Woody Allen is perhaps the most well known hypochondriac. According to Don Hilty, professor and vice chair of faculty development in the UC Davis Department of Psychiatry and Behavioral Sciences, Allen’s iconic bumbling caricature “feels like he’s ill and he’s worried about being ill, but technically he’s not.”
And Allen’s neurotic character had the luxury of a pre-Internet age, when he didn’t have all the horrible possibilities at his fingertips.
If you pull up Google and run a search of three words, “nausea fatigue dizzy,” the first reply on the first forum that appears offers a possible diagnosis of fybromylgia with a “chiaria malformation” of the brain.
If you were to say, run this same online search and take your diagnosis to a licensed doctor asking for a specific treatment regimen, you might fall under the unofficial classification of “cyberchondriac.”
“This is loosely defined as someone who researches their medical information online and then tells the doctor how they want to be treated,” said Ron Yukelson, a spokesman for the Sierra Vista Regional Medical Center in San Luis Obispo. “Or, alternatively, showing up in the doctor’s office being self-diagnosed.”
Yukelson added that many doctors would roll their eyes at a mention of the topic “because it’s so prevalent in their office practice and only getting worse.”
It’s a tricky thing, the Internet, simultaneously an infinitely deep pool of easily accessible information and an unchecked dumping ground for anyone who wants to try their hand at differential diagnosis.
Suck it, med school.
Hilty described hypochondria as a “pervasive feeling that something is dreadfully wrong. So when a doctor reassures them that they’re not going to die or that there’s nothing majorly wrong, they feel better momentarily, but then they start to worry again.”
Hypochondriacs confuse anxiety with physical symptoms, he said. The condition is usually associated with other mental illnesses such as depression or anxiety, which is typically how it’s diagnosed. So if you’re simply a chronic Googler, you likely won’t have to also worry you’re a certifiable hypochondriac.
According to an article Hilty co-authored in the journal Therapy, hypochondriasis accounts for about .8 percent to 6 percent of primary care encounters.
“Often, the patient has already researched on possible diseases and comes in requesting a blood test, a radiological study, and/or an invasive procedure,” the article stated. “The patient may additionally question the expertise of the primary care physician and request referrals to see different specialists.”
According to Dr. Naishadh Buch, chief operations officer of Lompoc Valley Medical Center, online self-diagnosis does have its positives—especially when trying to determine if what you’ve got is the common cold or something worse—with some caveats.
“For a lot of things, it is very useful. It’s educational. People can go to reputable websites and get good information. From that standpoint, I think it’s a good thing,” Buch said. “The bad thing is if you decide to diagnose and treat yourself based on the information available, not being aware of what the differentials might be. Out of the five things you could have, based on these symptoms, three of them are OK if you did them yourself, but the other two, if you’ve got those, then you’ve got a week to live.”
There’s a selection bias inherent to most online forums. In other words, anyone who had abdominal pain that just went away on its own or resulted from a bad piece of fish probably won’t write about it online. On the other hand, someone whose abdominal pain turned out to be a rare tumor might post about the experience.
If you’re going to research what ails you, Buch said, by all means check Web M.D., Medscape
.com, or other valid sites, but beware of jumping to conclusions based on unreliable information.
“Unfortunately, most of us could make our feelings and symptoms fit into a whole host of problems,” he said. “[Patients] do convince themselves they have a specific diagnosis, and then they want to be treated accordingly. So when they don’t get treated the way they want to be treated, they get ticked off at the [emergency department] physician and staff and write to me saying we’re all screwed up.”
Good judgment seems to be the key to a healthy self-diagnosis. Dr. Mario San Bartolomé, president and CEO of Ventana Health & Medical Center in Pismo Beach, said patients who self-diagnose are at least engaged in their own health, which is a big plus. The biggest hurdle is for the physician, he added. When a patient comes in with 12 pages of printout, convinced they’ve contracted a rare African flu, San Bartolomé said he likes to walk them through the differential diagnosis process he uses. That way, he’s not discounting the patient’s concerns; instead, they’re solving the problem together.
The Internet can be overwhelming for patients—even for doctors, San Bartolomé said. It’s teeming with data that can explain a simple headache with everything from neck tension to a brain tumor. San Bartolomé warns against such diagnostic websites or sites designed to sell a specific drug.
Instead, he tells his patients to go to familydoctor.org and medlineplus.gov.
Ultimately, Lompoc Hospital’s Buch said, online diagnoses shouldn’t be considered substitutes for a trained doctor’s evaluation, particularly when symptoms persist.
“With the exception of the common cold, really you do want to see a physician,” Buch said. “Those are the people who are trained in the art of diagnoses, and they’re the ones who can tell you whether you have a problem or not. … Being educated is definitely a good thing, but only up to a point. After that, go see a doc.”
Colin Rigley is news editor for New Times, the Sun’s sister paper to the north. He can be reached at crigley@newtimesslo.com. Sun Staff Writer Jeremy Thomas contributed to this article.
This article appears in Jan 19-26, 2012.
