Cornering myself at a table on the fourth floor of the library where I proceed to bury my head in the depths of books and papers, I wonder: why do I sit here hour after hour studying, striving to become a physician? It’s an existential question that many pre-medical and medical students ask themselves, particularly when it’s as though they are drowning in a plethora of information, feeling overwhelmed and frustrated. But the path to becoming a practitioner of medicine has never been described as an easy one. Medical school curriculums are designed to challenge and cultivate some of the brightest and most curious of minds for the sake of improving the health and well-being of those around us. The fundamentals of organ system pathology, physiology, histology, anatomy, immunology—I could keep going, but you get the idea—are swiftly crammed into the first two years with the expectation that you will not only remember, but be able to utilize these fundamental concepts during third and fourth year clerkships.
Despite the extensive learning and training process for prospective physicians, there are patients who have reservations about their doctor’s capability to diagnose conditions and provide proper care. Any patient can use a search engine on their smart phone to look up symptoms; and, without even speaking to their doctor, patients feel as though they are confidently able to figure out their health problems on their own. By the time they arrive for an appointment, many have already decided on a diagnosis and treatment plan.
Not to say that self-diagnostic tools online are all bad: in fact, sometimes outside knowledge and resources can improve the conversation between patient and physician. They can come prepared with questions about their symptoms, or contribute facts about their medical history that they didn’t previously share because they didn’t realize the information could be integral to their care. From a physician’s standpoint, the use of online resources such as peer-reviewed articles in national journals, evidence-based clinical information, or websites for checking drug interactions, can greatly benefit patients. However, websites and even blog posts or comments on social media about illnesses and effective treatments can do more harm than good without the analysis and input of a trained physician.
Though I’m in my second year of medical school, I’d like to offer my opinion on why the Internet isn’t the best place to search for medical information without the proper lens.
Patients are ‘what’ experts…However, they are not ‘why’ experts…it is the job of a physician and the medical staff involved in a patient’s care to explain why the symptoms are occurring.
Overuse of online diagnostic tools and medical websites can make patients feel anxious about talking with their doctor, or they may be obstinate in their preconceived expectations of diagnosis and treatment. To paraphrase something that was said by one of my professors, patients are ‘what’ experts: they know what their symptoms are, what was going on at the time symptoms began, and what they feel like. No one knows the “what” better than they do. However, they are not ‘why’ experts: after analyzing the ‘what’ information provided by the patient, it is the job of a physician and the medical staff involved in a patient’s care to explain why the symptoms are occurring.
Another patient pitfall of believing everything they read on the web is somatization of symptoms. That is, if a patient truly believes he or she is sick with a certain condition, the mind fools the body into demonstrating symptoms consistent with the person’s conscious belief that they are sick. For example, Kelly McGonigal’s TED talk illustrates how a person interprets and handles stress mentally has an impact on their physical health. She notes that it’s not stress that damages the body, but rather it’s the perception of stress that causes harm. Think about it this way: exercise stresses the body by increasing your heart rate, exhausting your muscles, and depriving your cells of oxygen: but, regular exercise has a positive impact on health. Deadlines are often stressful, but they can jumpstart a person’s thought processes and work ethic because they have a goal toward which they are working. Conversely, a person who is stressed about being unable to meet a deadline may feel physically ill—they ‘get a headache’ or feel fatigued just thinking about the volume of work that needs to be finished.
The Internet has also generated some mistrust of doctors and their competency. The concept of ‘seeking a second opinion’ has evolved to the point where patients can search multiple websites, and no two websites will present the same information. Some may even contradict or exaggerate the facts, leaving patients confused, or worse: a patient with a serious illness may brush it off in favor of a home remedy, while a patient with a minor problem may be convinced it’s worse than what they actually have.
Even patients who go in for office visits don’t always trust the physician’s judgment and decision-making. Thus far in medical school, we have learned the importance of discerning when to order tests. Sometimes a diagnosis can be rendered based upon presenting signs and symptoms in addition to a comprehensive medical history and physical exam. Testing can be expensive and may or may not be covered by a patient’s insurance, and the time it takes to run and analyze some tests is time that could have been could have been dedicated to caring for another patient. Despite a doctor’s insistence that in-depth lab work or an imaging scan isn’t necessary, some patients seek security in the concreteness of test results, as if they are more reliable than the word of a doctor. This notion is only one of the many reasons why hospital expenditures have increased over the past few years.
Lastly, the relationship between a physician and their patient is one of confidentiality and empathy. The Internet is incapable of facilitating dialogue between two people directly. The concept of an ‘online office visit’ is innovative, but short-sighted: a doctor cannot offer a comforting hand on their patient’s shoulder if they present with complaints of fatigue that suddenly bring them to tears, nor can they perform a physical exam that tests the patient’s muscle tone, reflexes, coordination, and so on.
As with many aspects of life, the medicine and science behind keeping us healthy are complex. From undergraduate pre-requisites, the time-consuming coursework of medical school, and rigorous residency training to research about surgery, clinical practice, genetics and the environment, medical devices, and pharmaceuticals—medicine integrates all of this and more; so, what makes us sick isn’t always explained by a simple checklist on a website. It’s called the ‘practice’ of medicine for a reason: it requires a certain type of lens, oftentimes with more than one person’s view through it, to truly understand the complex nature of human health and how to best care for millions of individuals on a case-by-case basis.
There will likely always be obstacles and misconceptions that hinder the profession, but for me, it goes without saying that doctors are in the unique position to diagnose and treat all manners of diseases and disorders. It is truly a privilege to learn about and practice medicine, and what keeps me studying for that extra hour or two is the realization that, in a few more years, I am the one that is going to be changing people’s lives.
Not only that, but the body is super cool, especially the vestibulocochlear system! Before you leave, YOU MUST check out the video below – blew my mind (and make sure your wear headphones)
Medical school is tough, even tougher is residency. sometimes we need to hear that voice of inspiration and excitement we carried before entering the journey.
The goal of WhiteCoated is to allow medical students and residents to contribute anything ranging from art to articles to podcasts that help others learn more about the field or rediscover their passion with the goals of bettering themselves and thus enhancing the care of their patients.