Self-diagnosis using the internet can be bad for your health – and your stress levels
November 1, 2003
A new disease is gripping thousands of people across Britain. Its onset goes something like this. The patient sits in front of a computer screen and taps away furtively. As the web pages materialise, he begins to sweat. There may even be an audible gulp. This is cyberchondria – health anxiety for the information age.
Last year, Britons spent £55 million on DIY health kits bought at the chemist; the most popular products include the urine sugar monitor for diabetes and cholesterol level testing packs. But there is another sort of home diagnosis that requires no specialised products, merely internet access.
There are now dozens of sites that allow the user to diagnose (or misdiagnose) a potentially fatal disease, simply by filling in an on–line form. Alternatively, a few key words entered into a search engine will throw up a wide variety of sites and discussion forums devoted to specific complaints.
This is both good and bad news for incorrigible hypochondriacs like me. On the one hand, the internet can provide instant answers to questions one may be too nervous to ask a GP. On the other, those answers may be wrong. The thrill of an instant verdict can quickly turn into a shudder of anxiety. Introducing a hypochondriac to a self–diagnosis site is like handing a junkie the keys to a pharmacy.
I have a simple rule: however alarming my symptoms, I don't go near the internet. For the purposes of this article, however, I decided to test the internet with a cluster of symptoms. First, I called up Google and typed in the words: "medical symptoms". The site that appeared at the top of the list of results was www.cancer–info.com (slogan: "Getting Better Every Day").
Up popped some inviting white boxes marked "symptom 1", "symptom 2", and so on. I entered "tiredness", "sore throat" and "swollen glands" – a plausible and not too frightening combination, I thought. Then I clicked on the diagnosis button and waited two seconds to learn my fate.
Syphilis. Not syphilis amid a range of possibilities, but just syphilis ("symptoms: sores, swollen glands, tiredness, fever, headaches").
Admittedly, the result was accompanied by a disclaimer – "This program is intended for entertainment purposes only! There is no guarantee as to the accuracy of this program" – but, if my symptoms had been real, I would have been too paralysed by fright to pay much attention.
Sites such as www.cancer–info.com, which is run by an American organisation called Cancer Information and Support International, seem designed to provoke cyberchondria in its most acute form. But other websites aim to disseminate medical information in a more responsible way: instead of providing crude tools for self–diagnosis, they retain medical experts to answer individual queries.
The best known British example is NetDoctor (www.netdoctor.co.uk), whose mission statement reads: "We believe that, in the future, the world of medicine will be dominated by a new patient who seeks out critical information on the internet, and that this will take a new type of doctor who must help the patient assess the quality of that information."
NetDoctor's medical advisers include professors of medicine and leading hospital consultants; it also provides a database of articles by doctors and scientists. Questionnaires allow users to test themselves for colds and low self–esteem, but not for anything really scary, such as cancer or Alzheimer's.
"Used properly, the internet is a phenomenal tool, helping people who might be embarrassed to talk to a doctor face–to–face," says Christine Webber, a NetDoctor psychotherapist. "Self–diagnostic sites, in contrast, can be extremely worrying. Doctors are there for a reason.
"When symptoms ring an alarm bell, the patient needs to be seen. The professionals on NetDoctor and another sensible website, NHS Direct, know enough to say: 'This can't be diagnosed over the internet – you need to talk to your GP'."
Before asking NetDoctor a question, the user is required to state that it "does not relate to an illness demanding urgent medical attention" – a statement that no fully-fledged hypochondriac could make with any confidence.
The truth is that, despite its ethical safeguards, NetDoctor is dangerous territory for people suffering from health anxiety. For example, it runs message boards devoted to particular illnesses: cancer, diabetes, IBS, arthritis and so on, as well as problems such as impotence and self–harm. These discussions are not moderated by doctors, and consist mostly of lay people asking each other questions and swapping advice.
Trawling through the board devoted to multiple sclerosis – a favourite disease of hypochondriacs because of its tantalisingly elusive symptoms – I came across the following exchange. In a message headed "Is this MS?", a woman called Kati complained of chronic lower back pain, pins and needles in her legs and attacks of numbness.
An anonymous response, headed "Could be", read: "Some symptoms do sound similar to my MS symptoms, but it could be something else." If Kati is a hypochondriac, that ambiguous answer could send her into a downward spiral of anxiety.
I asked my old school friend Dr Robert Weeks, a GP in Lincolnshire, what he made of online medical advice. He groaned.
"The internet gives you the facts, but it doesn't tell you how to interpret them," he said. "Many of my patients have been online before they come to see me, and it's not at all helpful, because they latch on to worst-case scenarios.
"People are not good at assessing risk. A woman came in to see me the other day who had learnt all about the supposed dangers of MMR on the internet and was absolutely adamant that her children weren't going to have it. Then I watched her drive her kids away with their seatbelts undone."
One thing is for sure: the genie cannot be put back in the bottle. For the foreseeable future, the internet will be on hand to provide an ever–expanding body of medical information, much of it misleading. As Webber puts it:
"Quality control is impossible, so we will just have to learn to use the internet wisely."
Or, if you are like me, to wean yourself off this alarming new resource.
Copyright © 2003,Telegraph Group Limited