Patient Care

Managing Patients Who Use Online Medical Information to Self-Diagnose

"Doc, I'm so worried. I was reading online, and I think I have fibromyalgia! What should I do? Can you prescribe me, like, serotonin uptake or something? I really, really need it. It's a pretty bad case."

This scenario is all too familiar in our current age of information. Anybody with a computer or smartphone is able to jump online and self-diagnose themselves. There's a wealth of medical information available at our fingertips, but because of blogs and crowd-sourced websites, that information may not always be accurate. Undoubtedly, one of the greatest challenges for practitioners is making efficient, accurate, and distinct diagnoses, but thanks to the Internet, untrained professionals (i.e., patients) are trying to master this skill on the fly, leading to misinterpretations and misdiagnoses.

According to research published in the Journal of Participatory Medicine, opinions are decidedly mixed in the medical field surrounding self-diagnosis. The issue presents a double-edged sword: While self-diagnosis threatens medical authority, it's also associated with better patient compliance and self-care. Essentially, the character trait that drives someone to seek out medical information is the same that accelerates a desire to improve and therefore follow a plan of care. Of course, in the case of a self-misdiagnosis, optimal treatment outcomes will only be achieved by correcting the diagnosis without being off-putting. Otherwise, you're at risk of losing your medical authority — or even worse, your patient.

Communication Is All-Important

Communication is the key to any good doctor-patient relationship, so if a patient diagnoses themselves inaccurately, it's important to approach the situation with delicacy. Acknowledge their valiant effort in diagnosing, articulate the correct diagnosis, and demonstrate common understanding. If applicable, explain the concept of a differential diagnosis, which is when different illnesses/injuries present with similar symptoms.

Here's an example of an improper way to speak to the same patient from above:

"No, you don't have fibromyalgia. You just don't sleep enough or drink a sufficient amount of water, both of which lead to headache development. Also, because of lack of water and exercise, your joints are a bit stiff. You don't need any medication, but try to sleep more, drink more water, and exercise."

On the surface, this sounds like a perfectly suitable response to the self-misdiagnosis. However, the doctor's answer here never acknowledges the patient's effort in seeking medical information. Moreover, the tone comes across as dismissive and even arrogant.

Try this instead:

"Wow, it seems like you really educated yourself on the matter; that's really impressive. However, there is one piece of information you should also consider: Fibromyalgia is a blanket diagnosis, so even though you may have fibromyalgia symptoms, it doesn't necessarily mean you have fibromyalgia.

"If I do prescribe you Milnacipran to treat fibromyalgia, it may be ineffective and could actually be detrimental. Based on that, I think it's best to first deal with every symptom individually and conservatively. As you probably know, headaches are commonly caused by a lack of sleep and/or water, and a lack of water or exercise can cause joint stiffness. So how about this: We focus on those three things for a couple of weeks and then check to see where you are. If we don't see improvement, we can look into dealing with using medication."

Such an approach recognizes the patient's effort in self-diagnosing but corrects that diagnosis without being belittling or arrogant. Rather than entirely discrediting the self-diagnosis, this method states the similarity in symptoms between the patient's self-diagnosis and the actual diagnosis. By approaching the situation with understanding, the doctor helps to develop a better rapport and trust with their patient.

Passing on the Right Information

Americans spend one hour per week seeking medical information. By doing so, we are more educationally equipped to better our health. In fact, over-the-counter medications are offered entirely on the presumption that people are able to effectively self-diagnose. However, erroneous diagnoses are inevitable, attributed to the dynamics of nonmedically trained individuals attempting to seek, understand, and conceptualize health information. As a practitioner, you can avert this through explaining as much as possible to your patients. Just as in the example above, simply be explicit and humble. Explain the difficulty when it comes to differential diagnosing and how similar symptoms are present across a variety of different medical conditions.

As a health care provider, it is your medical obligation not only to diagnose and treat but also to educate. Therefore, be sure to build strong relationships with your patients, and talk to them about the perils of self-diagnosing. Otherwise, patients far and wide will diagnose themselves, ask for particular intervention programs, and demand medications until some doctor relents. I don't know about you, but just thinking about this gives me a headache — or is that fibromyalgia?

Posted in Patient Care

Dr. Rami Hashish achieved his doctorate of physical therapy from the University of Washington School of Medicine and holds a doctorate in biokinesiology from the University of Southern California. Following his Ph.D. work, Dr. Hashish cofounded a footwear technology startup, JavanScience, which develops customizable footwear to help relieve and prevent foot and leg problems. Dr. Hashish is also active in the clinic, serving as the director of physical therapy for Regenerative Medicine - Pacific Pain & Wellness Group, at Urban Med in downtown Los Angeles.

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*This information is for educational purposes only and does not constitute health care advice. You should always seek the advice of your doctor or physician before making health care decisions.