Microsoft Flight Simulator is a very popular PC game and its appeal is based largely on its realism. It gives a nation full of adults who thought as children that it would be really cool to fly an airplane the opportunity to sit before a fake instrument panel in an imaginary cockpit and say things like "Tower, are we cleared for takeoff?" Juvenile thrills abound. If we suddenly thrust an avid Flight Sim player into control of an airliner in mid-flight, he might have some useful information. He could probably identify certain instruments or grab the right lever to lower the flaps, but said flight is ultimately going to end in disaster. Despite its significant realism, no amount of playing the game makes one an airline pilot.
Last week's post about VBAC raises a very interesting question that the advent of the internet hath wrought. Like the gamer who thinks that his simulated experience makes him a real airline pilot, the overwhelming amount of information made available on the internet can easily lead people to overestimate their own capacity for decision-making. Having the world of information at our fingertips is both empowering and deceptive. For every individual who makes better decisions by educating herself there is another who does what Americans do best: consume a small amount of superficial, decontextualized information which he believes makes him an infallible expert.
In recent years medical professionals have noted a disturbing new trend which is illustrated in this recent Canadian study of 300 doctors:
(Some) doctors said many patients are quick to self-diagnose using the Internet, and are often resistant to the physician's diagnosis and course of treatment.
Apparently this phenomenon, the "WebMD effect" if you will, is quite familiar to doctors and nurses these days. I can only imagine how many suburban hypochondriacs walk into the office/ER and offer the name of a condition rather than a list of symptoms. Microsoft released an internal study showing that not only is such self-diagnosis common but it often leads to unduly dire conclusions (headache = basal skull fracture). While some people who played doctor offer cautionary tales of self-diagnosis turned disastrous, my impression is that WebMD continues to serve as the Build-a-Bear Workshop of American healthcare – a one stop U-Diagnose-It site for hypochondriacs, the uninsured, and the "What makes the damn doctors and their fancy book-learnin' think they're smarter than me?" crowd. And WebMD seems like Johns Hopkins compared to what the rest of the internet offers the unwell. My personal favorite: "How to Self-Diagnose Appendicidis" which includes helpful tips like "You feel a pain in your gut."
Americans generally do a terrible job of locating happy mediums. There is a wide, unpopulated gulf between empowerment through knowledge and a dangerously false sense of security and expertise. Tools and information intended to allow Americans to make better, more well-informed decisions quickly jumped the shark and turned into blog posts with gems like "I just went to WebMD for a self diagnosis of a fluttering I feel in my chest at times." Rather than thinking, "I should probably ask a medical professional about my irregular fucking heartbeat" the classic American combination of laziness and arrogance sends people running to the nearest we browser to quite literally cure what ails them.
More information is always better, but it must be kept in context. Having all of the pieces does not mean that one knows how to assemble them. The internet can tell us a lot but it can't make us doctors, lawyers, stockbrokers, Generals, chefs, historians, scientists, and auto mechanics. Bringing the argument back to last week's post, spending time on pregnancy message boards and perusing MyNaturalHomeBirth.com (or something equally amateurish) does not give the reader the ability to pass a qualified medical judgment on anything. Sure, "experts" and professionals are wrong sometimes. However, something tells me that a doctor is right a little bit more frequently than some knucklehead typing "Is VBAC safe?" into a search engine.
peggy says:
A little knowledge: it is a dangerous thing.
Although I can get why people with no insurance would be fearful enough to fall for that, and show up at the doctor's thinking they're DEATHLY ILL, because if they didn't think they were DEATHLY ILL… they wouldn't go to the doctor?
I wouldn't, anyway. People are always asking me when I've got a cold if I plan to see the doctor, and I'm just like, "uh… no? I have OTC meds already?"
However, if I thought I had, you know, appendicitis, I would make the time and pay the cash to go.
BK says:
This is a very interesting conversation. Working for a non-profit health care provider serving people living with HIV disease, I hear a lot of stories from our docs and nurses about precisely the opposite problem – patients with no idea how to keep themselves healthy, or what health even is as a concept.
For as many people out there who think they are smarter than their doctor, there are probably equally as many, if not more, who have never been to a doctor, don't have internet access and only see a doctor when they visit the ER.
