You are 30 years old. You smoked for 10 years but quit last year. You started getting a dry cough recently and becoming strangely short of breath when walking long distances and you can hear yourself wheeze. A search for “cough with wheezing” on Google returns a very long list of medical words – some you know, some you don’t – like asthma, emphysema, bronchiolitis. And then you come upon some heavy-weight diagnostic jargon like “allergic bronchopulmonary aspergillosis,” “acute respiratory distress syndrome,” and “bronchogenic pulmonary adenocarcinoma.”
Now you are really worried.
Welcome to the world of medical information overload.
|Post in Brief:
Many doctors recommend against researching medically related information online because of the abundance of false data available. Realistically, as the information age continues to mobilize information, proper education on medical information gathering will be more effective than advocating abstinence from knowledge.
No, I do not actually advocate literally searching for your symptoms on Google.com, but the internet can be helpful if you do it right. Below I present a five-step process for medical enlightenment.
1. Establish appropriate urgency
Your #1 question to answer is the urgency of your symptoms. Will you ignore it, see a doctor soon, or go to the ED now?
There are no hard and fast rules. It is also difficult to establish urgency without medical training precisely because there are no fast rules, so the #1 tip is this: don’t rely on the internet for urgency. There are symptoms that simply do not have time for online searches and need to be acted upon immediately. If you have any reason to worry that your symptom cannot wait till tomorrow, call 911 immediately. You can call most emergency departments to get a physician on the phone for immediate medical advice for potentiAnything canal emergencies. If you are unsure, call a doctor.
2. Keep a broad differential
Once you have decided that your symptoms do not require emergent medical care, you have time to sit down. Your goal now should be self-education (i.e. instead of diagnosis – remember most diagnoses need to be made with a Some examples are physical exam, labs, and x-rays, none of which are available to you now).
One of the earliest skills medical students learn on the wards is creating a full list of possible diagnoses (the “differential diagnosis”). It is a difficult skill precisely because our minds are geared to focus only on the extremes: the most common diagnosis, the most severe diagnosis, the diagnosis your grandmother had. Tunnel visioning happens when one of these diagnoses keep your attention so much that you miss other possibilities, including, often times, the right diagnosis.
Keeping a broad differential simply means keeping a list of all the possible diagnosis. In clinical practice the differential diagnosis is arranged in the order of both likelihood (wrist sprains are just much more likely in a 30 year old) and significance (scaphoid fracture is more significant but less likely than a sprain). Remember, your goal is not so much to precisely diagnose your own condition – most doctors would need films and/or labs, and you have neither – but to establish a list of possibilities.
3. Use reliable sources
Once you have a list of differential diagnosis, you can go down the list and learn a little bit about each one. The web is full of false information. Because your health is at stake, it is important to use only trustworthy resources. Specifically, avoid forum style websites where people post symptoms seeking diagnostic opinions from strangers – a proper diagnosis without proper work-up is generally premature. The search is much more helpful if your goal is to learn some basic knowledge on your symptoms.
Below are three generally reliable sources.
Mayo Clinic is one of the nation’s top hospitals, and it keeps a database of accessible medical information. The content is generally two paragraphs of quick ins-and-outs on a symptom or diagnosis, and encourages you to speak with a doctor (of course, they hope you’d pick a Mayo doctor) for additional information. This is an excellent way to have a 30-second overview on your inquiry, but it lacks the details in the other two resources.
WebMD has a symptom checker that can help generate a differential, and for each diagnosis it has a reasonably evidence-based description. The upside is that WebMD contains relatively complete information, but this comes at a cost of being too descriptive, and its actionable advices can become buried in medical jargon.
UpToDate Patient Content – Since its inception, UpToDate has slowly become one of the most widely used online resources in medical schools and academic hospitals by resident physicians. The main database is rather dense and written at the level of clinical practitioners, but UpToDate also contains a smaller database of high quality, patient-focused free content. The down side is the sheer volume of information, but the writing is high quality and focuses on clinically important information.
4. Focus on clinical information
Most medical students quickly learn that there are two major types of medical information: basic science (Note: “basic” here refers to “foundational” rather than “simple”) and clinical science. The difference between basic and clinical science is the difference between learning why bread rises when baked and learning how to bake good bread. In almost all cases where you start off with a symptom and looking for a diagnosis, you want to focus on clinical science.
Clinical manifestations are the list of symptoms that characterize the diagnosis. Not all symptoms are created equal. Common symptoms such as cough, diarrhea, abdominal pain, etc, can mean lots of things. Having only 1 out of 4 on the long list of symptoms is often nonspecific, but having 3 out of 4 of the iconic symptoms increases the specificity for that condition.
It is here that you use the gathered information to arrange the broad differential health diagnosis in order of likelihood. For example, patients with COPD frequently cough, but people who have coughs can just have a common cold, the flu, pneumonia, or COPD (see above on keeping a broad differential). Patients who cough, wheeze, have significant smoking history, and are shortness of breath are far more likely to have COPD than flu.
Finally, remember that most doctors spend their entire life perfecting the craft of clinical diagnosis. It is okay if you feel confused here.
5. Trust your doctor, but empower yourself
There is another reason why I focus on doing online research as a form of self-education instead of self-diagnosis. This process can’t replace doctors. After investing hours of your time exploring your unique set of symptoms, you should still see a physician if you continue to be worried. Your research will supplement your next clinic visit and keeps your doctor alert.
Information asymmetry is one major component of the so-called principal-agent problem, where the agent (doctor) sometimes fails to act in full interest of the principal (you). I believe that proper self-education is the only good way to alleviate this information asymmetry.
Your physician will always have additional information like vital signs and physical exam, as well as years of experience and a fund of knowledge. However, educating yourself in a robust and methodical manner prior to a visit helps making sure doctors don’t miss diagnoses that are simple to exclude with a more thorough history-taking. “Well, your cough and shortness of breath is probably not tuberculosis, but we should go over a few more questions. If the answer to all of them is ‘no,’ then we don’t need to work it up further.” Better history-taking and physical exam help honing the diagnostic process and allow you to both avoid unnecessary tests and to receive appropriate work-up.
At the end of the day, while a haphazard approach to web-searching your symptoms and pains can be a recipe to unnecessary panic, keeping a broad differential, using reliable sources, and learning clinically relevant information is an excellent way to helps you work with your physician to deliver better care.