After a long sojourn in St Elsewhere, I am back home, writing, not a scientific article on breast cancer or surgery but instead something a little more at hand–the facts of life (with a scientific twist).
Often these journalistic endeavours by us medics are best designed by you the patient–by that I mean, the topics most interesting are not those which are to me, say for example, growth factor signalling in cancer but the very topics we (you and I) will discuss in the consultation room. Hence, the title of this column.
Be cautious
One of the first impressions I had about starting a new practice as a breast specialist at home was how "connected" patients were in T&T and pretty much are bringing it into the consultation process well before I could even work out their diagnosis. Now, don't get me wrong, I'm not saying that surfing the Internet before going to, during or after your consultation with the doctor is bad–on the contrary. But I am saying it should be cautious. Many of my patients have a condition called nipple discharge–fluid from the nipple. Recently, one of my patients called in a panic because she "googled" this symptom and the first 80 hits were all about cancer. I can assure you in a 38-year-old with her exact history, that's bottom of the list.
But why did google paste "cancer" all over her screen? For that, we're going to have to address one of the mechanisms upon which google works to rank order the information it contains–if you pay to have preferential displays you come up first, irrespective of whether its relevant of not. Thus you have to appreciate there is a financial basis upon which information a search engine will display in order of priority. It's got nothing to do with your health needs or the truth about your condition. Consulting a doctor first, however, and his advice should have no financial basis and thus unbiased.
Is web-based information reliable?
Now let's turn to the issue of whether the contents of web-based health information is reliable. Personal experience thus far has told me that often my patient will come and discuss some of the relevant concerns they read on the web. Often I have to undo the inaccuracies of their "downloads." But hey, why believe me? Does science have anything to say? Many studies have examined the factual content and quality of medical advice on the web. The World Health Organisation (WHO) produced a report (http://www.jmir.org/2001) which addresses this very issue and describes it as 'worrying'. It states that over 100,000 web pages dedicated to patient information is present and growing but NONE are very accurate and vary widely.
There is the unregulated problem of commercial companies and pharmaceutical companies sponsoring many sites and subtly promoting their products. These factors have profound impact on the medical team-patient axis.
WHO report makes scary reading
With such problems of inaccurate patient information, widespread practice of fraud, potentially dangerous claims and risk of exposing patients to harm–RAND health (US) has produced a study entitled Proceed with Caution: A Report on the Quality of Health Information on the Internet which makes scary bedtime reading. The WHO report also demonstrated that even when the information is of high quality, it can cause unintentional harm, due to a variety of reasons such as language barriers, inappropriate audience,
For each health issue there will be several sites which will have user friendly, patient oriented information that will help to supplement and improve your dialogue with your medical team. This tool is best used following advice from your team who will guide you to the most useful to spend time reading through.
After all, they are the best ones to tell you which ones contain the most factual and up to date advice and those that display the HONcode seal of compliance with transparency and accountability practices. The World Health Organisation (WHO) produced a report (http://www.jmir.org/2001) which addresses this very issue and describes it as "worrying." It states that over 100,000 web pages dedicated to patient information is present and growing but NONE are very accurate and vary widely. There is the unregulated problem of commercial companies and pharmaceutical companies sponsoring many sites and subtly promoting their products. These factors have profound impact on the medical team-patient axis.
Here's my advice. Hold off the keyboard. Talk to your doctor, ask about trusted Web sites...Then go visit to your heart's content. Avoid random google searches unless you are confident you know what you are looking for.
Remember, a doctor a day could keep the apple away!
Look out for Dr Rajen Rampaul's CONSULTATION ROOM in your WomanWise magazine.