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Checking vital signs through cyberspace

By Mary Ann Albright
Published: December 13, 2009, 12:00am
3 Photos
Physician Assistant Scott Jonason, from Lacamas Medical Group, examines patient Brad Johnson's sore shoulder last month.
Physician Assistant Scott Jonason, from Lacamas Medical Group, examines patient Brad Johnson's sore shoulder last month. Jonason said more patients are turning to the Internet for medical advice before visiting his office. Photo Gallery

Some physicians consider the Internet an obstacle in providing health care. Others consider the World Wide Web and all it has to offer a blessing. But everyone seems to agree informed patients contribute to better health care.

Here is a list of doctor-prescribed Web sites that provide a wealth of information about various medical conditions but should not be used as a substitute for a physician:


• The National Cancer Institute — www.cancer.gov


• Centers for Disease Control and Prevention — www.cdc.gov


• MayoClinic — www.mayoclinic.com


• WebMD — www.webmd.com


• MedlinePlus — medlineplus.gov


• American Academy of Family Physicians — familydoctor.org


• American Cancer Society —

www.cancer.org


• U.S. Department of Health and Human Services’ Healthfinder — www.healthfinder.gov


• University of California San Francisco AIDS Research Institute — hivinsite.ucsf.edu


• KidsHealth — www.kidshealth.org


Web sites provided by Southwest Washington Medical Center, Physician Assistant Scott Jonason and Dr. Terry Williams.

Ongoing belly pain? Must be pancreatic cancer.

Got any moles on your body? Likely means you’ve got melanoma.

Experiencing headaches? Those are caused by brain tumors.

While the symptoms could be an indicator of those diseases, they’re more often than not due to something far less severe. The belly pain could be indigestion. Most moles are discovered to be benign. And those headaches could be caused by caffeine withdrawal, lack of sleep or stress.

So why all of the panic about life-threatening illnesses? The Internet, according to some doctors.

With a few taps to the keyboard, one can find hundreds, if not thousands, of answers to nearly any question. And of all the topics entered into search engines, health issues remain near the top of the list. According to research by the Pew Internet and American Life Project, 80 percent of American adults, or about 113 million people, have searched for health information online.

Web sites can provide a wealth of information about various illnesses and diseases, suggest treatment options and open the lines of communication with providers. But while the Internet can be informative, some physicians argue it can be equally as dangerous. Anyone can post information on the World Wide Web, meaning Dr. Google isn’t always the most reliable source. Nevertheless, many people peruse Web sites and some even attempt to diagnose and treat their own illnesses.

Of the millions of adults who search online for health answers, 75 percent don’t verify key quality indicators such as the source and creation date of the information, according to the Pew Internet and American Life Project.

When Web searchers do seek a professional opinion, physicians are faced with an additional obstacle: clearing up the misinformation.

"There’s always been junk science out there," said Scott Jonason, a physician assistant with Lacamas Medical Group in Camas. "But now, because information is so readily available, we are spending a lot more time debunking."

Jonason said he’s had numerous patients enter his office and recite information they’ve gathered from Web sites. Some will say they know what illness they have, based on what they’ve read online, and will insist on tests to prove it. Others will explain a course of treatment they discovered on the Internet and want to follow it to combat an illness.

The problem, Jonason said, is that not all of the information they present is accurate.

"It’s good to have informed patients, but sometimes their interpretation of the information is off, so we spend time trying to straighten it out," Jonason said.

The most common myths Jonason works to debunk revolve around immunizations for children, he said. Many people read about the dangers of immunizations in online articles without scientific support or research. Parents read those articles and are adamant their children should not receive vaccinations, he said. Before agreeing to the patients’ wishes, Jonason said he explains the scientific research contradicting false information on the Web.

"Sometimes there’s no convincing," he said. "You have to just allow them to make that decision, even if you don’t agree with it."

Besides being inaccurate, information on the Internet can also be slanted and provide only a fraction of the complete picture, said Dr. Terry Williams, a family medicine physician at the Kaiser Permanente clinic in Orchards.

When a person sits down in front of a computer and enters symptoms into a search engine, he or she is presented with a list of possibilities. Oftentimes, though, the list does not include the full spectrum of diagnostic possibilities, but rather lists the most commonly visited sites. That, Williams said, can lead people to continue researching the common response and not the actual problem.

The narrow window of possibilities and the potentially inaccurate information can sometimes end up costing the health care system as well, said Dr. Ashok Modha, a neurosurgeon at Rebound Orthopedics & Neurosurgery.

Physicians may have to perform numerous tests to prove to the patient that his or her own diagnosis was incorrect and find the correct diagnosis. In some cases, patients may still not believe physicians and will shop around in an attempt to find a doctor who will agree with their self-diagnosis, Modha said.

Another concern is the significant possibility of misdiagnosis when people attempt to do so based on search engine information, he said.

"Medicine is just as much an art as science and an Internet search engine or medicine Web site cannot take the place of human interaction and touch as provided by your MD," he said.

An online misdiagnosis may do more than just waste time and money; it could cause psychological harm, Modha said.

If people enter symptoms into a search engine and incorrectly diagnose themselves with an illness, they will likely continue to search the Internet for more information about their diagnosis, Modha said.

