Dr Anthea Martin from the MDDUS writes nicely in BBC Health today about “cyberchondria”, or the phenomenon of internet self-diagnosis. All working GPs will recognise this; it happens to me very frequently. The patient comes in bearing a printout from a website, with a list of symptoms underlined, and says, “I want to get tested for mercury poisoning/ candida/ Lyme disease – I have all the symptoms.”  According to this article, many doctors will find their heart sinking as they square up for a discussion about why it’s not what the patient thinks it is.

The thing is, I don’t believe that’s the case any more. It certainly isn’t with me. One of the core skills we learn as GP trainees is to “explore the patient’s health beliefs”. In other words, the consultation is much more likely to be mutually beneficial if the GP can extract from the patient what they believe about what’s wrong with them, and what they believe to be true about the condition. We use the acronym ICE – what are the patient’s Ideas about what is wrong with them?; what are their Concerns about the diagnosis, and what are their Expectations of what will happen next (will she examine me, do I need a test, am I going to die?).

This might be relatively straightforward:

  • Patient: “I have a pain in my breast; I’m really worried.”
  • Doctor: “Yes I can see you’re very anxious. Was there something in particular that you were worried about?”
  • Patient: “Well my mum has just been diagnosed with breast cancer, so….”

Cancer is a huge worry for most people, and many people have quite complex beliefs about it, often erroneous. They might think that breast cancer is a common condition amongst young women (this is particularly true when high profile celebrities develop a disease), when actually it is far more common in women over 50. Sometimes it’s much more complicated, and it takes a bit of luck or some serious “digging” before you reach that point of shared understanding, like my patient Mrs V who believed that an x ray she had had during pregnancy had harmed her child.

When patients arrive having diagnosed themselves over the internet, I feel as though I have been given a gift. Immediately I know what the patient is worrying about – I don’t have to go digging quite as deeply to find out why the patient is here.  I usually begin by thanking the patient for bringing it in, I have a quick read (and at this point it really doesn’t matter whether the printout is from somewhere bona fide like the excellent www.patient.co.uk or whether it’s somewhere much less reliable). I clarify the history, exam as I need to, organise investigations if appropriate, but crucially, I incorporate the patient’s health belief into my explanations about what will happen next. Kindness and respect are key here: even if I think the self-diagnosis is very unlikely, if you ignore it, you will get nowhere. So I might say: “Mr Smith; this has been really interesting for me. I can see why you thought it might be Lyme Disease, but I’m not sure it is, because [x,y,z]. I would have thought glandular fever was much more likely because [a,b,c]. But if things aren’t getting any better, we should probably revisit this in a couple of weeks/ once we have the blood results back and we can look a little more closely at things.” This patient is far more likely to believe that I have taken him seriously (because I have), than one whose doctor doesn’t address those concerns.

The corollary, too, is that for every patient who is worrying about a rare illness that he’s discovered on the internet, there might be a dozen who’ve been given valuable information about how to manage a fever in an infant, or what to do about a verruca, who then won’t feel they have to take themselves to the GP about it. As long as I can encourage my patients to use reputable sources, the internet has a huge power to educate and inform about health issues, and reduce demand to boot. So-called “cyberchondria” is such a small issue in comparison.



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12 responses to ““Cyberchondria”

  1. CS

    Corollary number two being “that for every patient who is worrying about a rare illness that he’s discovered on the internet, there might be” a patient who actually does have the rare illness he’s discovered on the internet.

    After several years of being pushed between doctors and given unsatisfactory diagnoses such as chronic fatigue syndrome, I took it upon myself to start reading a lot of the medical journals available on the internet, made a differential diagnosis, arranged for tests, gathered evidence to reduce this to a likely candidate and then pushed to see the relevant specialist.

    Now thanks to that specialist and her colleages at a London Hospital I am doing much better. But my biggest thanks is to ‘Cyberchondria’, without which I would still be receiving no treatment for my rare, incurable but very treatable chronic illness.

  2. “One of the core skills we learn as GP trainees is to “explore the patient’s health beliefs”.”


    Even when I was out in GP land and completed my GP training, through the late 80’s and early 90’s, it was heavily informed by Balint and focussed on “the patient agenda” so discussing the patient’s concerns is bread and butter to most medics.

    More, when you do that, instead of rattling off squillions of questions, if you let the patient talk through all they want, invariably it saves time.

    Another case of the mainstream media being behind the times, or biased, or sticking to old generalisations . . .

  3. A brillian doctor once said to me a lot of GPs these days forget to actually listen to the patient. He said listen to the patient, and they will tell you what’s wrong with them.

  4. jan

    cyberchondria to the extreme:

  5. mina mass

    in the days when most med students were male, it was a given that each and every student believed they had almost every condition save pregnancy before their training had ended…
    cyberchondria sounds kind of normal to me.

    • and in the days when i was a med student they had admitted women ( who when they say they are sick they are! ) In the course we were treated to a famous lecture about porphyria and the royal families of europe given annually which attracted an audience from all sorts of faculties. It ended with the famous lecturer saying he was approached one year after one of these lectures by a student who had recognised the symptoms in herself and her family. As he gave an excellent lecture, no one, however junior, paying attention could muddle the symptoms up with anything else so when investigated further she was indeed a sufferer.

  6. walshamite

    First, we all, as patients, have to make a diagnosis before the doctor is consulted, “What’s up with me? Is it serious? Should I seek help? Will this go away if I leave it?”, a process of rationalising symptoms into some sort of tentative diagnosis.
    Second, many jobs revolve around non-medical diagnostic skills (e.g. education, engineering, economics). Diagnosis is a transferable skill, not unique to medicine. Which doctor would hesitate to suggest the cause of his car’s problem to the “expert” mechanic? If my lawn shows brown patches, I use books and the web to find the problem. So, I imagine, does my doctor.
    Third, no-one knows one like oneself. A doctor can only guess at the patient’s thought disorder or sexual adequacy. The patient is the only real expert on himself. That expert, with internet access, can surely be a helpful collaborator.

  7. A well-informed patient who researches their own symptoms before the Office Visit is a blessing to a good doctor. Daily, I am amazed at the deductive powers of my patients and their ability to form a coherent differential diagnosis list we can discuss. Respectfully, I think any doctor who is bothered by a well-researched, well-read patient should check his/her premises…

  8. Gosh. I know this is an old post, but I just had to comment to say that I wish I had access to a doctor who thought along these lines. I am the kind of person who prefers to take control of my own health and make my own (informed by professionals, where appropriate, of course) decisions. I find it alien to think that someone could be living with a problem and NOT do some research for themselves. Knowledge is power. And yes, Google can be a dangerous thing – you can easily convince yourself you’re dying (!), but I think it’s fair to say that most people are intelligent enough to be able to handle reading about medical conditions and use the information in a positive way. My own recent experience of (many) GP’s has made me realise that they are just that – general practitioners, who don’t necessarily have all the answers for all conditions. I was only able to get a referral to a physiotherapist after reading for myself that a ‘headache’ could actually be being caused by neck pain – not once did any GP ever suggest that to me. Thank you for an interesting post.

  9. Pingback: Cyber-chondria | Pain Positive

  10. Pingback: Cyberchondria – by Someone Who Understands | Health

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