doctors · health care · patients

How to Deal with a Patient Who Self-Diagnoses

It’s becoming almost a stereotype.  A patient comes in to a physician convinced he has some condition he read about on the internet.  By the time that patient sees the physician that patient is an expert on that particular condition.

I'm an expert.  Just look at me
I’m an expert. Just look at me

There has even been a name stated for this subject.  “Cyberchondria.”  A person starts feeling a pain in the abdomen and goes to a website to see what it might be.  After a few things looking familiar, the person settles on a diagnosis and then goes to a doctor to tell the doctor that he has appendicitis.

This, of course, can be a bit of a problem for the doctor.  The doctor is probably still paying off student loans for costs incurred learning about such things as appendicitis.  And since the doctor also can’t just take the patient’s word for it, the doctor also runs through some tests.  The well read autodidact will understand why the doctor wants the WBC screen and urinalysis.

How should a doctor react to this?  There are two ways to do it.  The first method of this is to scoff at the patient.  Of course, there are plenty of people out there who, despite the presence of the internet, are fairly well ignorant when it comes to nuance.  On the one hand, the internet has a great deal of knowledge that is easily accessible to the masses.  While this may lead a person to understand the best medicine for the treatment of the particular condition that the patient has self-diagnosed, the patient may lack the understanding that the medication the patient wants is contraindicated for the totality of the patient’s condition.

The direct marketing of medications to consumers no doubt makes this problem worse.  Viagra was the king of this.  Erectile dysfunction is something fairly simple to diagnose.  A medication becomes available for just that issue.  Men went in droves to physicians asking for a prescription for the new wonder drug.  And in most cases it worked out fine.

On the other hand, a physician may end up learning something that he or she did not know from a patient.  The slick patient will bring in copies of relevant literature for the physician to see.  While the physician may notice that, “The last week has had a lot of people insisting they have an Arnold-Chiari Malformation” and curse The Discovery Channel and Mystery Diagnosis, the physician will also take into consideration that one or more of these patients could actually have it.

It becomes the role of the doctor in this matter to play the role of the gatekeeper.  The doctor should take the time to understand what the patient is discussing and understand that if a patient comes in with a diagnosis, the first thing on the patient’s mind is that “The patient wants to be heard.”  The doctor may of course think that, “This is a strange presentation” of that “this diagnosis seems a bit far fetched.”

Still, the physician would probably want to rule whatever it is out.  And let the patient know that the patient has been heard.  Even let the patient know, “I haven’t heard of that before, but there is always a first time.”

Rare is the doctor who made it through medical school and residency without diagnosing himself or herself with numerous conditions or diseases that were covered in lecture.  The lay public now has that information available to them.  Show some empathy and you and your patient will have a stronger relationship in the future.

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