Having access to online health information doesn’t make you a doctor

Recent data suggests that over 60 percent of American patients consult the web first before going to a doctor.

That’s all good, and even encouraged, but trouble comes when they feel that online health information can replace physician advice.

Bryan Vartabedian talks about these so-called “amateur physicians,” and how they think they know more than they actually do. There is a danger of knowing too much information, and being unable to correctly apply what you read.

After all, just because you have instructions to build a car, doesn’t mean you can do it.

Dr. Vartabedian talks about clinical judgment, which cannot be found online: “Clinical judgment is the foundation of good medical decision-making. But you won’t find it on the Internet. It can’t be found in the cloud or the hive. It isn’t free and it’s tough to get.”

Indeed, that’s what medical school and residency are for.

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  • Anonymous

    I’d attribute that to the growing “me generation” and their growing disregard for any authority other than themselves.

  • skeptikus

    OK. So you’re saying that doctoring cannot be captured by an expert system, i.e., a computer program that algorithmically analyzes symptoms.

    Well, why not? All complex systems can be so reduced.

    More to the point, do you have ANY evidence that people who diagnose via the web have worse outcomes than those who go to doctors? If you believe in science, you’d have that data before you start knocking e-doctors.

    Given that studies have shown that 15-30% of clinical diagnoses are wrong and given that medicine is largely ineffective in promoting health on a population scale (Albanians live 6 months less than we do, but spend 1/1000th on per capita health care), maybe you shouldn’t be so arrogant.

  • Sam

    Let’s see, I could go online and find medical information in seconds for free, or I could call up my doctor set an appointment for days later, take time off from work, wait in the office for an hour, have him shuffle me out of the office in 10 minutes, and then leave with a hefty bill. Convenience matters, and the internet is good enough for most people. Instead of lamenting that people aren’t consulting their physician first greater efforts should be made to improve the information online.

  • http://www.sensei.com MySensei

    What many don’t understand is that information provided on the Internet pertaining to health care is merely supposed to be guidance and give you some insight, not replace doctors. There is a reason why they are medical professionals, and yes, the Internet provides anything and everything at our finger tips thus making it more convenient. But I for one refuse to replace this so called convenience with a real person, especially when it comes to my health.

  • http://www.drknp.com drkocis

    Ya you are absolutely right …now days people are getting more and more use of internet to diagnosis their disease …and they found a little knowledge form internet , people think they are capable of treating their disease with out concealing with doctor,which is extremity wrong .”by reading how to drive a car its impossible to drive” so think it

  • skeptikus

    Why this fixation (from the patient’s side neurotic and from the doctors’ side completely self-interested) with “seeing a real doctor”? Is there ANY evidence that computer-derived info. leads to worse health outcomes?

    Without such evidence, doctors should just keep quiet and allow this natural informational economics/ epidemiological experiment to unfold.

  • http://fertilityfile.com IVF-MD

    I’ve asked the patients who come see me in person for infertility treatment and find that 97%+ have consulted the internet. Many continue to supplement what I counsel them with independent information from the net. There is good information and bad disinformation out there. Who are we to think that patients are so stupid that they can’t use critical thinking to distill the good from the bad? I invite my patients to do their own homework and to discuss their findings with me when we cooperatively make treatment decisions.

  • Tom

    Skeptikus cracks me up, clearly so sure that this concerns everyone else. Haven’t been seriously ill, have you? What happens when you find a lump that’s growing, and doesn’t go away? Go to the internet? Something tells me that when it happens, Skeptikus is going to be first in line at the office… Sorry, kid, problems happen, and sometimes an informed opinion is worth paying for. Even more surprising to Skeptikus, diseases don’t always present as they do in the textbook (or on the internet). Yes, the diagnostic process requires experience. Thanks for the laugh!