When they do visit their physician, they don't have or ask any questions, can't remember side effects of meds or don't necessarily notice new symptoms – often because they've never thought about their body and health in a thoughtful way.
If nothing else, anecdotally, this helps support Ed's point that we seem to live in a nation of extremes…
Shane says:
In regards to this post, I am guilty on two accounts:
1. While in ground school earning my private pilot's liscense, I bought Flight simulator so that I could practice the jargon. For some reason the alpha, bravo, niner system took me a while to master. I didn't even have the "joystick" necessary to make the game actually interesting though, so it was a pretty wasted purchase.
2. With regards to the main point, I am also guilty. When my daughter was just over two she went completely cross eyed quite literally overnight. So of course, I entered it in a search engine only to be horrified by the thoughts of Cerebal Palsy and brain tumors. As you would probably expect, she was just very far-sighted and now has to wear glasses in order to help her eyes not cross. (I must say the $500 we had to shell out for glasses was actually spent with a huge sigh of relief, given our earlier fears.) Parenting and rationality don't always go together, and parenting with the internet is a strange and dangerous thing.
Having said that….I do think it is good that people educate themselves in order to have meaningful dialogues with and question their doctors. More people should ask, "are you sure I really need this medication, couldn't I just exercise?" or "Do I really need this procedure, what are the chances of it improving my condition?" My husband had to argue with his physician in order to convince him of the necessity of prostate exams before forty because all the men in his family over 50 have had prostate cancer. Being proactive and informed about your health is in general a good thing, and asking the right types of questions can actually improve your relationship with your doctor. But this type of dialogue which I have in mind may be the medium ground that is fairly atypical.
Ed says:
Don't get me wrong, we're all guilty here. I don't run to the doctor every time I have a symptom, nor do I pay a stockbroker for advice.
I've also walked out of doctors' offices, usually because they seemed like assholes or they weren't interested in listening to me. But one thing I have never done and would consider quite foolish would be to argue with a doctor who generally seemed competent because of something I self-diagnosed on free websites.
Web Dunce says:
The average doctor sees about 2000 patients a year. They are also bombarded by pharmaceutical reps peddling everything from Advair to Viagra with wonderful incentives to prescribe a particular medication. Couple that with the saturation of drug commercials on tv and radio that practically convince people that they are suffering from xyz. There is a serious disconnect between doctor and patient in the American medical system. I can't speak for other countries as I haven't lived in any long enough to require medical care. However, I do know from experience that it always helps to go into the doctor's office with at least an idea of what could be wrong with you because, frankly, they just don't have the time to devote to your particular problem (usually about a minute before having to move on to the next patient). Sometimes self diagnosis is your best chance at getting to the bottom of your health issue. Can it be harmful? Absolutely. There is no substitute for good medical care from your personal doctor (if you're lucky enough to have one). However, you must consider that doctors constantly misdiagnose conditions. But let's be realistic, sites like WebMD and others provide vital information to the public. They are an invaluable resource to people who don't necessarily want to self diagnose, but who may want more information about a medical condition that their doctor couldn't manage to spend five minutes explaining clearly. Unfortunately, we are long past the days when you could feel confident blindly obeying doctor's orders. It is your responsibility to be as informed as possible about what may or may not be going on in your body.
J. Dryden says:
The problem with web-based autodidacticism is that A. personal bias will always play a role–most of us either want to be *truly* sick in order to justify our proclivity towards bitching and moaning, or want *not* to be sick out of fear or stoicism, and so will find explanations for symptoms that fill one bill or the other. Ideally, I suppose, people can use WebMD to assemble a list of symptoms that enable them to articulate fully and precisely what they're feeling, so that doctors don't have to conduct interviews with people who don't know how to talk about their bodily sensations. ("I dunno, doc, I just feel kinda…off, you know?") And B. people–parents, esp.–are also using the web to diagnose others, a point at which this phenomenon becomes truly scary, from "My child has ADD" to "I won't have my child inoculated because I read a bunch of places that it causes autism." People killing themselves with ignorance/arrogance/folly? Fine, cool, Darwin-in-action. People applying those same flaws to child-care? Not good. The ones I feel bad for are not GPs, but pediatricians.
Chris c says:
if our healthcare system didn't suck so badly people might trust it more