Internet as a self-diagnostic tool

An increasing number of patients bring internet-based health information to medical consultations. Individuals research their current signs on the internet to determine whether they should see a doctor. Many disorders mimic each other and without proper medical education and training, one cannot understand the difference between these conditions, potentially delaying a doctor visit. This could result in an increase in morbidity and even mortality. They also use the internet as a self-diagnostic tool when sorting out their symptoms, but it may not be the most accurate of all the online software services now available. sni

Although information about possible diagnoses and their management has previously been available through books and leaflets, the development of self-diagnosis websites is different for several reasons.sni sni

Why are people comfortable with self-diagnosing?sni

This comes down to psychology where evidence makes people believe something is relatively likely to happen, despite the real chances being low. If a healthy person under 30 has chest pain, it is unlikely to be related to the heart, but because there is so much on the web linking the two, they forget the low background statistical probability. It is important that people are aware of these differences and possible harms and benefits that could arise from the use of self-diagnosis websites.sni

Effects of self-diagnosis websites

Clinical decision-making has changed its focus. The lay person who consults the healthcare professional is no longer the submissive and compliant “patient,” rather, an expert partner who brings his experience of illness to the differentially specialized medical practitioner. Medical knowledge has escaped flowing as information through myriad electronic networks and internet sources, enabling patients to access and interpret information about disease well in advance of their encounter with the doctor. Access to formal medical information is no longer confined within or controlled by medical institutions.sni

Decline in medical authority

Self-diagnosis obviously challenges the authority of medicine, an authority which may already be in decline. We are seeing changes in the status of doctors signified by increasing patient complaints, the growing use of alternative therapies, media portrayals of doctors, and lack of financial autonomy. A decline in medical authority is not necessarily a bad thing, even from medicine’s perspective. The notion of internet self-care and the changing nature of the doctor-patient relationship have been lauded as negative changes in the health system.sni

Historically, patient-doctor relationship was characterized by an authoritative, paternalistic doctor managing the care of the submissive patient. Incomplete knowledge prevented patients from participating at anything but a very low level in their treatment and its direction. Now they make choices with medical guidance and do not hand over their care. Change in the relationship between doctor and patient, wherein there is a role convergence, enabling a greater participation by the lay person in the clinical encounter can be helpful provided patient is seeing the doctor and not relying on his internet knowledge alone.sni

Participation in diagnostic decision making

With respect to patient self-diagnosis, the modern patient clearly would participate in diagnostic decision making, but not necessarily with ease. The fact that patients could overlook other morbidities, or have inadequate training to consider differential diagnoses is a prominent theme. This reflects the fact that just as self-diagnosis presents potential benefits it can confer harms as well. With this in mind, it is not surprising that the argument is closely balanced both in favor of, and in opposition to, the principle of self-diagnosis.sni

The discussion of self-diagnosis and when it is appropriate should be an important priority for medicine. Learning when patients can appropriately and safely diagnose and manage common conditions may eventually lead to changes in health services. Further, one should consider that the distinction between early recognition of symptoms and self-diagnosis may not be particularly clear. Encouraging symptom recognition is an important health-preserving aim, regardless of whether, in the end, the self-diagnosis was correct.sni

Self-diagnosis is a complex matter, because it is a relational one, tightly bound up in the way people and doctors position themselves and interact relative to one another and relative to particular disease categories.sni

By: Dr Fawad Kaiser, Psychiatrist

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