Are we altering our clinical practice, communication and patient information sufficiently to spare our patients the ill effects and unnecessary worry of cyberchondria?

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Author: Daniel Hardiman-McCartney MCOptom, Clinical Adviser
Date: 9 October 2015

I was introduced to a new term last week, "cyberchondria".  Although it was a new word I instantly knew what it meant and realised I have seen many patients affected by it. I have used the expression "cyber-diagnosis" or "Dr Google", somewhat light heartedly in the past, but are we now altering our clinical practice, communication skills and patient information sufficiently to work with our patients to spare them the ill effects and unnecessary worry of cyberchondria?

The term was first coined by Microsoft researchers in 2009. Ophthalmologist Niro Narendran describes cyberchondria as "the unfounded escalation of concerns about common symptoms based on material that the patient has found on the internet".  The problem is compounded by poor and variable quality of information coupled with a lack of patient understanding in interpreting the information that they find. Narenden surveyed ophthalmology patients to ascertain whether they had investigated their symptoms prior to their consultation; unsurprisingly, 27.2% had done so and the majority of those believed information on the internet to be of a good standard.  

We should not see this as a confrontation by our patients doubting our ability; on the contrary, it can be an opportunity to build a more equal and mutually respectful relationship with our patients.

Our patients being informed is undoubtedly a good thing, but what happens when they are misinformed? Often patients are unable to judge the quality of the information they find online,yet this online information is trusted by them> A study of cancer patients in the US found patients ranked the quality of information found online comparable to that of their doctor! The widespread use of social media means everyone can have a go at diagnosis, with the potential to make every Twitter user a GP and every Mumsnet poster a paediatric ophthalmologist. Research has shown that people tend to latch onto the worst diagnosis and even if told otherwise by a medical specialist they remain convinced of the more serious ailment; such is the age of the cyberchondriac.

But before we ban the public from googling their symptoms, ensuring we can continue in our privileged position of medical expert, we should consider: what if the patient is more informed than we are and what if they are right? In June this year the case of Bronte Doyne was widely reported in the media. The teenager believed she had a rare form of liver cancer, which she had self-diagnosed online based on her symptoms. She pleaded that her doctors refer her but they refused and, tragically, she was correct and died this summer. Doctors speaking on this topic are inclined to agree that the internet does tend to be quite effective at highlighting rare conditions. However, as we know, common things occur commonly and clinical judgement and effective differential diagnosis will remain critical to ensure good diagnosis for the majority.

So what can we do to reduce this epidemic of cyberchondria? We could do more to help support our patients to be better informed through education - highlighting good quality sources of information and signposting them. We should stay abreast of current online content, so we can critically appraise it in advance of being presented with it for the first time during an eye examination, enabling us to discuss it with confidence and explain why it may or may not be relevant in the particular case. But most importantly, we should accept this change in culture, and be open to discussing possible diagnoses as equals with our patients.

We should not see this as a confrontation by our patients doubting our ability; on the contrary, it can be an opportunity to build a more equal and mutually respectful relationship with our patients. A more informed patient means one who is more likely to look after themselves, which gives you more time to discuss what is important at a higher level during the consultation; in addition it gives you the ability to guide your patient to higher quality post-examination online resources to ensure they are well informed, not misinformed.  

British Journal of Ophthalmology: Internet use by ophthalmology patients 

Daniel Hardiman-McCartney FCOptom
Clinical Adviser, The College of Optometrists

Daniel graduated from Anglia Ruskin University, where he won the Haag Strait prize for best dissertation. Before joining the College, he was Managing Director of an independent practice in Cambridge and a visiting clinician at Anglia Ruskin University. He has also worked as a senior glaucoma optometrist with Addenbrooke’s Hospital in Cambridge, with Newmedica across East Anglia and as a diabetic retinopathy screening optometrist. Daniel was a member of Cambridgeshire LOC from 2007 to 2015 and a member of the College of Optometrists’ Council from 2009 to 2014, representing its Eastern region.  

He is Clinical Adviser to the College of Optometrists for four days each week, dividing the remainder of his time between primary care practice and glaucoma community clinics. Daniel is a passionate advocate of the profession of optometry, committed to supporting all members of the profession and ensuring patient care is always at the heart of optometry. He was awarded Fellowship by Portfolio in December 2018.

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