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Too Many Internet Doctors of Medicine

Discussion in 'General Issues and Discussion Forum' started by Kevin Kirby, Sep 12, 2014.

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  1. Members do not see these Ads. Sign Up.
    With the number of patients telling me their diagnosis before I have a chance to examine them increasing every week, I think I may start handing out these certificates to all of my patients who have already self-diagnosed their condition from the internet and only want to see me for a "second opinion". :rolleyes::cool:

    Thanks to Craig Payne for sending me this one!!
     
  2. Nick Curry

    Nick Curry Member

    Too much time on your hands, Kevin!!!!
     
  3. No, very efficient use of what little time I do have.:cool:
     
  4. Craig Payne

    Craig Payne Moderator

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    In all seriousness, this is starting to become quite a big issue. Anyone who has been to anyone of the Boot Camps that I did this year knows I spend quite a bit of time on this addressing the and Kevin knows I mentioned it at the conference in Spain earlier this year.

    Especially when it comes to things like foot orthotics, the information that is available on the net is sometimes quite scary, are contradicted by evidence etc etc, but patients we treat are reading this. At each Boot Camp I have done recently someone related a really good anecdote of what a patient's preconceived biases were as a result of Dr Google - those biases prevented them accepting what was clearly the best option for their management.

    How many of you who treat a lot of patients with diabetes have been asked about honey to treat ulcers? ... or even worse know one that used the typical honey from the supermarket and used it on an ulcer? ... after all, if its online, it must be true!

    Patients are coming in more informed or more ill informed. They come in with more preconceived bias's than what they did in the past.

    We have to address these issues we have to understand these issues and a blog post I wrote recently I talked about as part of assessing the history of a runner we need to determine those bias's they have as that will frame, maybe not the treatment recommendations but it will frame the approach that we take to make the treatment recommendations.

    Dr Google does have a lot to answer for but this is the way it is heading.

    Having said all that, we are all guilty of it. I recently resorted to Dr Google to find out about something going on. I did exactly what I have been critical of others going. But also like to think that I'm smart enough and have the critical thinking skills to understand and see all the logical fallacies, the cherry picking, the confirmation bias's etc that are going on and find my way through them.
     
  5. drsarbes

    drsarbes Well-Known Member

    THAT is funny.

    I think we also have a few too many INVESTMENT ADVISERS and DOCTORS OF CLIMATOLOGY.


    Steve
     
  6. horseman

    horseman Active Member

    I like the certificate! A patient of mine is a well published psychiatrist who has the same problem. He asks them why they don't treat themselves as they have all the information? He also has a bin by the door...:D
     
  7. RonDPM

    RonDPM Welcome New Poster

    My uncle, who is is also a podiatrist, now retired, used to have a sign in his office which said
    " The success of your treatment depends on which one of us is your doctor"

    Ron Werter
     
  8. Craig Payne

    Craig Payne Moderator

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    and too many "researchers"
     

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  9. Craig Payne

    Craig Payne Moderator

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    and these as well:
     

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  10. Craig Payne

    Craig Payne Moderator

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    no sooner than posting the above, this one turns up in my alerts!
     

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  11. Craig Payne

    Craig Payne Moderator

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    This one sums it up really well
     

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  12. I believe this one hit the nail squarely on the head!
     
  13. Craig Payne

    Craig Payne Moderator

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    There was a coroners inquest into a fatality during a home birth here in Melbourne a couple of yrs ago. One point that the coroner made during the findings was that it did not matter what views one held or wanted to believe, you can always find someone online to agree with them or confirm them, no matter how misguided they are .... is this is the logical fallacy of 'confirmation bias'.
     
  14. Craig Payne

    Craig Payne Moderator

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    sound familiar:
     

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  15. Craig Payne

    Craig Payne Moderator

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    oh, yes.....
     

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  16. markjohconley

    markjohconley Well-Known Member

    I never thought you'd get there, never too late to admit your past deficiencies, welcome to science, mark
     
  17. Craig Payne

    Craig Payne Moderator

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    and this one:
     

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  18. Craig Payne

    Craig Payne Moderator

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    A new dummies guide!

