Worrying ourselves sick

You have a headache that won’t go away. In search of more information, you Google your symptoms and discover you might have eyestrain or tension. Or food allergies. Or meningitis. Possibly even a brain tumor.

How can the average person make sense of all the health information available on the Internet?

Often they can’t, and it may be to their detriment, suggests an American Medical News article outlining the increased anxiety some doctors are seeing among patients who research their symptoms online.

From the article:

The increase in using the Internet to self-diagnose comes at a time when many physicians are encouraging patients to be more involved in their medical care to help improve health outcomes, particularly for chronic illnesses. Some health professionals say researching medical concerns on reputable websites can be a positive step for patients, because it helps them become more educated about their health. In doing so, patients sometimes accurately diagnose themselves, particularly when it involves common illnesses, such as appendicitis and strep throat, doctors said.

More often, though, the large number of health websites, some of which are unreliable, mislead patients into thinking they have a medical problem, say health professionals. They say the outcome frequently is heightened patient anxiety and unnecessary screening tests that can result in medical complications. Cyberchondria also demands that physicians spend more time in office visits as they discuss why the individual thinks he or she has a particular disease, educate the patient on why that diagnosis is unlikely and then determine the true cause of the symptoms.

I can attest to some of this firsthand. For the past decade I’ve belonged to an online lymphoma discussion group. Lymphoma is one of those cancers whose symptoms are often vague. It isn’t easy for the layperson to distinguish between fevers and enlarged lymph nodes that might be a sign of lymphoma vs. fevers and enlarged lymph nodes that are a sign of something more benign, such as an infection.

On a regular basis, people join the group who haven’t been diagnosed with lymphoma (often they haven’t even had a biopsy yet) but are worried sick they might have it because of what they read on the Internet. Most of the time their fears turn out to be unfounded. In fact, some of the staunch old-timers in the group have started issuing a standard line of advice to these folks: Get off the Internet until you’ve had a chance to talk to your doctor and/or have a formal diagnosis. Some are reassured by this but others aren’t, and their distress can be painful to see.

A little bit of worried-well behavior is not necessarily bad. Sometimes it can prompt people to take necessary action. Sometimes the patient even turns out to be right. At what point, however, does it cross the line?

A question worth asking is whether cyberchondria is just another form of the classic hypochondria, amplified by easy access to online health information. Academic studies on cyberchondria seem to be few and far between. (When I conducted a search via the U.S. National Library of Medicine and National Institutes of Health, I found exactly five published reports.)

The most recent study appeared last month in the Journal of Anxiety Disorders. It explored whether health anxiety is linked to the online use of health information and concluded that yes, there’s an association and that individuals who already have underlying anxiety about their health can become worse the more time they spend researching health information online.

Perhaps this is at least partly a matter of degree. It’s one thing to worry; it’s quite another for the anxiety to escalate into full-blown hypochondria, which can become so obsessive as to interfere with careers, relationships and quality of life.

Among those interviewed by American Medical News was Dr. Rahul Khare, an assistant professor in the Department of Emergency Medicine at Northwestern University Feinberg School of Medicine in Chicago. Dr. Khare said he’s seeing an increase in cyberchondria, especially among young adults who show up in the emergency room after researching their symptoms online.

Patients are “way more knowledgeable” than they used to be, he noted. “But too much information without proper guidance can cause anxiety or fear.”

I don’t think we’d want to return to an era when patients were told a minimum of information and paternally advised not to worry. The challenge these days is just the opposite: learning how to sift through vast amounts of data and figuring out which pieces are relevant and which aren’t. It gives me a whole new respect for what it takes to learn how to think like a doctor.

2 thoughts on “Worrying ourselves sick

  1. The challenge is also to find reliable information, and to be able to present it to your doctor in a respectful, logical and balanced manner.

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