    Oh, and as far as capturing complex systems with computer modelling… Bwahaha!!! Let me know how that neuromodelling, stock-picking, and climate modelling is working out. Your assertion is rubbish, and is so easily disproven…

  • Anonymous

    While I wouldn’t suggest that the Internet is the best source of medical information, Skeptikus’s computer algorithm idea for determining most diagnoses isn’t a bad idea. Groopman’s book “How Doctor’s Think” suggests that physicians are trained to use a hueristic method to come to a diagnosis. Why couldn’t this be programmed for basic cases?

    Of course, not all diagnoses will be textbook and that is when you go to the professional. However, an amateur can solve some problems on his own. Why always defer to and spend big bucks on the professional?

  • http://freelancemd.com Freelance MD

    What? I can’t watch a video on youtube and start treating myself and others?

    There’s a post on Medical Spa MD about a woman in Texas who was selling Botox online and teaching women how to inject themselves with videos on YouTube. You should read some of the comments from these women who are describing injecting themselves with something called ‘Freeze’ which is supposed to be a Botox replacement. They’re actually angry that the site got shut down.

    Idiots will do anything.

  • Anonymous

    I’m a veterinarian, but I’m with IVF-MD. I don’t care if my clients go on the internet before they see me. Actually, it’s kind of funny when they trot out their research and I’m familiar not only with the source but the author and can provide a critical analysis of the quality of the information. (It helps that I keep up with my journal and reference book reading, veterinary and medical, as there is occasional relevant cross-over.) I frequently recommend high-quality websites for my clients to consult and have even handed out copies of accessible journal articles. It’s easier for me to work with informed clients and I don’t feel threatened at all – why should I be, when my veterinary friends call to ask me about current journal articles because they know I’m well-read? I have yet to run into a client who has read more than I have about my field.

    Occasionally a client will say something that makes me laugh, like the client who, post-Internet, was concerned about her animal’s possible arthritis (I had to explain that degenerative joint disease is the current preferred term for her animal’s problem but one could also say he has arthritis… sigh).

    Some (though not all) of the physicians I’ve seen over the years, however, are not as well-read about their fields as I am about mine, and it’s not hard to figure that out. Though I’d keep up with my reading regardless, maybe an informed patient base will motivate more physicians to stay current… and I think that would be a Very Good Thing.

  • JPB

    Having had a physician tell me that an article in the Lancet was crap (before finding out where it came from), I don’t think most physicians give their patients enough credit for having a brain!

  • Anonymous

    The less you know, the more you think you know.

    The more you know, the more you realize how less you know.

  • Susanne

    Thank you, IVF-MD.

    Yes, who are you, Dr. Vartabedian, to imply that patients are too stupid to discern the good information from the bad? To me, this smacks of arrogance on your part.

    I doubt seriously that most folks who go online for health information are doing so because they want to self-medicate. Perhaps Dr. Vartabedian would rather patients blindly accept everything he tells them instead of fully researching issues pertaining to their health. I’d think an informed, educated patient would be welcomed by most docs, but perhaps not in Dr. Vartabedian’s case. And just what if a patient, in the course of online research, was to stumble across a novel therapy for his/her ailment and the Dr. was not aware of it?

    Yes, there is good and bad information out there on the web. There also are doctors who don’t always give out good or correct information, either, despite their educations and years of practice. Were it not for the web, we would not have been able to research all of the therapies available to treat my mother’s brain cancer. The local oncologist, claiming to be an expert in this area, was anything but. He put my mother on the standard protocol and wanted her to continue it even when the experts at a major university research center ran tests and said it was no longer working. He claimed to have never heard of using the (recently FDA-approved) drug Avastin for treating her disease.

    I think Dr. Vartabedian needs to get off his high horse and rethink his position on patients researching health information on the web. Most who do are just looking for answers and want to be prepared when meeting with their healthcare providers. What is so wrong about that?

  • Blake

    I think people are being way too critical of a perceived insult in this blog post. He wrote that internet information can be encouraged but that trouble comes when internet information replaces, not supplements, physician advice.

