It's a tangled Web when patients research illness- Internet diagnoses challenge doctors

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Monday, October 17, 2005

It's a tangled Web when patients research illness
Internet diagnoses challenge doctors

By Shari Rudavsky
The Indianapolis Star



CARMEL, Ind. -- The patient walked into Dr. Matthew Nelson's office in
Hamilton County, announced that he had looked up his symptoms online,
determined that he had Lyme disease and demanded specific antibiotics
to treat the malady.

Nelson could only sigh. He's all too familiar with patients who go
online to self-diagnose.

"In the past, we actually looked at your symptoms and tried to diagnose
you," said Nelson, an internist and pediatrician at Riverview Hospital
in Noblesville with a practice in Carmel. "Now I have to de-diagnose
the patient and say, 'These are probably the reasons you don't have
this.' "

With more people turning to Dr. Internet, experts urge caution.
Although many sites offer sound information, just as many sell a
product, promote a controversial view of an issue, or provide outdated
or inaccurate information.

Still, that doesn't stop people from looking.

A study published this year found that 41 percent of 2,007 people
interviewed in a telephone survey -- and 56 percent of those who used
the Internet -- had searched for health or medical information in the
past year.

Seventy percent of those surfers asked about a specific problem,
according to the study, which appeared in August in the International
Journal of Medical Informatics.

Since suffering a heart attack last January and discovering that she
has diabetes, Mary Margaret Wisner of Indianapolis goes online often to
learn about her conditions.

Some days, Wisner, 57, visits Irvington Internet, a cafe her son
co-owns, to search for tips on what to eat or alternative products to
take, information her doctors have not given her.

Still, she always checks with her doctor or pharmacist.

"I don't just take it as the gospel truth, but I don't do that with the
doctor either," she said. "I wouldn't know anything if it were up to my
doctors; 95 percent of what I know as to how to take care of myself, I
learned from the Internet."

Physicians, however, need not worry about the Internet supplanting
their expertise, the study found. Of those who looked for health
information on the Internet, 55 percent contacted their physician
afterward.

"Health-care information online seems to be an adjunct to health care;
people are using it as one tool among many," said Michele Ybarra, an
author of the study and president of Internet Solutions for Kids, a
nonprofit group in Irvine, Calif.

People between the ages of 40 and 60 relied on the Web the most as a
health-information resource.

Patients go online to check out a drug's side effects, to learn more
about a condition they already have, to find others who share their
disease or to try to diagnose their own malady.

So does the Internet make a doctor's job harder or easier?

"I think it does both," said Dr. Lisa Richter of Speedway Family
Physicians, a Westview Hospital clinic. "It definitely gives patients
another avenue, but sometimes it makes them too aware of things."

Lay people have always been able to go beyond what their doctors have
told them in the search for more medical information, checking out
books or journals aimed at professionals. The Internet has made the
practice both easier and -- with its plethora of Web sites -- much more
complicated.

"It takes a lot more work to wade through the information to sort out
the good from bad," said Dr. Michael Weiner, a scientist with the
Indiana University Center for Aging Research and the Regenstrief
Institute. "We know most Americans have access to health information.
Whether they're good at sorting it out remains to be seen."

That's why some professionals, such as Dr. Matthew Surburg, have taken
matters into their own hands. Surburg, of Han*** Family Practice in
Greenfield, hands patients a form letter advising them how best to use
the Internet to answer medical questions.

Some sites do a better job of helping the viewer do that than others,
said Dr. Stephen Barrett, a retired psychiatrist in Allentown, Pa., who
operates www.quackwatch.org. He recommends sites that offer filtered
information rather than just presenting a study's results.

"What you ought to try to do is go to sites that fit everything
together," he said.

Real-life physicians have another advantage over their cyber versions,
Surburg said.

"Even a reliable site still doesn't take the place of a physician's
input because the Web site can't examine you and integrate everything
into one picture," he said.


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