Is It Just Me?

Is it just me, or do others find this article to be

the Patient Is a Googler


Thursday, Nov. 08, 2007

We had never met, but as we talked on the phone I knew she
was Googling me. The way she drew out her conjunctions, just a little,
that was the tip off — stalling for time as new pages loaded.
It was barely audible, but the soft click-click of the keyboard in the
background confirmed it. Oh, well, it's the information age. Normally,
she'd have to go through my staff first, but I gave her an

Every doctor knows patients like this. They're called "brainsuckers."
By the time they come in, they've visited many other docs already
— somehow unable to stick with any of them. They have many
complaints, which rarely translate to hard findings on any objective
tests. They talk a lot. I often wonder, while waiting for them to
pause, if there are patients like this in poor, war-torn countries
where the need for doctors is more dire...

You have to read the whole thing to get the full effect.  My
take on the latter point is this: if complaints don't translate into
objective test findings, it is because the doctor is looking in the
wrong place, or the doctor needs better tests...

Sometimes, patients need to be taught how to be good reporters.
 Most can learn, and are happy to do so.  Yes, it
takes time.  But as a physician, your time is what you are
selling.  Don't resent people for wanting your product.
 Perhaps they could be taught to use the time more
effectively, but again, most people are happy to learn.   It is not fundamentally different than teaching someone how to use an asthma inhaler.

If a physician finds him/herself calling the patient ugly names, then
it is time for a vacation.

I remember the first time a patient used the Internet to look things up
before the first appointment.  I thought it was great.
 It actually saved me time, rather than wasting it.
 Nowadays, it is commonplace, and it still is a time saver.
 Sure, I sometimes feel like a broken record, explaining why
the term "chemical imbalance" is misleading, or why the published
mechanism of action of an antidepressant is not very important.
 But I would much rather have people ask about this things,
and get some clarification, as opposed to not asking, then wondering
why there is a discrepancy between what I recommend, and what people on
the message boards are talking about.

As a physician, one always must remember: it is not your own body you
are treating.  It is someone else's body.  It belongs
to them.    

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I'll go out on a metaphorical limb and stick up for the article's author.
The author seems to be describing a patient who's "shopping" for a doctor to tell her what she wants to hear, not "who will give her the correct diagnosis and treatment".
Tech-support people have to deal with an analogous situation frequently, and I've got to sympathise with the article's author in this case.
To be fair, there are a lot of lazy and ignorant tech-support people out there, too, so it's not entirely unheard-of for a perfectly reasonable and knowledgeable person to bounce from one tech-support person to another trying to find someone who knows how things really work who actually will be able to solve their problem, but this is not the most common situation.
I imagine the same must be true for medical professionals, who are, after all, essentially tech-support for bodies. On the upside, perhaps medical professionals don't get many people who will proudly proclaim themselves to be "medical-illiterate" and then proceed to assume the doctor doesn't know what he's doing either.

If it weren't for paragraphs like this, I might agree with you, SMC:

Susan got me thinking about patients. Nurses are my favorites -- they know our language and they're used to putting their trust in doctors. And they laugh at my jokes. But engineers, as a class, are possibly the best patients. They're logical and they're accustomed to the concept of consultation -- they're interested in how the doctor thinks about their problem. They know how to use experts. ...

A seasoned doc gets good at sizing up what kind of patient he's got and how to adjust his communicative style accordingly. Some patients are non-compliant Bozos who won't read anything longer than a headline. They don't want to know what's wrong with them, they don't know what medicines they're taking, they don't even seem to care what kind of operation you're planning to do on them. "Just get me better, doc," is all they say.

At the other end of our spectrum are patients like Susan: They're often suspicious and distrustful, their pressured sentences burst with misused, mispronounced words and half-baked ideas. Unfortunately, both types of patients get sick with roughly the same frequency.

"Non-compliant bozos"? Very professional of him.

Patients go to doctors when they're sick and afraid. They shouldn't have to worry about making the doctor like them by laughing at his jokes and measuring up to his standards, nor should they be punished for trying to understand instead of just accepting that he's the "expert".

Damn. I guess I should have previewed. The three middle paragraphs should be quoted, not just that one. They're his. I start again with "Patients go to doctors..."

I wish there was a way to edit these comments - even if it's like LJ where you can delete and re-enter.

Double damn. I actually start with ""Non-compliant bozos"? Very professional of him."

Blockquoting is handled very weirdly at SciBlogs...

My guess is that, for his own protection if nothing else, this is a composite patient, probably exaggerated for effect.

I've had patients insist that I carefully read a 100+ page opus of rambling prosaic, disconnected autobiography studded with printed out references.

I've had patients who interrupt every sentence out of my mouth, expecting a 30-minutes mini-education in the intricacies of medical diagnosis and philosophy, seemingly coming from their sense of a constitutional right to be an Inquisitor about their medical experiences.

To some extent, I think some of these people are responsible for all the articles out there about how to fix health care.

Fortunately, these extreme patients are few and far between, but every once in a while I have to set boundaries, sometimes show them the door before we barely get started. There must be a modicum of trust in your doctor, or you're wasting the time of two people. There also should be a certain level of decency in both directions. If you enter my office like the verbal equivalent of a mad dog, I will not hesitate to call animal control.

Most patients just need high-speed transcortical lead injection treatment.

By Doctor Farnsworth (not verified) on 11 Nov 2007 #permalink

No, it's not just you. I was put off by the snarky, superior tone.

I think he was trying to describe a particular type, and not all googling patients, but patients like me have a word for this type of clinician: "former doctor."

He starts out with me on his side because I'm an engineer.

But my experience with the medical profession's treatment of many members of my extended family counts against him. (I'll spare you details.) If you assume that three out of four physicians are functionally incompetent, then you have made the first step on the road to finding competent medical help. (The widespread resentment of Christopher Reeve among spinal-injury specialists is no fluke.) The next step is to distinguish the difference between competent and incompetent, which is harder. The best used to do something else before they entered medicine, and are very dissatisfied with their colleagues' performance and attitudes. They say "nobody knows", often. They want to try things.

By Nathan Myers (not verified) on 12 Nov 2007 #permalink

A patient can be more educated about their particular condition because they've only got their condition to worry about, whereas a doctor has to know a little about everything.

This does breed resentment and defensiveness, but only among the "less good" doctors. Those who are competent and comfortable in their own experience actually like it when a patient can communicate better and knows a little vocabulary.

Yeah, you'll always have the alt-medicine worriers but mistrust of "Western medicine" grows when the doctors don't take time to answer all their patients questions, even the stupid ones. If the patient isn't desperate for answers, they've no reason to go online looking.