Patient self-management is great, but is a “have browser, will heal” strategy really a good idea? Perhaps it’s a really bad idea.
People have deep emotional concerns with psychosomatic implications that cannot be resolved by asking Dr. Google.
A few years ago I was training for the annual Alyn Hospital charity bike ride.
ALYN Hospital is Israel’s only pediatric and adolescent rehabilitation facility. ALYN treats children with a wide range of congenital and acquired conditions including cerebral palsy, neuromuscular diseases, spinal cord injuries, brain injuries, burns, terror and motor vehicle accident victims.
That year – over 600 riders rode from Jerusalem to Eilat on a 500km,5 day ride.
About 8 weeks before the ride,at the top of my training cycle, I started having pain in my left calf.
I did the logical thing, and asked Dr. Google. Dr. Google said I had a case of over-use and microtears in the muscles of the calf. I scheduled a visit with an orthopedics specialist at my HMO, the Israeli healthcare organization Clalit.
It was 3 weeks to the appointment, and I felt I could not just ignore the situation.
According to Dr. Google – an injury like this would take 4-6 weeks to heal. The recommended plan was icing and cross-friction massage – which I verified with my local/friendly physiotherapist. By the time I met the orthoped, most of the pain had gone away. I walked in.
He asks me – “How can I help you?” I tell my story and say I suspect microtears due to overuse. He says – “that is precisely what happened, what kind of bike do you ride? – I ride also!” So – we had a nice little road biker chat and then he pulled up a picture of the calf muscle on his computer and showed me what was happening. He said “You’ve probably seen this picture?” I said I had.
The orthoped told me – “just keep the icing and cross friction massage going and go back to training. You’ll be fine.”
My story was pretty straightforward and may not be representative. I have a graduate degree in physics, I’m trained in the scientific method, I’m skeptical about funky cures, and not very paranoid about my health.
There is such a thing as having too much information
Experienced physicians though, will tell you that in general, patients who are better educated and and take the time to search for informaton before the visit to the doctor are usually the most “nervous”, the most hypochondriac and the most who are constantly polling physicians for medical advice.
The problem with asking Dr. Google is that the information is based on fragments of data from patients, doctors and caregivers that is posted in forums and social media on the Internet.
When a person has fragmented and partial information about something, he will tend to make the wrong interpretation about symptoms, illness ,pains,etc.
He will imagine things, simulate bad things happening. Wrong interpretations lead to hightened concerns not to better health.
Patient self-management, necessary but not sufficient
About 90% of the care a person needs to manage a chronic disease must come directly from the patient. Evidence is growing that self-management interventions, such as self-monitoring and decision making, lead not only to improvements in health outcomes and health status, but also to increased patient satisfaction and reductions in hospital and emergency room costs.
While patient self-management may be necessary in improving health outcomes, especially for chronic diseases, it is not sufficient.
Beside patient self-management, we cannot ignore the emotional needs of human beings.
People are not cars with an internal network of microprocessors and microcontrollers that can report remotely that the oil need to be changed.
People have deep emotional concerns with psychosomatic implications that cannot be resolved by asking Dr. Google – and for that, they need to talk to their physician, who has the experience, the training, the access to evidenced-based medicine and the knowledge of how best to apply that evidence-based medicine to diagnose and treat the patient’s particular clinical issue.
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