    Learn to:
    - Rely on Anecdotes
    - Use poor grammar
    - Make use of comic sans
    - Properly use the wildly popular shill gambit
    - stand your ground when attacked by those pesky facts
     

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  19. drhunt1

    drhunt1 Well-Known Member

    I look at this issue FAR differently than most, (what's new?). How many times do we as practitioners have to "re-educate" our patients because of horrible advice and information given to them by other doctors? We've all had this...we've all seen it first hand. A patient is told that growing pains are normal and little Johnny or Suzie will "grow out of it". Ditto with pseudolack of tibial torsion and/or an in-toed gait. Or how about the patient that hears ONE TIME they're allergic to a drug...and from that point forward, they tell every doctor they see they're allergic. How about the patient whom shows up with heel pain because of a heel spur, which their PCP told them they had? In fact, years ago, some orthopedic surgeons had a website up called heelspur.com. Good riddance...it's no longer up.

    I welcome the fact that patients are involved in their own health care and take the time to perform a modicum of research on it. I listen patiently, then tell them my thoughts. Once I begin to discuss mechanisms of their complaints along with anatomical charts to emphasize the points, they understand and are appreciative of the efforts I make. More recently, I began to use the videos I produced and downloaded to a tablet to allow them an opportunity to educate themselves while I visit other patients. Upon my return to that room, without exception, they are thankful for the effort I made and understand the anatomy/mechanics MUCH better than they did before. My experience is that those that are willing to take the time to explore their own symptoms in an attempt to solve their own problems are much more willing to listen to more educated opinions. They WANT to learn. I find these patients much more compliant, as well. We should recognize their need to learn, embrace the fact that the IT is here to stay and know there's a lot of good, and bad, info on it. It's the other patients, mostly post-op, I've had that don't/won't listen to my advice or instructions that frustrates me...but it has little to do with what they may have "learned" reading the IT.
     
  20. Craig Payne

    Craig Payne Moderator

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    Matthew, that is not the 'real' problem that is being created by 'Dr Google' and what the memes are poking fun at.

    I a am a member of several skeptic groups and am actively involved in fighting several pseudoscience issues on several fronts.

    Here are two recent egs:
    One involved the mother of a 5 yr old boy who needed a kidney transplant to survive. The hospital quite rightly refused the transplant unless he was vaccinated. She was asking around in the anti-vax circles what to do? The child will die without the transplant. If the child got the transplant and was not-vaccinated and caught a vaccine preventable disease, they will also possibly die due to being immunocompromised. She was seeking 'confirmation bias' via Facebook. IMHO, that child should be removed from that mother.

    The other was a mother who took her son to the emergency dept (I don't recall what the problem was) and refused to allow the doc to inject something (I can't recall what it was) until she had time to check with her mummy's group on facebook if the injection would be OK to give .... are you freakin kidding me?????!!!!

    This is the sort of nonsense that is becoming more prevalent. Nothing wrong with better informed patients - its the misinformed fanatical ones that are a problem.
     
  21. drhunt1

    drhunt1 Well-Known Member

    Craig-I understand. If anecdotal examples are worthy, then let me share one from here in the States that might help you understand my point...which is, perhaps doctors have created this "monster" to some degree. When I would sit in exam rooms talking to patients' parents about "little Johnny or Suzie's" growing pains, I would invariably ask if they had taken their child to the Pediatrician. They would answer yes, and that's where they had learned of the growing pains. I asked them if the doctor's answer to night pain in their child was satisfactory and acceptable. They ALL answered no. In other words, they left that Pediatrician's office suspecting they had been "gamed". This is happening with increasing regularity, as primary care docs are pushed financially to see more patients and offer less information, (accurate or not), before moving on to the next. We have created our own enemy. Doctors here in the States used to be considered the most trustworthy professional group by polls taken...more trustworthy that even judges and clergy. We have lost that top mark...passed by nurses. Fewer people wholly trust their physician and can't find others to take their place. Simply put...it's a mess with no answers offered with ObamaDon'tCare...in fact, the situation has been made immeasurably worse.

    I view doctors as the pinnacle of scientists. But recently it has become increasingly obvious to the layperson that science has become politicized as the scientific method on hot topic issues is now viewed as working backwards from a conclusion, not working forwards from a hypothesis. Combine that perception with less time spent in the PCP/patient interface, and it's no wonder why the general public is running to the IT as a primary source of information. Facebook examples are tantalizing, but IMHO, are just indicative of an underlying lack of trust with ALL doctors...which doesn't speak well about that woman's PCP, does it?
     
  22. Matthew:

    Excellent post. :good: I completely agree with you.
     
  23. wdd

    wdd Well-Known Member



    I think it ("gaming" the patient) is probably happening with the same or even a lower frequency than in the past but that patients are becoming more aware of it happening (as a result of better education and increased reporting in a more open society) and feel that they have another option or fall back position, ie consult the online oracle.

