One of the great things about the Internet is how it has changed being a patient. If you are at all like me and prone to thorough researching of any medical ailment that hits, you know that the Internet has had big effects on how we relate to our doctors:
- When I go in to see a specialist I am usually quite up to speed on the basics of my condition, the parameters of possibilities for what the diagnosis might be, and how the body part in question functions. (See this New Yorker cartoon.)
- One problem is how to convey to the doctor how much you know so you don't both waste time. Some doctors don't want to hear how much you know, because they are afraid it will revealed them as naked of an special insight or expertise. The best ones quickly jump onto your wavelength and get into the more advanced topics.
- You also often encounter alternate medical theories, which can sow doubt in the doctor standing before you with his conventional outlook. The Internet amplifies dissenting voices, so that conventional wisdom can be more easily knocked off its pedestal. If not digested with a very critical eye, this can easily fill your head up with junk. You could see how doctors could find that annoying.
- At the same time though, often the conventional wisdom is wrong (and/or unfounded!). Internet research often throws into stark relief just how sharp are the limits of medical knowledge in many areas, which can also lead to a morass of ambiguity and doubt. The dirty secret of medicine is that a huge amount of what doctors are running around telling people is not actually based on research. When you lose faith in doctors, you lose the comfort of having a confident person in a white coat who knows all the answers tell you what your problem is and exactly what to do. I find that I have a lot less patience now for Voice of God doctors who can't handle being knocked out of the role of infallible expert. Often when I see a specialist what I'm looking for is a consultant, who can reality-check and narrow my own self-diagnosis. Someone who is secure enough to be upfront about what she knows and doesn't know. I know too much to be comforted by the white-coat role, it's just annoying.
- But the Internet also collapses statistical differences. What I mean is that there may be a symptom you have, and one possible cause is something benign, while another cause is some devastating horrible fatal disease. Your doctor knows that he sees people 4 times a week complaining of that symptom, and only once every few years is it caused by the fatal disease. But online you rarely get that "feel for frequency," which is one of the things a real live doctor can get you. The fatal disease might loom nearly as large in the online discourse as the everyday cause, and even though you may read that the symptom is "usually the result" of the benign condition, that message gets contradicted by what you read.
- Another irreplaceable thing live doctors offer is not just a feel for frequency, but also the ability to feel, period -- to assess the nature of a lump or some part of your innards and through their experience and their feel for things, determine things about your condition. This is what Michael Polanyi called "tacit knowledge", and you can't put that on the Internet.
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