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 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.”
It used to be you had to physically look up medical information, actually sit down and flip through a book. Now the challenge is finding good information. Dr. Scott Bisheff is the medical director of Sierra Vista’s emergency room. While he said his patient population typically doesn’t self-diagnose online—someone in need of emergency care probably isn’t going to hop on the computer first—he said the ease of access to medical information is generally a positive, with some qualifiers.
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 his experience.
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 patients come 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, and 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 as webmd.com, or sites designed to sell a specific drug.
Instead, he tells his patients go to familydoctor.org and medlineplus.gov.
In fact, some hospitals use the Internet as an early screening for patients. About 3 1/2 years ago, French Hospital Medical Center launched HeartAware along with five other online screeners though its HealthAware Assessments. The hospital leases the software from a third party and uses it to screen patients who are then given the opportunity to come in for a more extensive checkup.
About 20 to 30 people per month use the program and schedule an appointment, according to Denise Gimbel, a registered nurse and coordinator of HeartAware for the hospital’s cardiac rehabilitation department.
“I really see these online resources as being very useful to patients,” Gimbel said. However, she added, it’s good to vet Internet sources. Look for clues like .edu, .org, and reputable names like the Mayo Clinic.
“The patient needs to be educated; they need to understand the doctor doesn’t always have time to spend half an hour telling the patient everything he needs … and online resources are very good as long as people go to reputable sites,” Gimbel said.
And finally, to quote the man himself: “I was nauseous and tingly all over. I was either in love or I had smallpox.”
News Editor Colin Rigley can be reached at firstname.lastname@example.org.