When you feel unwell, do you turn to your doctor or ‘Dr Google’ first? Nutritionist Rose Carr and HFG dietitian Zoe Wilson explore both the good and the bad sides of self-diagnosing your health complaints online.
At one time or another, most of us have turned to the internet to self-diagnose a rash, bug bite or an upset tummy. While the internet can provide a wealth of knowledge when it comes to simple health complaints, are we taking risks with our health by relying on it too much? Or is it a valuable resource we should use more often? There are two sides to the argument.
The pros of doing your own research
Reinforcing your doctor’s advice
The internet is fast becoming a valuable health resource. A 2007 UK study conducted in-depth interviews with a small group of people with chronic health conditions (such as diabetes and heart disease) about how their online research affected their relationship with their doctor. The survey found that overall, the internet was viewed as a complementary tool for facilitating discussions with their doctor – but not as a replacement for their doctor’s experience and personalised advice. Online research also helped patients prepare a list of questions to ask during their consultations.
Information you find on the internet can also confirm and expand on information provided by your health professional. This is especially useful when your consultation might be time-limited, or when the amount of information is hard to take in all at once. In this case, you might want to ask for reliable website recommendations, so you can do further reading.
If you’ve done your own research, be sure to discuss it with your health professional. They shouldn’t feel threatened and they’ll want to answer any questions you have. Remember, they have gone through years of study, so they’ll want to share their expertise with you. And if you’ve found information that’s different from what your doctor tells you and you‘re not sure what to think, don’t hide that; you’ll find it’s worth talking about. There’s also no harm in seeking a second opinion from another GP or a specialist.
If you have been diagnosed by a health professional, internet forums – where you can discuss your issues with others – can be extremely helpful. This may be especially true for anyone with a rare condition. It may even be a way to find an expert clinician in the field.
For example, in early 2010, at the age of 28, Ben Bravery was diagnosed with bowel cancer. After his diagnosis, he turned to the internet for information, support and to share his experience with others. One benefit of online support groups, he says, is that they are easy to establish and run – and aren’t limited by geography. Often, online support groups are the only ones available in remote and rural areas. People often have a lot of questions following a diagnosis, and internet forums and websites allow people to ask them in a safe way. They can access information that would have otherwise been unavailable to them.
What can you trust?
But how do you know for sure if the information you find is reliable? “With so much online information about health and disease available at your fingertips, it’s tempting to simply Google any health issue you may be experiencing”, says Accredited Practising Dietitian Bobbie Crothers. “But we can’t always trust online sources and we don’t know exactly who is giving the advice.”
Crothers is one of the many experts involved with the recently launched Healthshare website. This is an Australian, health-focused social networking site where members can connect with others facing similar health issues, as well as post questions and status updates, create blogs and search for practitioners. Healthshare has eight key focus communities – all of which have forums monitored by a panel of health experts, survivors, patients and carers – covering issues like diabetes, heart health, menopause, depression, osteoporosis and weight management.
And the cons…
It’s not always credible
While the internet can be a good place to find general information about various symptoms and diseases, remember that not everyone who provides medical advice on the web is qualified to do so, even if they present information that looks credible. Medical professionals worry that some people may not question the advice they read online.
It’s not tailored advice
It’s always best to see a doctor or specialist for a personalised diagnosis, since he or she can conduct tests to account for any underlying factors that you might not be aware of (high blood pressure, for example). Once a diagnosis is confirmed, your doctor can then tailor your course of treatment to your needs. If you do internet research, no matter the advice found on various websites, you should never start, stop or make changes to your current medications or supplements without your doctor’s advice.
From a nutritional perspective, online research can sometimes lead to drastic diets or eliminating foods or groups of foods without good reason. Healthy Food Guide nutritionist and director of the private practice Mission Nutrition, Claire Turnbull, says she sees people every day who have decided to eliminate gluten or wheat in the hope that it’s the answer to everything from bloating and tiredness, to not being able to lose weight. In fact, many of these people aren’t actually following a gluten- or wheat-free diet – and don’t understand the difference between the two.
“When it comes to bloating and tiredness, there are so many other things that can be part of the problem – like FODMAPs, iron deficiency and poor quality sleep, as well as other more serious health issues that may not get picked up if you self-diagnose”, says Turnbull.
