December 9, 2013 | Posted By Jane Jankowski, LMSW, MS

A recent article published in ACPInternist ( estimates that 35% of adults have looked online to try to diagnose a medical condition for themselves or for someone else, based on a 2013 survey.  While many providers dread having to explain that minor ailments are indeed minor because the patient fears something more dire based on website material, it seems that other providers are learning to accommodate and embrace the possibilities the internet holds for both patients and physicians. Like it or not, it seems clear that the online medical tools have become a part of many doctor patient relationships.

Given that you are reading this on a website, it seems reasonable to presume that my audience here is internet savvy and likely to be aware of the many types of websites and services available to healthcare consumers. There and numerous informational sites, symptom Mayo Clinic symptom checker, medical detective services where (for a fee) a large group weighs in with opinions on what an elusive diagnosis might be . Just to see what these tools offer, I decided to play ‘patient’ with Isabel, a relatively advanced symptom checker. I entered a few vague fictitious symptoms which could be present after a garden variety long day: fatigue, headache, and muscle aches, to see what would pop up. A shocking list of common and uncommon diseases popped up very quickly. What is readily apparent is absence of clinical judgment, and I can understand the irritation of physicians who may face patients who enter rather benign symptoms into Isabel’s (or similar) database only to later (not too much later – given the list of horrors) arrive at the office asking about liver disease, Dengue fever, and toxoplasmosis. I would expect that if I showed up at my primary care provider’s office with fatigue, headache, and muscle aches there would be more questions to answer as well as the unspoken observations of a skilled clinician who can assimilate all of the features a patient presents. Web tools cannot substitute this clinical judgment gleaned from rigorous education and years of experience.  For patients with lower thresholds for health related anxiety, symptom checkers may prove problematic and the term ‘cyberchondria’ noted in ACPInternist applies.

The up side exists, though, because not all patients will worry excessively. In fact, I feel that those who will fear the worst would likely do so with or without the internet. A symptom checker, for example, might encourage concern for a patient who would have otherwise dismissed symptoms as benign to seek treatment to do so. Websites can serve as education tools for many patients, and perhaps allow for a richer conversation between a doctor and patient. Though a feared illness may not be on the provider’s differential, the patient can be educated as to why thereby furthering the patient’s understanding of their own health status. For patients who present questions to providers which have been prompted by internet searches, another opportunity exists for providers to help patients understand what constitutes a credible resource. Perhaps the new tool for physicians might include a “How to” for patients that seem to rely on websites for health information. 

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.