Now don’t get me wrong, becoming a doctor is no small feat. You have to go through four grueling years of medical school followed by an internship and years of residency. Not to mention the literal costs involved, including the hundreds of thousands of dollars to go to med school and opportunity costs. You don’t do any of this because you don’t care about people. And yet.
And yet, it sometimes feels like you, Dear Doctor, have been taught to hate the very people you’re attempting to treat. The most recent symbol of this, for me, is the mug floating around the internet which reads, “Please Do Not Confuse Your Google Search With My Medical Degree.” Could this be any more condescending? If you like to sip your coffee from this mug on your morning rounds, I have a few words for you.
Did you miss the studies showing that one of the best ways to improve patient outcomes (something you should be for, yes?) is engagement? What’s one of the best ways for patients to become more knowledgeable about their condition? Reading about it. Okay, and where can the public access information about virtually any medical condition? The internet!
Don’t get me wrong; there's a lot of nonsense on the internet. But that doesn’t mean it’s all nonsense. With a PubMed membership, your patient can read all the very same studies you can. Let me make clear, if you are fine with your patients reading articles on PubMed and only get upset when they get their advice from www.quackmedicine.net, I totally get it. If that’s you, carry on. I’m not speaking to you. Right now I’m talking to all the doctors who get annoyed at their patients for learning more about their condition. The doctors who see that either as the patient getting too big for their britches or as evidence that the patient must be a hypochondriac.
Contrary to what this condescending mug suggests, there are very good reasons for your patient to run a Google search or two about their symptoms. First and foremost:
5. Doctors’ misdiagnoses rates are unacceptably high.
I’ve written a number of articles about this. I’d suggest reading in full 4 Out of 5 Doctors…Are Wrong, but here’s the short version: 4 out of 5 doctors are wrong about a lot of things.
Okay, here’s the slightly longer version. For autoimmune diseases, for instance, it takes on average five years and five doctors to get to a proper diagnosis. That means the first four doctors were no help while the patient suffered with their disease for five long years. Do you know what the vast majority of autoimmune, dysautonomia, and rare illness patients are told repeatedly by doctors before they finally get to a diagnosis? That their symptoms are all in their head, they’re making them up, or they have some sort of mental illness. So is it really wise to tell patients to take a doctor’s words as gospel?
Do you trust a colleagues' words blindly, Dear Doctor? If your mother is taken to the emergency room for palpitations do you take the ER doc’s first impression that she’s overly anxious as binding authority or do you insist she be given an EKG? Do you know how many women die each year because of being dismissed and sent home under this exact scenario? I bet you’d insist on talking to that ER doc and questioning her conclusions. So then why do you hold your patients to a different standard?
4. Your medical degree means absolutely nothing if you don’t listen to your patient.
If you’re a longtime reader of this blog, you know the horror stories patients have of being dismissed by doctor after doctor. There was the woman who was committed to a mental institution rather than treated for the nonfunctioning gallbladder that almost killed her. There was the woman who lost her family and many years to misdiagnosis. There was the woman who bled for eight months and ultimately had to have a hysterectomy at the age of 24 because of not being properly diagnosed for years. Sadly, this is only a small sampling. Do you know what all of these women have in common? What virtually every woman sharing a story on this blog has in common? They were all dismissed by their doctors as being malingerers, hypochondriacs or depressed/overly anxious.
You like to flaunt your medical degree, Dear Doctor, and it’s true that your knowledge is a powerful thing. You have the power to take a person suffering (like me, last month, when my eardrum burst from a nasty ear infection) and make them better (thank you antibiotics and the Nurse Practitioner at the Minute Clinic). But all the power that’s inherent in your medical training is lost entirely if you don't believe your patient when they report their symptoms.
I’ve been astounded at what symptoms doctors have managed to attribute to psychological causes. I just recently got a submission from a woman who was told by a doctor that her runny nose, congestion and loss of smell is due to depression. For obvious reasons, she’s seeking a second opinion, and yes, she’s spending some time on Google. If you, Dear Doctor, see mental illness as the culprit of every single one of your patients’ symptoms,* no matter how far-fetched that conclusion, your medical degree stops having any value.
3. Your medical degree doesn’t make you an expert on every single disease & doctors very rarely do any research.
Doctors aren’t familiar with every single illness. It would be impossible. Medical knowledge doubles every three years (by 2020, it is projected that medical knowledge will double every 73 days!!) and there are thousands and thousands of rare diseases, so I get it. You can’t know everything. So why then, Dear Doctor, when a patient comes into your office with symptoms that sound strange, do you immediately run through the catalogue of diseases you do know, rule them out, and then proceed to tell the patient that to a medical certainty the symptoms must be all in their head?
