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Don't dismiss 'cyberchondriacs'

24 February 10 10:46 GMT

Dr Anthea Martin
Senior Medical Adviser with Medical and Dental Defence Union of Scotland

As the internet becomes more and more easily accessible it is perhaps inevitable that patients should try to self-diagnose.

In this week's health opinion column Scrubbing Up, medical law expert Dr Anthea Martin warns doctors against dismissing all web-wise patients as 'cyberchondriacs'.

" Picture the scene. A man walks into a GP's consultation room and the doctor's eye is immediately drawn to a 10-page print-out in his hand.

The GP suspects the patient has spent hours researching all of his symptoms on the internet before arriving at the appointment, armed with his dossier of medical information.

It's possible he has diagnosed himself with anything ranging from a simple cold or flu to some exotic disease such as dengue fever.

So, what would be the GP's initial reaction? Does she welcome the chance to discuss her patient's health, or does a look of panic cross her face while she gazes anxiously at the clock wondering how long the consultation will take?

For doctors who fall into the latter category, it is possible to feel some sympathy.

According to a new study, many GPs feel intimidated by the increasing numbers of web-wise patients arriving in surgeries.

Results showed that doctors experienced "considerable anxiety" when faced with a patient bringing information from the web to a consultation, while others admitted to feeling threatened and challenged.

Expert patients

It can be quite disconcerting to have a patient present you with a thick pile of information and expect you to read, digest and comment on it all within a ten-minute appointment.

One GP admitted to not being very happy about patients using the internet, saying: "They all seemed to come to me with things I'd never heard of and very often with things which seem rather bizarre or inappropriate."

Some GPs said they were frightened of losing control of the consultation and of the prospect of having to admit to their patient that they have read something they don't understand.

One doctor revealed that when confronted by an internet-informed patient their reaction was "Oh God, how am I going to deal with this?"

Other concerns raised in the study - the first of its kind in the UK to look at GPs' attitudes in this area - included anxieties that internet information might be inaccurate, misleading or raise patient expectations to unrealistic levels.

But there were some positive reactions from GPs, with one commenting: "I am usually quite excited about people having looked at the internet because actually then they have got some health beliefs that I can work with."

The research was led by North London GP Dr Sanjiv Ahluwalia and published in the February edition of the British Journal of General Practice. And while many of the GPs that the researchers spoke to admitted feeling concerned about internet-informed patients, they also found ways of coping with their negative responses.

Dr Ahluwalia said some would play for time allowing their anxiety to ease by asking open questions and adopting open body language.

Other GPs would get over their fear of being seen as ignorant by deliberately admitting their ignorance and showing respect for patients' information.

Certainly some patients will be more likely than others to present their GP with an internet print-out, and different doctors will no doubt handle these situations in their own way.

But ripping up the patient's carefully printed notes and binning them in front of them is likely to send the consultation down the wrong track.

The message for doctors is clear: don't dismiss web-wise patients.

The risk here is that they may miss an important medical problem.

Doctors must listen to what every patient has to say and should consider carefully information presented to them by the patient - even if after doing so they decide to dismiss that self-diagnosis of dengue fever.


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