Sunday, 18 November 2012

Experts

The Internet is both the best and the worst thing to happen to medicine ever.  Well, ok maybe penicillin was pretty important.  And I guess anesthesia was also a big break - rather than simply getting people drunk and hoping they didn't wake up during the procedure, it allowed us to do whatever we wanted for however long we wanted.  But I digress.  These days everybody seems to think that they can google something and instantly become a medical expert.  Nevermind the fact that becoming a doctor actually takes around a decade of school and training.  A 5-second internet search apparently allows people to skip years of training and practice.

A short while ago I admitted a young man who had been involved in a fairly serious car accident.  He had bonked his head pretty hard (that's the technical term) and had a small contusion in his brain.  As per our protocol, I had repeated his CT scan several hours after he arrived, and it confirmed that the contusion had not changed at all.  I admitted him to the intensive care unit, and though he was initially very confused, he improved dramatically over the next few days.  The night before I was going to discharge him home, I got a very irate phone call from his very irate mother.

"How the hell can you be thinking about sending my son home?" she asked me.  "You haven't even done an MRI of his brain!"

No of course I hadn't, I told her.  I very calmly explained to her that her son was getting much better and there wasn't any need to do any further imaging.  The only reason to do a test is if you plan on potentially changing the treatment based on the result.  No matter what any test showed, his treatment wouldn't change.  I tried to explain calmly that not every brain injury patient needed an MRI.  It was a very expensive test that wouldn't change anything. 

Oops.

As soon as the words escaped my mouth, I regretted saying them.  Her screaming grew louder.  She accused me of not doing anything and not caring about how her son was doing.  She then accused me of simply trying to save the hospital money.  I held my own, and nearly an hour later, I finally hung up the phone, absolutely satisfied that I had not convinced her one bit.

Not surprisingly, her son continue to do well, and I sent him home.  He did not get an MRI.

All I ask is that you just please let me do my job. I'm not saying you can't ask questions and challenge me, because I'm not perfect.  I actually appreciate questions.  But you have to understand that google doesn't make you an expert, and unless you've been to medical school, I know a hell of a lot more about this than you do.

I wonder if I can use Google to search how to deal with idiots with a smart phone who think they know more than they do.

6 comments:

  1. That's most likely the best way I've ever heard it put. The only thing I've ever enjoyed about being in the emergency room is hearing relatives of someone admitted to the er talk about how the doctor isn't doing his job because its nothing like House or like Google says. And I've witnessed the chaos web md creates. You search up a small shoulder ache and leave the site believing you have lung cancer. What a joke :S

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  2. I agree with you, but some doctors are actually idiots.
    I have intracranial hypertension, and my neurologist sat on her computer in front of us and googled the medication use. We have done research and discussed my case with interstate neuros, as well as talked to many people in a support group who have the exact same symptoms as me, and not one agrees with my neuros treatment plan. We came to her with the name of a recommended medication that I wanted to try, however she wants me to "wait this one out" even though I've been deteriorating, and have been in the ER numerous times with trouble breathing, kidney stones, and clotting- all caused from the medication. Some doctors are very close minded when it comes to the patient's wants. :(

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  3. I webMD, with a grain of salt, only when I have seen the same doctor for the same unresolved issue three times. I then take in a list of what medicine or plan of action I want; as long as it isn't a narcotic then I leave that up to the doctor and don't mention them because they are pretty useless anyway.

    Usually after talking for a few minutes with my research and what they have done that hasn't worked they comply or I fire them. It's my body and I refuse to let a complacent doctor hurt me long term because they haven't the knowledge and refuse to look for answers. Now, there are exceptions such as when I need extensive testing and the doctor keeps me informed on the basics and there is a clear path of what he needs tested so he can do his job.

    I do not wish to reveal my medical past but I have only had to fire one doctor and that is because he wanted to just hand me narcotics instead of a healthier route with non-narcotics and physical therapy. On the same token I have felt the need to webMd only twice. Usually my doctor is right and I rarely question their plan of action for whatever my issue is.

    This woman was out of line but a patient being their own advocate isn't. I do not have the patience, dedication or stomach to be a doctor so I rely on the internet because it is my only option when something is wrong and my doctor has failed to resolve the issue after three visits, with some exceptions depending on my issue at the time.

    My mother is an ER nurse and I ask her a lot of questions and I have listened to and seen some ridiculous things in her ER. To the extent that families of different patients have gotten in fist fights over family B asking family A to leave because of their disruptive behavior and generally being utterly asinine.

    I am amazed by ER personnel and what ridicule they are subjected to.

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  4. This is where you need to be able to say "sure you can have an MRI but there is no clinical need so you would have to pay the full cost. That'll be £2000 please (or whatever)".

    I wonder how long she would have persisted if it had been out of her own pocket.

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  5. Unfortunately there is no way to deal with idiots with a smartphone. It's what I do for a living and the only solution thus far is the mute button and creative profanities.

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  6. The problem with medical expertise is that chronic patients are able to study their own problem for years, while doctors have to cover everything that can go wrong with the particular area or aspect of the body they're specialized in. Of course, the majority of know-it-all patients will be idiot Googlers, but some patients really know more about their disease than their doctor.

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