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December 29, 2008
Cybermedicine

A couple of seemingly isolated events have me thinking about the state of cyber-medicine.

As I was walking into the hospital today, I saw a young couple carrying a beautiful newborn girl, attired in a gorgeous pink onesie. As I walked past them, I overheard one of the parents say “So, the way I understood it …” I imagined they had just left a doctor’s office and, on their way out, were trying to “decipher” what the doctor had said.

Then as I was meditating on this, a message dropped into my junk mail folder, asking whether my patients were suffering from “cyberchondria.” Apparently, Microsoft commissioned a study to improve its Web-searching capabilities and found that patients who research their symptoms and conditions online sometimes develop “unfounded fears” that what they’re suffering from may be worse than what they actually have.

In the middle of the last century, the French philosopher Michel Foucault wrote two important books that should be part of the canon of medical education: “Madness and Civilization” and “The Birth of the Clinic.” The first is an anthropological history of mental illness and madness during the so-called classical age, from the end of the 16th century through the 18th century; the second deals with medical communication and perception. It is to this second book that my mind wandered after these two seemingly "isolated” events.

Foucault talks about human perception and how the individual patient is truly that: a singular synthesis of the illness that afflicts him or her, contrary to our medical thinking that tries to catalog everything in series or cases.

I see this failure of perception everyday. We interrupt patients after they offer only a few sentences of the history; we already “know” what’s going on, so we must lead the conversation in that direction. We don’t wait for “full disclosure” because we already decoded the symptoms.

And then we talk.

We talk in incomprehensible medical jargon while patting ourselves on the back for our “expertise.” We speak in short, forceful sentences, which will (we hope) provoke a reaction of acceptance and compliance. Then we walk out, sometimes asking perfunctorily if the patient has any other questions.

And so, in the hallway, the parent wonders, “So, the way I understood it …”
This then leads them to that unfathomable fountain of all knowledge: the Web. We’ve all been there before: You walk into a patient’s room, and they welcome you with a stack of printouts from myriad Web pages that already diagnosed them.

“Doctor, I read in soandso.com that I may have leukemia.” “Doctor, are you sure about that X-ray? I read in the online paper that that test can kill me!” “Doctor, I researched your credentials online, and I am not impressed!” (I’m still waiting for this one …)

We have a responsibility to our patients to provide them with excellent, top-of–the-line information so they can make informed decisions. But what happens when the patient is better informed (or misinformed) than we are?

This brings me back to Foucault. In his book on madness, the French philosopher wrote that one of the stumbling blocks of psychiatric care is the disconnect that exists between the language of reason and the language of madness. “The language of psychiatry,” Foucault wrote, “is a monologue of reason about madness.”

Do we interact with our patients in a monologue? That’s probably why they need to decipher what we say. That’s why they engage in another dialogue, one that is artificial but seemingly clearer: the dialogue that takes place between their fingers, the keyboard and the World Wide Web.

Are our patients suffering from cyberchondria? If they are, we have only ourselves to blame.
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About Ruben J. Nazario, MD
Ruben J. Nazario, MD, is now medical director at Inovalon, a health care data analytics company, and is medical editor for Elsevier's First Consult. A pediatric hospitalist, Dr. Nazario is a veteran of both community and academic pediatric hospitalist programs. All material represents his own views and does not reflect the views of his employer.
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