of the Community Health Network. "It becomes our job to work them through the scientific and evidence-based information we have."

Some sites do a better job of helping the viewer do that than others, notes Dr. Stephen Barrett, a retired psychiatrist in Allentown, Pa., who operates the site He recommends sites that offer filtered information rather than just presenting a study's results.

"What you ought to try to do is go to sites that fit everything together," he recommends.

That's why it's critical that doctors help their patients sift through all the information they find, say experts like Peter Goldschmidt, founder and president of the Health Improvement Institute in Bethesda, Md. Because some areas of medicine still spark controversy, it's wise for laypeople to explore different approaches, basically getting a second Web opinion. Then, they should take it to their doctor for his or her opinion.

Real-life physicians have another advantage over their cyber versions, says Surburg.
"Even a reliable site still doesn't take the place of a physician's input because the Web site can't examine you and integrate everything into one picture."


Can you trust it?

How to recognize the good, the bad and the ugly of medical Web sites:

• Steer clear of any sites that sell a product, particularly one that purports to cure a wide variety of maladies.

• One exception to this rule is a pharmaceutical company's Web site offering information on a specific drug. Even then, tread with caution, says Dr. Michael Weiner, a faculty member at the Indiana University School of Medicine."They're some of the best providers of information about their own products; it's just that one has to decide what's valid and what's not," he says.

• Check who runs the site. Make sure they clearly identify the advertisers. Also look for the date that the information was published or last updated.

• Check to make sure there's a way to contact the site coordinators, Weiner says. Can you call a sponsoring organization for more information and expect to talk to a person who's knowledgeable about the topic?

• Look for sites that appear to be well- balanced, says Michele Ybarra, president of Internet Solutions for Kids, a non-profit in Irvine, Calif. "There are very few conditions where there's only one treatment, so you want to make sure the site talks about multiple treatments."

Log on here

Here are some online sites that get high marks from the experts when it comes to health and medical information:

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