Turnbull adds that a gluten- or wheat-free diet is not necessarily healthier. “It can mean that you have an inadequate fibre intake and a low intake of some vitamins and minerals if you haven’t substituted foods correctly. So even if it was appropriate for you to be following this type of diet, good planning and advice is needed.”
General practitioner Dr Phyllida Cotton Barker believes the internet has huge potential to provide good information, as long as we can identify which sites can be trusted (see ‘How to find credible health information in cyberspace’, right). One strategy she believes can be useful is to stick with identifying your symptoms – rather than trying to diagnose an overarching condition. You might find useful suggestions that won’t do you any harm. If they don’t work, you haven’t lost anything apart from time. But if you can’t alleviate the symptom, it’s time to visit the doctor!
Feeling better in traumatic situations
“The internet provides an easily accessible platform through which to learn and communicate about my illness [bowel cancer]. I have used the internet to locate organisations related to my cancer and young people with illnesses. I have used forums to ask questions about treatments and to answer questions others have had about treatments I have experienced directly. I chat online to patients my age about things I can’t talk about with my friends because they haven’t experienced it. I have also joined online support groups where we share our experiences, latest lab results and tips. If I develop a side effect from chemotherapy, I don’t just want to write about how painful it is and how it frightens me, I want to understand why I have the side effect and what is going on inside my body. This means pulling together information from a variety of sources and then relating it to me and my situation. For key aspects of my cancer, I often ask a member of my medical team to [check] it first – I do not want to add to the growing amount of medical misinformation online.” – Ben Bravery
Self-help can help
“I have had tummy problems – bloating, diarrhoea, constipation, pain – for years on and off. Over the years, I’ve seen doctors about it and had all sorts of diagnostic tests – colonoscopy, colonography, blood tests for coeliac disease, pelvic ultrasounds, you name it. In the end, the diagnosis (because there wasn’t anything else wrong) was IBS. But in terms of what to do about that, my GP had no advice. She couldn’t tell me if I should avoid any foods, or do anything else that might help. The only thing she suggested was antidepressants! Which wasn’t for me.
After looking online, I came across an article on IBS and FODMAPs – new research about certain foods that can aggravate IBS symptoms for some people. I decided to find a local nutritionist who had expertise in this area, and she put me through a proper FODMAPs elimination diet. The change has been incredible! I felt better within weeks, and now that I have been through the process and know which foods to avoid and how to compensate for them in my diet, I feel really empowered. If I hadn’t done that bit of online research, I’d still be suffering.” – Name witheld
How to find credible health information in cyberspace
Anyone can publish anything on the internet, so it’s up to you to evaluate what you’re reading. Ask yourself these questions:
Who is behind the site? Is it a commercial enterprise, a personal home page, an independent body, a government body or an academic institution? Check for an ‘About us’ section. Reputable websites will clearly state the qualifications or experience of the authors so you can evaluate their expertise.
Websites cost money to manage and keep up-to-date, so think about why the information is being provided. Is it to sell something? Can I verify the information from other reputable sources? Why would I use this site as a credible source of information?
Over time medical advice can change, so reputable websites providing health information will specify the date when that information was prepared or last reviewed. As a rule of thumb, if the health information is more than two years old, look for something more current to either verify or supersede what you’ve found.
The following websites are useful investigative tools, but they fully understand their own limitations. Here’s how WebMD puts it: “The site does not provide medical advice. The contents of the WebMD Site... are for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the WebMD Site!”
In other words, they can provide information but they cannot diagnose what a set of symptoms means for you.
If you’re not sure whether or not to seek medical help, we recommend calling healthdirect Australia. This is a trustworthy alternative to the internet, funded by federal, state and territory governments. It’s a free health information service staffed by registered nurses. When you call, a nurse will talk you through your symptoms to arrive at an assessment of how serious the symptoms are, where you should seek help and how quickly you need help. The advice may range from ‘self-care’ through to “see your GP within 24 hours” or “we’re ordering an ambulance for you now”. Healthline Australia (1800 022 222) is available 24 hours a day in NSW, ACT, SA, NT, TAS and WA. If you live in VIC, call NURSE-ON-CALL (1300 606 024). Queenslanders can call 13HEALTH (13 43 25 84) for similar services to healthdirect.
Healthdirect Australia. Available at URL www.healthdirect.org.au. Accessed September 2011. Stevenson FA et al. 2007. Information from the internet and the doctor-patient relationship: the patients perspective – a qualitative study. BMC Family Practice 8:47.