Paging Dr. Google

Having grown up in a world without personal computers or the Internet, I am endlessly fascinated by the ways in which new technologies change our lives.  I now find it remarkable that I was ever able to write anything longer than a personal letter with nothing more advanced than a typewriter.  My first typewriter with a memory, which held about a page of text - a forerunner of word processing software - was tremendously helpful.  My writing of e-mails now outnumbers handwritten personal letters by orders of magnitude.

A recent graphic circulated on social media networks delighted my sense of humor.  It posed the question of what would be the most difficult thing to explain to someone who was suddenly transported to today's world from the 1950s.  The answer: I have in my pocket a device (a smartphone) that affords me access to all of the information in the world; I use it to look at pictures of cats and get into arguments with strangers.  What splendid irony.

The impact of technology was at the core of a recent article I read about the use of Internet search capabilities by people trying to figure out what might be causing medical symptoms they are experiencing.  The author referred to this as consulting Dr. Google.

The writer's central thesis was that people who do this are likely to encounter a bewildering array of possible causes and great difficulty in sorting out which ones are worthy of serious consideration. Thus a person who is anxious about something might well embark upon such a search only to have the anxiety greatly intensified rather than assuaged.

The author's recommendation: step away from the computer, pick up the phone, and make an appointment to see your primary care doctor. Spending the money on such a consultation, which might consume 20 minutes of your time at the doctor's office, rather than hours of angst-inducing Web searching, is a good deal (especially if you are insured and have a modest co-pay for an office visit).

As I read this, I was seized by the urge to find this writer, grab him by the lapels of his blazer, shake him vigorously, and say, "No!  What is wrong with you?"

There are two reasons for this.  First, I give people who sit down at a computer and try to fathom a puzzling question credit for having some mental balance and some ability to discriminate sense from nonsense. I realize there are exceptions, but I think most people are on pretty solid ground here. I see people in the emergency department fairly often who have researched their symptoms on the Web and then come in concerned about a specific cause or two. Sometimes they are right on the mark.  And sometimes they don't have what they are worried about, but I know from the get-go what they are worried about and can readily investigate it and reach a reassuring conclusion.

The author of the article engaged in hand-wringing about the fact that there are some sources of information on the Web that are frightfully unreliable.  True, of course.  But I think most folks who search the Web have acquired significant ability to separate wheat from chaff.  And I have found that much of the most useful information comes not from mainstream sites (like WebMD) but from discussion boards and streams of comments on blog sites.

Some years ago I had a patient who complained of a sensation of repetitive electric shocks in his head.  I sat down at a computer and discovered something on discussion boards that I didn't find on any regular medical Website.  Such sensations could be caused by abrupt withdrawal from anti-depressant medicines called SSRIs.  I went back to the patient and learned that, sure enough, he was depressed, had been prescribed such a drug, and, after taking it for months and finding that it wasn't helping his mood, quit taking it - shortly before his electric shocks began.  I told him to start it up again and explained how to taper and discontinue it gradually.  He called me a month later to say that had worked beautifully and to ask me to refer him to a mental health professional who would treat him with conversational therapy instead of medicine.

The second reason I was aghast at the writer's suggestion that you abandon the Web and see your doctor instead is that your doctor already spends an inordinate part of his time in the office reassuring the worried well.  Your primary care doctor has a lot of patients to see: people with chronic heart and lung disease, high blood pressure, and diabetes, whose chronic illnesses require regular visits to assure that they are well-managed and optimally controlled.  When he is not taking care of those people, he should have time to see patients with acute illnesses.  You have a high fever and a terrible cough and think you might have pneumonia?  You have horrid pain in the right upper abdomen that comes on after fatty meals and want to know if it's your gall bladder?  You should be able to get an appointment to see your doctor in a short time frame - today would be nice - without competing with the patients who are worried about a rash that appears between the hours of ten and eleven in the morning on the second and fourth Tuesdays of each month.

Use the Web.  Ask friends, family, co-workers.  Be self-reliant.  Do not seek professional health care for every little thing that doesn't feel quite right.  If you - and all of his other patients - make an appointment to see your doctor for every little thing, thus taking up all of his time reassuring the worried well, guess what will happen when his patient who might have pneumonia calls the office?  That's right.  She will be told there are no appointments left, and she'll have to come see me.

If you are suddenly unable to speak or move your right arm and leg, or if you cannot breathe because there is a ton of bricks sitting on your chest, pick up the phone and call 911.  We will take good care of you in the ED.

But if you are the worried well, please feel free to have a seat in front of your computer.  And if, after you engage in as much searching as it takes for you to get some sense of what the problem might be, you are still baffled, take out your health insurance card and see if there is a phone number for an "ask-a-nurse" line.

Please don't call your doctor's office and make an appointment for every little thing.  He has very few open appointments.  And the doctor shortage is intensifying, so this is only going to get worse.