Article, "Dear worried well, the internet is not your friend"

Oh gosh, look at all the psychologisation in this article, I didn't notice it first read. They could be talking about ME patients, the language is so similar:
But trustworthy medical websites are not what you will always get when you use a search engine, so it’s easy to be led to astray. Misinformation can lead to catastrophising (thinking the worst), rumination (dwelling on a troubling thought) and increased attention directed toward the area of discomfort, which can increase the experience of pain in the affected area.
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That last one is of course somatisation.

This is exactly what many think is the cause of ME.
 
Online sources of health information are broad and varied. They range from symptom checkers to charity websites, supporting those with selected chronic illnesses, to the personal blogs of people with various disorders. A number of commercial websites also provide free health information, alongside a recommended treatment.

If you’re worried about new symptoms, it’s important that you only access websites where the information has been written or reviewed by medical professionals, such as NHS Choices. These websites attempt to provide an unbiased and balanced view of symptoms that is informed by evidence-based medicine and clinical practice.
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This seems to suggest NHS Choices is a better source of information than, for example the MEA website. I have looked at the section on ME on NHS choices and it's dreadful - recommends CBT and GET, including 'exercise that increases your heart rate', eg walking and swimming.
Though it does also recommend the MEA for further information!
 
If you’re worried about new symptoms, it’s important that you only access websites where the information has been written or reviewed by medical professionals, such as NHS Choices. These websites attempt to provide an unbiased and balanced view of symptoms that is informed by evidence-based medicine and clinical practice.
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Or perhaps the IOM, or CDC, or NIH?

Just asking.
 
Yes @Trish !

There are some beautifully patronising touches to the piece.

One is the treating of the information superhighway as less a 'web', and more a series of one way streets and toll roads (upon which we mere plebs cannot and should not venture).

I liked the fact that either she doesn't know how to use a search engine well, or does, but thinks nobody else does.

If I (and many people who use search engines regularly) were to 'google'
site:www.nhs.uk itchy skin
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it would bring up a list in which the information I was looking for would be likely to be at the top of the list. Maybe my wandering womb would prevent my using skills I already have. Who knows with these psuedo wombs?

A usage of a mathematical tool that I'm sarcastically calling 'Bayes' Alchemy' occurs in the quote from Woolie, in which a number of 'cans' (or 'probablies', or 'coulds') is strung together, with the result that the less likely something is, the greater the probably at the end of the equation. This seems to happen a lot with psychologists for some reason.

Reading back on my first post, I missed out the irony of her position in the piece, the paper she was a co-author of, and her receiving funding from Arthritis UK.

People should not 'google' symptoms before contacting a doctor, except when they have arthritic symptoms, in which they should also search for papers on arthritis to get the message that early intervention is good.

Given that intervention withing the first 6 months is ideal, and the delays between seeing a GP and getting a referral to a specialist and getting confirmatory tests, this means the person with arthritic symptoms needs to intuitively know that

  • the 'googling' exception applies to them,
  • and they may possibly need a further referral to a Dr. Brown who has access to a
  • working flux capacitor,
  • a DeLorean car and a
  • stretch of road in which to reach 88mph.

(Note that in the second 'Back to the Future', older Biff is walking with a cane and possibly has Arthritis. He is still able to use the car as a time machine, so the time machine is accessible to people with disabilities. )

A quick application of Bayes' Alchemy, and this scenario becomes less a sarcastic point, and in fact a highly likely and plausible scenario. ;)
 
rgn007 said:
There are, in my experience, "worried well".
I'm a nurse in a GP surgery and examples of these are:
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Perceptions in general are prone to bias, which is why scientific evidence in the form of research is preferred. My own (likely biased) perception is that some medical personnel will exaggerate or over-simplify "stupid/crazy patient" stories to make a point or create a humorous anecdote.

In either event, I don't find anecdotal accounts helpful at all for these sorts of issues.
 
Pffffh! Just go and die quietly please...

This is the motto of the person who wrote the article.

However I came across very helpful NHS staff, really amazing people really want to help. I also met some not very helpful ones, I'd say they are minority.
 
rgn007 said:
My first post since becoming a member and the "worried well" in the original post caught my eye. Also the first response of such people being scapegoats to the funding of the NHS.

There are, in my experience, "worried well".

I'm a nurse in a GP surgery and examples of these are:

1. Patients that make appointments for an ECG (electrocardiograph) for no reason, or even being advised they need one by a clinician.
2. Patients with normal cholesterol results keep wanting it rechecked when they are low risk the first time round.
3. Patients who make appointments to see if they are due to be seen.
4. People who keep requesting blood tests every 3 months when they have been normal for 2 years.
5. People who keep requesting Vitamin B12 injections when they had no symptoms of being low and their levels are actually above normal.
6. Making appointments for a common cold after 2 days and demanding antibiotics.
7. People who insist they need inhalers, then realise they haven't actually been taking it correctly for many years so the drug may as well have been put down the sink.
8. People with self limiting conditions, but demand a referral for an instant fix.
9. People with self inflicted conditions due to lifestyle, but want pills rather than lifestyle change to rectify the problem.

