A tale of 4 “WebMD Effect” patients
Oh, Internet. What wonders you have wrought during your short lifetime! Now anybody can become an expert in any medical condition with a few hours’ perusal of your fine webpages.
The trickier and more complex the diagnosis, the easier it is to become an expert! It used to be that things like electrolyte balance in acute renal failure were dark, dim secrets–now anybody can help out their care providers with things they’ve learned from the ‘Net.
The latest thing I heard was from a woman whose son was diagnosed with myasthenia gravis after a viral illness. We’d extubated him the day before and started him on Prednisone. She was extremely resistant to the idea of his getting the drug. Apparently she’d searched for side effects of Prednisone on WebMD and found that they were pretty nasty.
I agreed with her, of course. The side effects of Prednisone are nasty. So, I pointed out, are the side effects of NOT BREATHING, which was what we were looking at.
Then there was the patient who told me earnestly that she didn’t want to start on levothyroxine (with a TSH of 7) because she’d read on some page somewhere that thyroid supplementation would cause a person’s thyroid to just stop working. She felt better, she said, visiting a homeopathic doctor and drinking expensive water in an attempt to get her thyroid up and running again.
That patient was followed, two weeks later, by one who told me he’d been drinking natural turpentine (whatever that is) in order to get rid of liver parasites (he had no symptoms of liver parasites) on the advice of a naturopathic website. He said it tasted awful. I said it must have. What else was I supposed to say?
The best interaction that I had with Doctor Google, though, was when the well-meaning family of a stroke patient came in with their own tube-feeding concoction. They had assumed the majority of his daily care in preparation for taking him home. They did all his daily care and were learning his PT and OT exercises as well. The dietician and I discussed the situation in low tones and decided to let them try it for a couple of days. Nutritionally, their mix was just fine, but it had a lot of fat in it (“so he’ll feel full” they said) and almost no fiber. After a couple of days of Exploding Butt Syndrome, they backed off and let us resume the nasty, awful, nonorganic, not-whole-foods tube feeds that had worked well for their dad up to that point.
I love the Interwebs, I do. But just for a while, I wish people would back off and not try to diagnose themselves or prescribe their own therapies based on webpages that are stuck in 1997, with Flash animations and tinkling digital music.
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Agatha Lellis is a nurse whose coffee is brought to her every morning by a chipmunk. Bluebirds help her to dress, and small woodland creatures sing her to sleep each night. She writes a monthly advice column, "Ask Aunt Agatha," here on Scrubs; you can send her questions to be answered at firstname.lastname@example.org.
By Agatha Lellis