I recently came upon an article on the site kevinmd.com, a place on the internet where some of my own work has been published in the recent past. The piece, entitled “Don’t judge patients for researching their health issues” was written by Suneel Dhand MD, an internal medicine physician. In it, he started his musings with “it’s difficult to imagine a world now without Google and the internet. It’s also strange to think that most people alive right now received the bulk of their education in the pre-internet era.”
I can remember that all through my formal education, up to and including college, medical school and residency, I always had written notebooks full of information, copied handouts given to me by professors and notetakers, and stacks of heavy books containing the latest information at the time of their publication. These reams of paper notes could literally fill dozens of large plastic binders and take up a lot of space on bookshelves and tables. The textbooks were large, ponderous, heavy and expensive. One internal medicine book might cost more than one hundred dollars, a fortune for a medical student with very little expendable income. The goal of collecting all of this written material, of course, was to have the most up to date knowledge of the time, the cutting-edge information that was going to make you a better student, resident and doctor. It was an effective strategy, of course, until the next set of notes came out or the next edition of that expensive textbook was published. You were then immediately behind the curve, not up to date and worried that you might not know enough about the latest and greatest theorem or procedure or medication.
Enter the internet.
According to Dr. Dhand, “one of the most important ways we are now using the internet is to make informed health choices and read up around our illnesses. Unfortunately, this hasn’t always been met with enthusiasm by all members of the medical profession. “Another saying that I have seen on cartoons and coffee cups goes something like this: “Don’t confuse your Google search with my medical degree and thirty years of experience.” Patients have been quick to embrace this new firehose of all things information, but some doctors, especially from a generation or two ago, are sometimes threatened by their patients Googling diagnoses, treatments, medications, and other medical information that in years past was the intellectual property of their physician who would dispense it as carefully as he did medicine. The days of Marcus Welby MD have long since passed, I’m afraid, and that doctor with his closely guarded secrets does not exist any longer.
Dr. Dhand also writes, “If there’s any physician who gets annoyed, intimidated, or frustrated by patients and families who Google search and ask them questions, that doctor should take a long hard look at their internal belief system. I, for one, always welcome questions and challenges to what I’m saying, and see this as a natural part of being a professional. “I agree with this view, with a few caveats that I will outline below.
First, a relationship between doctor and patient should be a collaborative one. Physicians have worked long and hard to study and learn as much as they can about the practice of medicine so that they can help you when you come to see them for a specific ailment. Good doctors have your best interest at heart and want to give you the best advice and share the most up to date knowledge with you that they can. They expect you to trust that this is the case. By that same token, a good doctor will welcome your opinions, your knowledge about your own body and how it is reacting to a disease state and your own research and thought into what might be helpful to you in treating that disease. You may have come upon some of that knowledge by searching the internet, reading books and magazines, hearing the opinions of friends and family, or relaying the opinion of another doctor. As long as doctor and patient respect each other and collaborate on the best course of action, no one should be frustrated, intimidated or annoyed by that process.
Second, it is the patient’s responsibility to use good judgment and due diligence when looking for information about their own health. One of the downsides of the ubiquity of the internet is that there is much bad information to be found, in addition to quality knowledge. Patients can up their search game and get the best info to be found by going to respected sites when they need information about diseases, medications, and other treatments. A few of these might include: http://medlineplus.gov/ for general information about diseases and medications; http://drugabuse.gov/, which gives substance abuse information for patients, families, parents and providers; http://nami.org/, for general support related to severe mental illness; and http://dbsalliance.org/ for information on depression and bipolar disorder. I am also partial to https://www.mayoclinic.org/, which has wonderful searchable databases full of info that can be printed out and shared with others.
Third, physicians must be open to hearing what their patients have to say. In his article, Dr. Dhand states that a good patient comeback to the physician meme above might go something like this: “Don’t confuse your 1-hour lecture on my condition with my 20 years of living with it. Yes. Doctors, we are here to serve, answer questions, and show empathy. Not judge our patients for researching their own health issues.” I am so very fortunate to care for a patient population that is wise about illness, what works, and what does not. I also work with a wonderful, caring staff who share my concern for our patients and want very much to help them recover. I learn something new almost every day I have a clinic because of the willingness of my patients to share their lives and struggles with me. It is one of the most rewarding things about practicing psychiatry.
In summary, a doctor patient relationship should be collaborative. Patients bear some responsibility to use due diligence when educating themselves about their illnesses. Physicians should be open to listening to others so that they might continue to learn and grow.
Together, we can search for the right questions, the correct answers and the best path to recovery.