    Have you ever heard of “student syndrome”? Medical students being exposed to volumes of information, much of it terrifying, often jump to tremendous and devastating conclusions about their own health. It then takes the experience of residency and practice to temper this knowledge and understand what is plausible and what is not. The internet cannot supplant experience, nor do many websites pretend to. However, many intelligent people, including medical students, don’t yet understand this and can draw incorrect conclusions based on black and white facts, without understanding a “clinical picture.” These people should then bring their concerns to their physician, a clinician practiced in the art (and not just the science) of medicine, and together they can work on a plan.

    There is a reason that physicians don’t practice by themselves for a number of years after acquiring all the information of medical school. Patients should not practice by themselves after gaining information from the internet either. It’s a team effort.

  • Anon

    A typical patient equipped with the internet is, at best, equal to a second year medical student. That is not an insult. A second year medical student typically has extensive undergraduate training in the natural and biological sciences, is intelligent, and has spent two years exhaustively studying human physiology and pathology. Someone doing internet research may delve to a greater depth into a specific disease and know much more about that particular disease than a second year, or even a non-specialist physician, however, the second year medical student has access to that same information and can pull it up when needed by their iPhone.

    So, who thinks that second year medical students are qualified to make clinical judgments of any kind, even with all their textbooks laid out in front of them? Patients are, of course, the most qualified and only ones capable of making personal decisions relating to their own health. But, accurate clinical judgments assessing a clinical situation and developing an appropriate treatment regimen? There’s a reason medical students are worth less than mice in a hospital.

  • skepticus

    Again, evidence people. Is there any evidence that the internet improved health outcomes or harmed people? The last two posts wax poetic about medical training–but, of course, it’s not clear the clinical judgment (that mysterious desiderata of medical education) actually improves outcomes. Has anyone tested doctors’ judgments against a computer algorithm? Or, for that matter, do doctors even test their own clinical judgments and make their scores public. I.e., do they compare their performances so as to determine who’s “clinical judgment” is better. One suspects doctors unwillingness to shed light on this “ability” reflects the facts that there’s not much there, there.

    Internet-enabled medical diagnosis is running that experiment. If we could abolish the medical prescriptions, the experiment could really take off. In the meantime, doctors calm down and look at the evidence.

  • Tom

    Clearly Skeptikus is convinced that computers represent the only hope for humanity. Once robots diagnose us, all will be well. He would be well advised, before programming the robots to diagnose, to understand the diagnostic process. One wishes him luck on his quest for knowledge, so he and his army of robots can wipe out the medical profession.

  • Blake

    A lack of evidence is not evidence to support your claim. The lack of evidence just means no one has wasted their time and money to study it yet.

  • http://healthmedwatch.blogspot.com/

    I’ve been a health care consumer for a long time, for small complaints- an upper respiratory infection, a broken toe- and for slightly larger ones, like open heart surgery. And I’ve been an patient advocate for my parents and children. And I tell you this: the clinical and business knowledge accumulated over almost 30 years as a health care professional has been a blessing. With it, I’ve been able to successfully counter many errors visited upon us by the health care industry. To me, the Internet is an adjunct, an ally in my bid to stay alive and to stay (relatively) healthy.

    That said, make no mistake: I admire good physicians, and I grant them high respect. But I want to work together with my doctors in a collaborative effort to maintain a continuum of care. Anything less seems impossibly careless.

  • http://www.twitter.com/matthewbowdish MatthewBowdishMD

    As a physician, I like when patients come in with information acquired from the internet (or elsewhere, for that matter). It makes the discussions more interesting and me a better physician considering all options. Most of the time, these folks are also more engage in their health care decsisions, and make more informed decisions with my input. Doctors should not feel threatened by such patients. Any one that does, or takes an arrogant attitude towards invested patients, should be avoided, imho.

  • Aestivate99

    It’s likely that no one will see this comment since I’m late to the discussion but I just wondered why no one has asked why highly respectable medical entities have websites with information for consumers like me if it’s not to be used. Mayo Clinic, Harvard Medical School, NIH, the list goes on. Maybe docs should help their patients by providing a handout/guide to reputable websites instead of just throwing out the baby with the bath water. Thank you Dr. Bowdish for pointing out that there just might be a few arrogant docs out there.

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