- The Washington Times - Monday, December 6, 2004

Dr. David Shocket, a gastroenterologist at the Washington Hospital Center in Northwest, recently saw a 72-year-old woman with long-standing gastrointestinal complaints.

“She insisted she be tested for celiac sprue,” Dr. Shocket says. It’s a condition in which patients’ intestines can’t process gluten. “She had read [on the Web] doctors aren’t testing for it,”

The doctor explained that her condition didn’t make such a diagnosis feasible and that the test would be expensive. Eventually, he relented and ordered the test.

“It was the only way she’ll be satisfied,” Dr. Shocket says.

Such is life when a world of information, some of it inaccurate or inconclusive, exists just a modem or broadband connection away.

In the good ol’ days, say 1989, people with health concerns had to wait until a doctor either confirmed or denied their worst fears.

Today, a few clicks of a computer mouse lets people diagnose themselves.

Doctors says the Web’s information flow runs both good and bad. It empowers patients to learn the latest information about whatever condition they may have, but it also ferments irrational fears.

Dr. Daniel Lieberman, director of the Clinical Psychiatric Research Center at George Washington University, says the trend reminds him of what is loosely referred to as “medical student syndrome.”

“They read about these serious, rare diseases and they ‘develop’ the diseases they’re studying at the moment. It’s cause for joking, but it’s also pretty anxiety-producing,” Dr. Lieberman says.

The same is proving true with nonstudents, thanks to the myriad health sites across the Internet.

He says a few folks even derive pleasure from rendering harsh diagnoses for themselves.

A common pseudo-complaint is attention deficit hyperactivity disorder, which he says is underdiagnosed in adults.

“There’s a lot of information out there [on the condition], but the symptoms are so widespread and vague,” he says. “We can all do with a little bit more concentration.”

Sometimes a “connected” patient is a better patient.

“It’s common people bringing in printouts from the Internet,” he says. “Sometimes, they’ve accurately found a problem they’ve had. Their research makes them a more active partner in their care.”

In other cases, like the gastrointestinal patient, a doctor may not have enough time to spend debunking the Web-based theories providing so much anxiety.

“Doctors may not have time to explain why an alternative treatment might be easier,” he says. “They might just write a prescription.”

Surfing the Web for medical help can be “habit forming,” he says, a situation worsened in chat rooms.

“You have people with very strong feelings … with the most extreme opinions,” he says.

Dr. Shocket says he routinely sees patients influenced by Web research.

“Patients are more aware of certain diseases and symptoms. Occasionally, they suggest a test that’s quite appropriate, or even suggest a test you didn’t think of,” Dr. Shocket says.

The downside, he says, is when patients march into the office demanding a test “you know makes absolutely no sense.”

Dr. Shocket says one e-mail that’s been making the rounds for years claims doctors aren’t using a particular screening test for ovarian cancer.

“It’s controversial, and it’s not approved,” he says, information one won’t find in that ever-circulating e-mail.

John Grohol, a psychologist working outside of Boston, says it’s only natural for people to suspect they have conditions they hear about.

“Anytime you expose people to more information, there’s that concern that they’re going to see themselves in a disorder,” Mr. Grohol says. “Usually, they’ll ‘Google’ their symptoms and come back with all these diagnoses. … The more they read, the more they become convinced they have it.”

Mr. Grohol says a qualified mental health expert will counsel someone who relies too heavily on the Web for medical help to take the online information “with a grain of salt.”

“They should understand mental health and medical diagnoses can only be made by a professional. They take into account the extenuating circumstances” of a patient’s case, he says.

Dr. Rudolf Hoehn-Saric, head of Johns Hopkins University School of Medicine’s Anxiety Disorders Clinic, says today’s patients are far more savvy, thanks to the Internet.

“It can have a positive effect if it’s reasonably done,” Dr. Hoehn-Saric says of Web research. “But the trouble with this information is you really have to sort out what’s applying to you and what’s not.”

For example, some medications cause side effects in maybe one in 50,000 people, he says, while other treatments cause difficulties in as many as 30 to 40 percent of patients. The Web might not include those distinctions in the material presented, he fears.

“Some people are becoming afraid of taking medications. They saw some side effects that don’t apply to them,” Dr. Hoehn-Saric says.

The Web can be more helpful for patients with pre-existing conditions, such as diabetes. He says they can ask more pertinent questions of their doctors thanks to their Web research.

Dr. Shocket says he steers patients toward more reputable health sites to help them find the most accurate information available.

A good rule of thumb, he says, is to lean on foundations for various illnesses, such as the Crohn’s & Colitis Foundation of America, which can provide detailed, relevant information most likely to be factually based.

“Not every ‘dot.org’ is reputable. I’d be biased toward national organizations,” Dr. Shocket says, as well as information found at www.webmd.com. He is not affiliated with the Web site.

That’s where many physicians go for information, he says.

No matter where patients find extra information on their personal health, the matter demands a solid relationship between patient and his or her doctor.

“There has to be a level of trust. If you don’t trust your doctor, you should find another one,” he says.

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