The Internet Says I Have a Brain Tumor!

My 83-year-old mother called me with the following question: “My friend Janie has a rash and the ladies at cards looked at it. Dina says her husband’s cousin has the same thing and that it’s psoriasis, do you think it could be psoriasis?”

Now, the card ladies do have their talents, but their diagnostic skills are dubious at best. Convincing them that their pooled illnesses and hospital stays do not add up to a medical degree is an impossible task. It takes a great deal of discussion, sometimes aided by photos, to counter the collective expertise of the card group. And yet, when they consult me, it’s more for confirmation of their diagnosis than for my medical opinion.

The modern version of the card ladies is the internet medical site. There are several of these sites that take you through an algorithm that ends with your diagnosis and a prompt for you to see your doctor for the appropriate treatment. And while there is undoubtedly a treasure trove of useful advice and information contained within, as a physician, I must implore caution.

Physicians are not immune to the anxiety that new symptoms provoke. However, we have the luxury of turning to the doctor sitting next to us and saying, “I’m dizzy, not a brain tumor, right?” and having the other physician talk us off the ledge. For the rest of the world, in the shadowy pre-dawn hours when the headache starts, the internet is the best option for advice.

Remember, though, the site designers have an obligation to prompt you to seek care. They don’t want to be responsible for your thinking your cough is a simple cold, when in fact it is pneumonia, and then have you become sicker because you didn’t seek care. They need to provide you with all worst-case scenarios. When I see you in the ER, I go through the same algorithm, but I don’t tell you all the terrible things I have to rule out because it will needlessly worry you.

The modern-day version of the card ladies is the internet medical site.

Not a week goes by in the Emergency Room that I don’t see a patient armed with a printout from the Internet detailing their diagnosis and treatment. When my clinical assessment agrees with that of the computer, it’s a pleasant, cooperative patient encounter. When the computer and I differ, it creates an instant mistrust that’s hard to counter. When the internet tells you that you have a brain tumor, the damage is done, the seed planted. My job, in the patient’s eyes, is simply to provide the CT scan that will seal their fate. For less nervous patients, reassurance and a discussion of alternative diagnoses suffices; for the anxious at heart, nothing short of a biopsy will do.

When searching the internet for a diagnosis, consider these guidelines to help you temper your worry and make your decisions:

1. Remember your age and your history. If you’re 25, have been working out your chest muscles at the gym this week and have chest pain, you don’t smoke, and no one in your family has heart problems, you are not having a heart attack—you most likely tore a muscle. If you’re 55, have chest pain with shortness of breath and sweating, you are not having indigestion. Go to the hospital.

2. Remember your biology. Most diseases share symptoms. Migraine headaches and brain tumors both come with headaches, vomiting and visual changes. The computer cannot tease out the subtle differences of quality and timing of symptoms that a patient, experienced physician can.

3. Be forthcoming. There are many times I feel like I’m fighting a ghost when talking to a patient. I can sense they are dissatisfied and still anxious, but they won’t tell me why. If I ask directly if they’ve been searching their symptoms online, they’re relieved that I brought it up, although a bit sheepish. From that point forward, the visit goes much more smoothly. I can address their concerns, discuss the computer’s diagnosis and my own, and offer the appropriate reassurance and necessary treatment.

4. Have a little faith. Doctors want you to be well. They want to arrive at a correct diagnosis. Nothing makes a physician feel worse than knowing they’ve missed something. We train long and hard to learn to care for you. Not every physician shares the same level of compassion or competence, but we all want you to be well and don’t want you to suffer at our hands. The computer doesn’t worry about you when you shut it off; we do think about you when you leave our office or ER.

5. Trust yourself. You know your body. No doctor or computer will ever know what it feels like to be you. When a diagnosis doesn’t feel right or a treatment isn’t working, seek another opinion.

6. Remember the card ladies. Janie’s rash was eczema, not psoriasis. Dina’s diagnosis may have been off, but her coffee cake was fantastic.