Have you ever considered doing any research? I used to be a practicing attorney. If a client came into my office with a fact pattern unlike any I’d heard before, I wouldn’t tell them that they must have no case and send them on their way. (Or worse yet, that they're crazy.) I’d do legal research and get back to them. Or refer them to another attorney with more expertise. But I definitely wouldn’t tell them I knew what the law was without looking into it further. That would be malpractice. Why is it acceptable for doctors to talk to their patient for five minutes, not have any clue what’s wrong, and then summarily conclude the issue couldn’t possibly be with the doctor’s own knowledge but must instead be with the patient’s mental health? If you’re not sure what’s ailing this person, have you ever considered saying something along the lines of, “I’m not sure what is ailing you. Why don’t I refer you to a specialist who may have more knowledge than I do?”
It’s precisely because doctors don’t do this that so many patients have to rely on Dr. Google. Let’s say you’re a patient with these two symptoms: persistent vaginal bleeding lasting 8 months and extreme pelvic pain. Now let’s say that you go to three doctors and all of them tell you your symptoms are caused by depression. Keep in mind you don’t feel sad in any way other than from the frustration of living with constant pain. Wouldn’t any sane person take to Google?
In fact, that’s often the only way to get a diagnosis. The patient is forced to figure out what is wrong with themselves. Then once they’ve made a self-diagnosis, search for doctors expert in that condition so when they see that doctor, they don’t get the “you’re crazy” run around. So, Dear Doctor, if you stopped pretending you knew everything, your patients wouldn’t have to spend so much time on Google. That’d be a win-win for everyone.
2. Your medical degree certainly doesn’t make you an expert on my body.
This ties into the previous point, but while you, Dear Doctor, may be an expert in medicine, I am an expert in my own body. I’ve been living in it my entire life. I know what feels normal and what doesn’t. I know the difference between feeling depressed versus fatigued. I may not have a medical degree, but that doesn’t make me an ignoramus, and the fact that you do, doesn’t mean that you’re God.
You, Dear Doctor, may hate it when your patients Google their symptoms and come up with self-diagnoses but if you talk to virtually anyone with a rare disease, more often than not the patient realized what their issue was before the doctor did. Why? Because they know what they’re feeling, they take their own health seriously, and it doesn’t take a brain surgeon to read a Pub Med article and say, “Me too. Me too” when they finally find a description of the condition they’re suffering from. So please, Dear Doctor, have some humility and some appreciation for your patients' own common sense.
1. The fact that you’re threatened by a patient becoming informed makes me question your expertise.
As I mentioned before, I used to be a practicing attorney. A darn good one, in fact, and I was never upset when a client was knowledgeable about his case. It made it easier for me to explain strategy, actually. But do you know which lawyers hate it when their clients are informed? The crappy ones. The ones who don’t want their clients questioning their every (usually poorly thought out) move. As it goes with doctors. The doctors who are the most highly educated on the conditions they’re treating also tend to be the ones who are most open to patient questions.
In my experience, the doctor least threatened by Google was my OB when I was pregnant. You have so many weird symptoms when you’re pregnant; it’s the natural thing to Google them before calling the doctor. In fact, at my first visit I hadn’t Googled one of my symptoms knowing how touchy doctors can be about that and my OB was shocked. “You didn’t Google it? Next time if you’re feeling weird, just Google it.” She was happy to explain what was going on, but honestly I’d wasted both of our time. This is how every doctor should react.
So why then, Dear Doctor, are you so threatened by your patients becoming more empowered? Are you afraid they might realize you’re not God? Trust me, they realized that a long time ago. Please, I implore you, embrace the Google. Absolutely educate your patients about the sites that are trustworthy versus the ones that are not, but don’t expect your patients to keep themselves ignorant about their medical conditions. That is not what’s best for their care, and it’s not what’s best for you and your dwindling resource of time.
*I hate that I have to keep repeating this, but this isn't to suggest that mental illnesses aren't real or aren't also debilitating. The point is, a doctor should do a full differential diagnosis and actually consult the DSM-V before blithely making a mental health diagnosis--especially since it's clear that many doctors like to label patients as "crazy" because they think it gets them off the hook of providing appropriate care. Not surprisingly, there are many physical diseases that are also commonly comorbid with mental illnesses, so even if a patient is depressed or anxious, that doesn't mean they don't also have some other physical condition that needs treatment.