Should the NHS fund the demands of the above, or should we be a bit more discerning?
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This is not an attack on you, and I believe that you have this experience but one of the things we are up against, is that people who overuse the health service are the ones that GPs see the most, so too many people are seen as being timewasters. My father was told by a consultant that he was fed up of people coming to him with nothing wrong and taking up his time. he had trouble swallowing and was dead two years later of oesophageal cancer. He had never been to a doctor for thirty years.

There is far too much dismissal of patients in the health service. As a student nurse my daughter witnessed an orthopaedic consultant exploding with anger at his resident when he discovered a woman had been sent home when she thought her leg was broken only to return a week later when the fracture had opened. He said that normal young adults did not complain about severe pain unless something was wrong and the cause should be found, not a simple reliance on tests. (X rays often don't show up fresh fractures) In other words symptoms must be taken into account, not just test results and that is being done more and more.

Does the person wanting ECGs over and over have chest pains? It is too easy to say that everything is clear but if there are still symptoms the patient will not be reassured. With ME we know this too well. I am sure I have a reputation as a hypochondriac as I kept asking if I had MS or Parkinson's or something else. It turned out I did have a serious neurological disease, it just wasn't one that was accepted at the time. Not fitting one disease says nothing about your state of health.

Even health anxiety is a psychological problem as much as anorexia or paranoia so more resources for true mental patients is needed, not to get angry with them or call them names. (We know all about that!)

As others have said, education would help a lot of people. Giving the right explanation can help a lot. A friend had such a severe pain in his leg he could not put any weight on it. He was dismissed as it just being his age, so he was worried that something was missed. When another doctor explained that muscles get fragile as we get older so tears happen more easily and it would heal but to use cold compresses and take paracetamol for the pain, he accepted it.

I also take issue with the "self inflicted conditions due to lifestyle". It is a sloppy buzzword sort of thing which takes serious issues and blames the victim far too often. My parents worked in a factory at hard physical jobs which left them exhausted but thin, my children's generation work in call centres where they spend eight hours a day taking calls continually. Then they spend hours on a bus or in a car to get home because they can't afford to live near their work. They come home exhausted but are fat.

Food is advertised all the time to make money but if you actually eat it then it is your own fault for getting fat, same with alcohol.

The internet is giving people information for the first time and we have to learn how to use it. But we must not forget that many people have suffered for years with things who can now find out what is wrong and can help themselves.
 
My GP is very happy that I look up and present a picture with possibilities to her. She says it is easier for her to investigate the problem when the patient is knowledgeable and aware of what is going on. She always says you know your body better than I do, you've been living in it for a long time. I like her so much, she's great.
 
And then today..
People should take three steps to try to solve a health problem before seeing their GP, a doctors' leader has urged.

Patients should see if they can sort it themselves, see a pharmacist or use a reputable online source of information, the Royal College of GPs says.

GPs "really feel the pinch" over winter because of demand, said chairwoman Professor Helen Stokes-Lampard.

If just 10% of people did not visit their GP, it would make "a huge difference", she said.

GP leaders say there are not enough family doctors working in England and that practices are closing at an "alarming rate".
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http://www.bbc.co.uk/news/health-42511553
 
All the advice to "look up the internet" or "don't look up the internet" is moot once patients have a reputation and a flag on their notes saying the patient is a hypochondriac and/or attention-seeker and/or drug-seeker (which, based on my experiences with doctors and hospitals, I've had for around 40 - 45 years). Then you will be fobbed off for as long as the doctor can keep it up, and you'll be bottom of the pile for appointments in hospitals because nothing is ever urgent.
 
Luther Blissett said:
A usage of a mathematical tool that I'm sarcastically calling 'Bayes' Alchemy' occurs in the quote from Woolie, in which a number of 'cans' (or 'probablies', or 'coulds') is strung together, with the result that the less likely something is, the greater the probably at the end of the equation. This seems to happen a lot with psychologists for some reason.
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I LOVE this! So apt!

'Bayes' Alchemy' is my new favourite phrase.
 
Mithriel said:
I also take issue with the "self inflicted conditions due to lifestyle". It is a sloppy buzzword sort of thing which takes serious issues and blames the victim far too often.
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Yes, I find this offensive too, @Mithriel. Its usually a judgement made by middle class people who've had every advantage in life, and the judgment is levelled against people with difficult lives, and few real choices.
 
An elderly relative of mine started slowly losing the control and use of her legs, and it took several years before a relatively rare progressive organic neurological disorder was finally correctly diagnosed with the appropriate objective tests. Amazing what you can find when you look in the right place, with the right tools.

I don't need to describe to ME patients what she went through before getting the correct diagnosis.

Clearly this problem isn't isolated to our little corner of medicine.
 
In speaking to a number of managers in care homes, one of the first tests they run is a vitamin test ( primarily for B12 and vitD)- they have seen a number of people referred to residential care whose neurological decline is linked to very low levels of these, many of whom improve significantly after supplementation.
These residents have been through the system to be in a position to be admitted to residential care.....
 
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