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The iDoctor-Internal Medicine to Internet Medicine

Times are changing and so is the art and approach to medicine. In this ever advancing age of technology and internet, health care has taken a quantum leap, with diagnostics to therapeutics having imbibed the technological revolution. This paradigm shift has changed our approach to search for symptomatic answers and thus we have become entangled in web of the IT world. The approach is paving way for a new stream of healthcare delivery based on internet assisted self-diagnosis and treatment (IASDT). It is not surprising to note that many medical practitioners exclaim – the patient merely asked me to reconfirm the IASDT!

The traditional manner of dealing with an ailment or medical symptoms was to consult one’s family physician or a medical care facility in the vicinity.  With changing times and the IT revolution, this approach seems to have taken a back-step. Many a times, the first reaction to a newly developed medical symptom is to place it before one’s preferred search-engine for diagnostic scrutiny. This results in search-engine symptom optimised diagnosis. The diagnosis that appears first on the screen may thus be the primary target of the patient’s curiosity to explore the probability theory. More often than not, this search may never go beyond the first page. The most probable diagnosis and its related treatment may thus be the initial foray into the experimental world of medical therapeutics for the patient. This approach often takes the patient from a web of knowledge to a web of confusion, chaos, uncertainty and anxiety.
As interesting it may seem, the first opinion is usually from the virtual world and may invariably be from the iDoctor. Whether this quest for IASDT stems from the fear of increasing costs of healthcare or from the ease to self-medicate is a larger question to ponder upon. While undoubtedly, health care has become more advanced and accessible, the costs of health care has also risen over a period of time, and so has our search for independence from established medicine. Often, this translates into either a pursued step towards self-medication or a mere second opinion for a medical practitioner, post IASDT.

This form of search-engine symptom optimised diagnosis, may often lead to potential risks of non-responsible patient related practices such as incorrect self-diagnosis or over diagnosis, unwarranted anxiety or panic, delays in seeking medical advice when needed, infrequent but severe adverse reactions, dangerous drug interactions, incorrect manner of administration, incorrect dosage, incorrect choice of therapy, masking of a more severe disease and possibly the risk of dependence and abuse. These risks may be pronounced in adolescents who tend to be more technology savvy and tend to over-rely on technology.

For instance, a simple neck swelling observed in a person, may, on an internet search-engine end up giving a diagnosis of lymphoma, neck metastasis, several varieties of benign tumours, including rare vascular tumours or infections such as tuberculosis. Even common symptoms such as chest discomfort arising from a reflux or gastritis may be mistaken for a heart attack, or blood tinged sputum in cough may instill the fear of lung cancer in a patient with lower respiratory tract infection. The contrary is also true; patients with specific symptoms that need further evaluation may tend to ignore symptom warnings. A smoker developing neck swelling may have a tendency to assume that 80% of the swelling are either infective or benign and hence ignore initial symptoms. This approach of using search-engines to compliment our wishful thinking may have the potential to change the course of the disease partially or completely.

Several studies show that the people try to perceive remote and worrisome diagnosis for themselves, while quoting assuring statistics for unlikely probability of the same condition to others. In many instances, self-medication products that are marketed widely in web pharmacy may provide a ready source of ease to the self-diagnosed ailments. These may also include alternative medicines, food supplements, vitamins, herbs or other substances contained in commercially available products. Several such products that are widely marketed may not have been clinically tested and do not have a scientific basis for their recommended medicinal use. Many over the counter drugs have shown to play significant contributing factor in development of chronic renal failures.

With the ease of access to information in the wired world, the sensible approach may be to read and interpret symptoms cautiously when using IASDT. Search-engine optimised self diagnosis and medication are sub-optimal and at best to be avoided. Reading in detail about a diagnosis, after a thorough clinical examination and diagnostic evaluation by a clinician would be the ideal way forward. This serves as an information base to improve interaction with one’s doctor about the nature of ailment, diagnostic and treatment options.  It also helps to explore recent advances in management of the specific condition and have a meaningful discussion with the treating doctor. Physician directed diagnosis with search-engine assisted discussion would prove to be invaluable to reduce anxiety, over-diagnosis and would certainly improve outcomes.

The writer is Dr Vishal Rao U.S, Consultant – Head& Neck Surgeon,Department of Surgical Oncology,HealthCare Global Enterprises Limited, Bengaluru.




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