Saturday 26 May 2018

Are you a cyberchrondiac?

In the internet age, patients are keen to get a quick ­diagnosis. But advice found online can be misguided and alarming

Cause for concern: Doctors say if you are going to consult the internet, use accredited health websites
Cause for concern: Doctors say if you are going to consult the internet, use accredited health websites

Áilín Quinlan

When Co Leitrim mum Yasmin Vorajee couldn't get an immediate appointment with her GP about a nagging pain in her breast, the mum-of-two consulted the internet.

Eighteen weeks pregnant with her third child, the business consultant's Googling left her even more worried: "It made me even more anxious, because there was an implication that it could be quite serious," she says, adding that the information she unearthed in relation to her symptoms pointed to breast cancer.

However, when Yasmin from Carrick-on-Shannon, attended her GP's clinic for the scheduled check-up some days later, her doctor was able to reassure her.

"After she checked me out she said everything was fine - she felt it was probably just hormonal. The pain went away," reports Vorajee, who adds that she learned a valuable lesson.

"What I took from that experience was to stick with the GP! Google is great but when it comes to your health, you really need to see your GP face to face, because if you get anxious or worried easily, it can make you even more so," says Vorajee.

The growing trend for patients to research symptoms online instead of, or before visiting the family doctor is leading to 'cyberchondria' - patients believing themselves to be at greater risk than they actually are, doctors heard during the Irish Medical Organisation's (IMO's) annual conference in Sligo at the weekend.

The phenomenon is now a daily issue for GPs all over Ireland, says Dr Harry Barry, a well-known GP and author of a series of bestselling mental health books, including Flagging Anxiety and Panic which is due to be launched next week.

"My favourite advice to people is to avoid Dr Google. Dr Google does not have 20 or 30 years of face-to-face medical experience behind him," says Barry, who believes that while some patients will consult the internet in a "sensible, practical way" using recognised websites such as those run by the Vhi, NHS or HSE, others will use the internet as "a form of safety behaviour and then get even more frightened".

A parent worried about a child with a high temperature may research it on the internet and notice that "a cause could be meningitis," says Barry, adding that very often the parent will then investigate the symptoms of meningitis and get really frightened, he says.

"There are cases where someone who is continually anxious hears about a friend who has bowel cancer.

"They Google it after experiencing something like tummy pain and then do 'jumps' - because one of the possibilities is that it could be bowel cancer and so they must have it.

"I have had people coming in like this who have looked up symptoms they might have and are worried about them."

One of the big problems, he says, is that if you input general symptoms into a search engine, it can throw up "50 conditions that could be theoretically life threatening".

"Fatigue, for example, can be linked to cancer or diabetes and if I suddenly start Googling these conditions, I may begin to think there's a problem."

While technology can be very useful in medicine, it should be used in the context of consistent, personalised GP care, believes Dr Ray Walley, outgoing president of the IMO.

"There are recognisable websites such as NHS, with proper up-to-date informed websites, but there are others that can have agendas and can have links to prescribing medication," he says, adding that the tele-consultations are not always necessarily good value for money.

"Some people do telemedical consultations on the basis that it's cheaper or that they have busy lives," says Dr Walley, who recalls how an 18-year-old patient of his recently opted for a telemedical consultation because she was unable to get to his clinic to see him.

"She was prescribed something she had a bad reaction to," he said, adding that such an incident was much less likely to happen in the context of continuity of GP care.

"She came back to me and said she's learned the lesson, that quick is not necessarily best. She has now requested me to refer her to a GP near to where she is attending college in another part of the country."

There is no reason why the GP network cannot expand to take telemedicine into account, he says, but it must be in the context of "personalised continuity of care with the same GP".

"Countless research over the past 40 years has shown that continuity of GP care is crucial to optimal patient treatment."

There is a growing tendency for people, especially those in their late teens and early twenties to consult the internet first - but Dr Walley warns, given the huge amount of information available from a wide variety of sources on the internet, members of the public can find it difficult to distinguish between good and bad advice.

"Everyone wants everything immediately and sometimes you have to wait for what's good," he points out, adding, however, that in Ireland, you can still often get a same-day consultation with your GP, or at least, shortly afterwards.

Most of the 3,000 GPs in the country, says Dr Mark Murphy, would echo his belief that the majority of the patients they would see daily would already have sourced internet information of some kind on their symptoms.

He told GPs during the conference that a study of 22 accredited online "symptom checkers" published in the British Medical Journal last year showed they overstated the risk to the patient, making them more anxious. Apps did not take into account the patient's psychosocial issues, he added.

"When people have quite complicated symptoms, we know that an internet search can result in inaccurate information," he said, adding that many providers of such information tend to be "risk averse" which means that they can overstate the actual risk posed by a particular set of symptoms, leading to a situation where a patient may believe there is something "very wrong" when in fact, their symptoms are mild.

GPs are concerned about the excessive use by patients of unaccredited websites, leading to heightened patient anxiety.

"Some patients are really anxious and many expect investigations to take place when in fact they are not needed," he said.

"If patients wish to access internet information about common symptoms, it's recommended that they visit, says Murphy, adding that this is a reliable, accredited health website created by the Irish College of General Practitioners and the HSE.

"People can refer to this website for the common symptoms such as high temperatures, cough, sore throat or pain in the ear," he said, adding that they will receive good information and advice.

Irish Independent

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