"They can convince themselves more and more that they have a particular problem," he said. "If the diagnosis they come across is bad, like it’s life-threatening or something that can make them pretty sick, it affects how a person acts."

It can consume their life and affect their work performance, their relationships and their actions, Modha said.

"That can have a pretty significant toll on a person, just from a psychological standpoint," he said. "… Sometimes these things can snowball and go on and on."

The increasing use of the Internet to fuel beliefs of serious illness has been coined by some as "cyberchondria." The term stems from hypochondria, which is defined as abnormal anxiety over one’s health, and is often linked with imaginary illnesses.

Cyberchondria can sometimes prompt people to try and convince their physician they have a certain illness based on symptoms they may or may not be actually experiencing, Modha said. Physicians may feel obligated to run sometimes painful and expensive tests to prove a self-diagnosis incorrect, which can lead to more stress and psychological harm, he said.

"Your mind can go wild," said Jennifer Hanscom, spokeswoman for the Washington State Medical Association based in Seattle. "That’s why I think it’s important that people see it for what it is: It’s a tool for information, but it’s not an endpoint."

For Williams, the Internet is a welcomed source of information. The family medicine physician sees the Internet as a tool to help open the lines of communication between doctors and patients and educate people about their health.

"I look at it as very, very positive," Williams said.

Patients sometimes come to Williams’ office after researching their symptoms and discovering possible diagnoses. Williams said he listens to his patients’ diagnoses and asks about their symptoms. He then explains why particular self-diagnoses are incorrect and investigates diagnoses that may have merit, Williams said. Once he determines a patient’s diagnosis, he explains how he came to that conclusion and encourages his patient to learn more about the illness, either through medical articles or credible Web sites, he said.

"It’s a give and take both ways," Williams said. "They give me information, and I give them information."

The Internet can also prove helpful in raising awareness. Patients can learn about routine tests they should have when they reach a certain age, such as mammograms, and become informed about preventative screenings available, Jonason said.

In recent years, more and more people turn to the Internet to find that information. The Web site WebMD reported an average of 59.8 million unique users visiting the site per month — for a total of 1.4 billion page views — in the second quarter of 2009. That’s a 24 percent increase in users and 31 percent jump in page views compared with the same time period in 2008.

For the most part, Williams said, patients are looking for information on Internet sites but ultimately want a physician to validate their findings.

And that’s how the Internet should be utilized, said Hanscom, whose nonprofit organization provides educational seminars and advocates and lobbies on behalf of physicians. Patients should use the Internet to prepare for a doctor appointment or research a diagnosis made by a physician, she said. But the Internet should not be used as a substitute for a doctor, Hanscom said.

"There’s a reason why physicians go to medical school to learn this information," she said.

Many diagnostic Web sites echo Hanscom’s sentiments. Sites like WebMD and the federal government’s H1N1 self-assessment warn visitors that the information should not substitute for a doctor’s diagnosis or treatment. The H1N1 site even requires users to agree to having read the disclaimer before continuing to the self-assessment portion of the Web site.

Some patients are also using Web sites to determine courses of treatment and medications needed to combat illnesses.

Christine Alvarado, a receptionist at Fisher’s Landing Urgent and Family Care, said once or twice a week she receives calls from patients requesting a doctor prescribe medication to treat self-diagnosed illnesses.

"They don’t understand that we can’t just write the prescription," Alvarado said.

After some convincing, the patients usually agree to see a doctor and allow the physician to determine the diagnosis and needed medication, she said.

The Internet isn’t the only culprit, though. Patients also ask physicians to prescribe them medications based on a friend or family member’s positive results or advertisements they see on TV.

"That’s probably the worst thing they’ve ever done is allow the TV advertising," Jonason said.

Advertising online and on TV creates, for many people, a perceived need that doesn’t exist, he said.

The pharmaceutical companies spend billions each year to create that perceived need. In the first six months of this year, pharmaceutical companies spent about $2.15 billion in advertising, according to The Nielsen Company.

Williams said he too has patients come into his office asking about medications they saw on TV or read about on the Internet. Most times, though, the patients suggest the medication and ask Williams for his opinion on whether it would be an effective treatment.

So why do people turn to the Internet before, or in place of, a physician? There are many reasons, doctors say.

The primary reason, Modha said, is because the Internet is, for many people, readily accessible at all times. Physicians, on the other hand, are not always immediately available to answer questions, he said.

At the Fisher’s Landing urgent care center, Alvarado said the most common reason is money. More and more patients have tighter budgets and don’t have the spare money for co-pays. Others have lost all insurance coverage and can’t afford to cover the cost of an office visit out of their own pockets, Alvarado said.

"With today’s economic situation, I understand that," she said.

Yet, there is little she and physicians can do for people who self-diagnose because the law requires doctors to be the ones to evaluate and diagnose patients, Alvarado said.

With physicians making those determinations, people are less likely to worry about illnesses they don’t have or disregard symptoms that could signal an illness needing medical attention, Modha said.

While some physicians see the Internet as an obstacle and others see it as a blessing, it seems most physicians agree on one thing: Dr. Google is not, and should not be, the diagnostic authority.

"As for self-diagnosis, it should be a first step in terms of curiosity," Hanscom said, "but ultimately, it should be a physician who makes that diagnosis."

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