Cyberchondria - the 21st century epidemic?
This Monday, my weekly slot on the Jeremy Vine show on BBC Radio 2 was given over to cyberchondria. The idea was simple - does Googling your medical symptoms convince you you're ill when you're not? The answer, very often, is yes.
A recent study in the British Medical Journal involved plugging 45 'standard' sets of symptoms into internet search engines. One in three got the correct diagnosis; nearly half had the right answer in their top three options. But two in five websites didn't even have the true diagnosis in their top 20 suggestions. After the show, one of our listeners sent in a photo of a t-shirt that read 'Please don't confuse your Google search with my medical degree'.
Of course, even if all symptom checkers are equal, some are definitely more equal than others. The symptom checker on Patient.info wasn't included in the BMJ study. I'd very much like to think it performed better than most, but I certainly can't guarantee it gets it right all of the time.
As a medical student, I remember being asked by a consultant, "If something sits on top of a lily pad, is green and slimy, lays eggs that turns into tadpoles and says 'woof woof', what is it? The answer is a frog, because in medicine no patient ever ticks all the boxes". Patients are people and people are all different. It's part of what makes medicine so stimulating, but also so challenging, to the doctor. We can tease out subtleties that no computer programme could get to grips with.
Even if you do get the right answer from an online tool, you may still panic. If I'm writing a 'symptom sorter' computer programme, I have to include heart attack as one of the possible causes of chest pain. The trouble is, the moment you read that, you're likely to be paralysed by fear and completely ignore the fact that you don't have any of the accompanying symptoms. Just yesterday a 23-year-old came in with chest pain, completely convinced he was going to have a cardiac arrest any second. He'd actually been shifting heavy furniture the day before and had strained all sorts of muscles, including his intercostals - the muscles between his ribs. When it happened, he Googled his symptoms because he wanted some ideas on how to treat a strained muscle - but the moment 'heart disease' appeared, he rang the practice immediately for an emergency appointment.
Now I'm a huge fan of patients finding out more about their own condition. After all, you live with your medical condition 365 days-a-year, while my colleagues and I only deal with you for a few hours a year at most. If you have a long-term condition like type 2 diabetes or osteoarthritis, making healthy life choices can revolutionise control of your condition. If you have a rare condition, you'll have far more of a vested interest in finding out the latest research than your GP, who may only see a couple of cases a year. That means it's not at all uncommon for you to know more than your doctor about your disease.
But that's further down the line, when you already have a diagnosis. Even here, it's essential to use reputable websites such as Patient.info (obviously!). The internet is entirely unpoliced, and anyone can post pretty much anything without fear of repercussions. I remember a few years ago getting a rash (forgive the pun) of patients concerned about the effect of the foaming agent SLS, found in common bath products and toothpastes, on skin cancer. My friendly local pharmacist did some detective work and discovered all the scares had emanated from one research paper 'published' by a distinguished professor in the US. It looked decidedly iffy to her trained eye and she ended up phoning him - to be met with a groan. Someone had put his name to completely false research and it had spread like wildfire on the internet, largely through makers of SLS-free products. There was nothing he could do to take it down.
There are steps you can take to identify legitimate sites. The top level domain .ac.uk, for instance, belongs to a UK university. .edu belongs to US universities (although apparently there are a small number of imposters). Patient.info pages offer links to numerous patient support groups. But ultimately, there's a good chance that if your doctor disagrees with your Google diagnosis, they have good reasons.
We don't always get it right, but we'll be happy to explain our reasoning. Of course if your symptoms change, you should go back. And if you can't get an appointment with the GP, try speaking to your local community pharmacist before you panic too much. They're a mine of useful information on all sorts of medical topics - and no appointment needed!