Sunday 17 December 2017

Mind Matters: The doctor-patient consultation is the best antidote to internet misinformation

Patricia Casey

'KNOWLEDGE is power," according to the 16th-Century English philosopher Francis Bacon. In the 21st Century, knowledge comes mainly from the internet.

Those of us working in the medical profession are keenly aware of the power of the internet, not just in providing cutting-edge information to doctors and allied professionals, but also, and perhaps principally, to our patients.

There are well over 100,000 health information websites and these span government-regulated sites, commercial sites, websites run by professionals and patient-driven sites.

In addition, there are blogs, forums, YouTube and other social media where patients can have direct contact with like-minded people, including patients, advisers and carers.

All of this has facilitated a gargantuan increase in the exchange of ideas about health and disease and a burgeoning knowledge about all aspects of people's illnesses including the treatments they are receiving, prognosis, and so on.

This should not surprise us since there has always been a very lively market in publications about health. Healthy encyclopaedias were once a must-have on the bookshelf and novels written by those who have weathered grave illness are invariably best-sellers as they document the courage of the suffers. These writers gave hope and instilled courage in those with serious illness.

There is an impression, growing in psychiatry, and possibly in other specialties also, that health anxiety may be fuelled by the internet. This has been dubbed cyberchondriasis.

Yes, it rhymes with hypochondriasis because this is what it is generating – illness anxiety caused by online activity. Even publications are now beginning to appear in the scientific literature on this phenomenon.

Hypochondriasis is an excessive preoccupation that one has or will develop a serious illness, and studies, mainly from the US, show that it affects about 5pc of the population.

Cyberchondriasis is the unintended consequence of a tool that for most is highly beneficial. But, for a minority, the internet is toxic. It is suggested that people with health anxiety use the internet to reassure them that symptoms they are experiencing are not serious.

However, there is also data showing that health-related websites contain a disproportionate amount of information on rare and serious causes of symptoms. So far from reassurance that the symptom is non-specific, the searcher may log off believing s/he has a rare and possibly fatal condition.

Instead of helping the person appreciate that the symptom constellation they describe makes no clinical sense, the internet may buttresses their belief that they have some rare or chronic disorder that requires further exploration and confirmation.

In psychiatry, diagnostic questionnaires are widely promoted online and individuals diagnose themselves as having bipolar disorder, attention deficit disorder or depressive illness even before they have set foot in the clinic.

As with physical symptoms, ascribing illness by ticking boxes and without any background context leads to false diagnoses when other non-clinical explanations are more appropriate.

For example, problems due to the stress and strain of daily living can mistakenly be ascribed a diagnosis, such as depression or generalised anxiety, when in fact neither are actually present.

The problem with internet sources of health information is that there are vast numbers of unregulated sites. Studies of internet usage show that users seldom verify the validity of the site and accept as correct all information provided.

Health anxiety can affect the lives of those the person lives with. Constant reassurance-seeking is emotionally demanding on others and, while it is tempting to offer it in the hope of quelling the person's anxiety, it is counterproductive and will increase the behaviour.

The explanation is that frequent checking, either by seeking reassurance from others or online, increases the awareness of and focus on bodily sensations and so perpetuates the preoccupation.

Health anxiety is also financially draining since scans, blood tests and medical consultations are sought, and doctors, fearing litigation should a serious illness be missed, frequently accede to these requests.

Knowledge is power but the knowledge must be accurate. Otherwise, there is a significant danger of harm to the individual.

Only websites from organisations officially representing the various branches of medicine should be used.

Ultimately, the old-fashioned doctor-patient consultation is the best antidote to misinformation.

Irish Independent

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