    Doctors here in the States used to be considered the most trustworthy professional group by polls taken...more trustworthy that even judges and clergy. We have lost that top mark...passed by nurses. Fewer people wholly trust their physician and can't find others to take their place.

    That was only a perception and not necessarily ever a reality. What has changed is the perception and not necessarily the reality, unless of course the greater number of people saying it's right makes it right.

    Bill
     
  24. drhunt1

    drhunt1 Well-Known Member

    Bill-perhaps...but consider this: nurses typically spend a LOT more time discussing medical issues with their patients than doctors are financially capable of performing. Patients love to have their medical conditions discussed at length...it's part of patient education and informed consent. Here in the States, there is a serious shortage of PCP's, and coupled with a reimbursement rate that is close to break even or less, it's no wonder doctors are forced to spend LESS time with their patients than ever before. Nurses don't have the same constraint. I've always thought that instead of increasing primary care residencies as ObamaDon'tCare actually does, the Feds should have allowed easier access for RN's with a BS degree to obtain their MS and become Nurse Practitioners. They will become the new PCP's for a population of patients that's increasing, and a body of MD students that do NOT want to pursue primary care medicine.
     
  25. mikamiko

    mikamiko Welcome New Poster

    It turns out there is a certificate, just found out.
    [​IMG]
     
  26. NewsBot

    NewsBot The Admin that posts the news.

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  27. NewsBot

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    Steve Novella weighs in:
    The Google University Effect
     
  28. Craig Payne

    Craig Payne Moderator

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    Dr Google not all bad:

    Press Release:
    Psychologists aim to help Dr. Google
     
  29. Craig Payne

    Craig Payne Moderator

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    Here is another:
     

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  30. Craig Payne

    Craig Payne Moderator

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  31. Craig Payne

    Craig Payne Moderator

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  32. Craig Payne

    Craig Payne Moderator

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    Another degree for me to go and get!!!
     

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  34. drhunt1

    drhunt1 Well-Known Member

    The author does bring up many valid points, but let me offer some explanations for this "phenomenon". Doctors, over the last 10-15 years, have seen a continual decline in reimbursements for, among other things, patient education. As the payments continue to dwindle, while costs for doing business continue to rise, doctors are forced to: a) see more patients/hour, and/or b) hire nurse practitioners or more often PA's in order to increase volume and, therefore, money flow. More patients/hour translates into less time between doctor and patient. While at one time, doctors could afford to sit down and discuss health issues with their patients, now, that system has been replaced with a more expediency, less detailed approach that typically leaves the patient scratching their head as to what just happened. Long waits in the waiting room, with an all too quick visit doesn't build trust or strenghten the relationship between the patient and their once revered physician. Medicine has become a business...much like being an electrician or a plumber, but government structured reimbursement rates have left doctors with few options.

    They once claimed that the knowledge of medicine doubles every 5 years. I haven't read if that time frame has been reduced but I'm assuming that it has. That means what a doctor learned in Med/Podiatry School is somewhat outdated by the time they leave their residency and enter private practice. While all fields of intellectual endeavor are experiencing this reality, no one field has been more sacrosanct than that of medicine. The public is now aware that doctors no longer have the time to answer all of their questions, and they are increasingly turning to other means of information, ie., the internet.

    For some reason, I have noticed that doctors are more willing these days, to impart misinformation to their patients that saying those simple words: "I don't know". Patients, for the most part, are not stupid...they understand when the information received does not explain or make their decisions easier. I have had many conversations with patients about this very topic, and they all state they would rather leave that office knowing that the doctor will "look into solutions" and that they won't fall through the cracks, as opposed to being 'flim-flammed' by the doc or someone in the office.

    I had this very conversation with all of the parents in my Growing Pains case study. Without exception, each of them were extremely disappointed in the answer: "Oh don't worry, it's just growing pains, and little Johnny or Suzie will grow out of it". Each and every one of these parents knew when they left that office that they were being fed a line. How does that instill faith in your, or your child's physician? It doesn't.
     
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    How Accurate Are Patients at Diagnosing the Cause of Their Knee Pain With the Help of a Web-based Symptom Checker?
    Leslie J. Bisson et al
    Orthopaedic Journal of Sports Medicine February 2016 vol. 4 no. 2 2325967116630286
     
  37. Craig Payne

    Craig Payne Moderator

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    I have done my research...
     

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