Doctor Thyself?

Well, I started working Saturdays this month...not something that I'm sure I will be repeating come February, but for the rest of January, I'm stuck spending part of my weekend seeing Disability claimants. I don't know if there's something special about people who would rather get a physical than do anything else on a Saturday morning, but it seems like the overall...sanity level of my Saturday claimants is lower than it is during the work week. The past two Saturdays I've seen multiple people that, using home medical resources (textbooks, WebMD, etc), have decided to doctor themselves for various ailments, and after their home remedies fail to fix the problem, feel the need to apply for disability. I mean, it makes sense to me...it's not like the now nine years of post-secondary education I've gone through means anything - the diagnosis of "tape worm and stomach cancer" you received from typing "diarrhea" and "vomiting" into some website is just as valid as my thorough history and physical, even though I just diagnosed you with gastroenteritis. One such patient presented last Saturday, stating that she was "oh so very tired (dramatic pause), and my leukemia is just getting so hard to manage."

Ok, as you might imagine, the "leukemia" got my attention. "What type of leukemia do you have?" I asked.
"Oh, I'm not sure if you're aware, but there are many different types of leukemia. I have one of them," she responded.
"Actually I am well aware of the different types of leukemia," I replied, "Can you recall what type you have?"
"Well," she stated, pressing a finger to her lip," I can't recall, I didn't bring my medical textbook with me, you see...but I know that it keeps me from making red blood cells, and that's why I'm on the iron I buy from Wal-Mart."
There were so many things wrong with that statement, that I felt the need to do a little educating.
"First of all, leukemia is a condition that affects white blood cells, not red blood cells" I said. "Secondly, leukemia is usually treated with, at the minimum, chemotherapy. Iron supplementation, especially if you're just getting it from Wal-Mart, does not really fit that bill. What you're describing sounds more like anemia, is that what you meant?"
"Oh no," she replied, "I'm sure it's leukemia. I spend a lot of time reading my medical textbook - you can never be too educated - and I'm sure that it told me, based on my symptoms, I have leukemia. I can go home and look it up, then call you, if you'd like."
"That's quite alright," I said. "Let's just move on to your fatigue."

While I do believe that one can never be too educated, I do think that knowledge in the wrong hands can be disastrous. The lady above is an obvious example of this. The emotional turmoil of being diagnosed with a chronic illness, especially something as scary as cancer, is a terrible burden to bear, and has long-term consequences that persist even if the disease itself is cured. If the untrained person gets on some website, diagnoses themselves with, leukemia for example, and actually believes that have that disease, they still undergo the same emotional scarring as the patient that is actually sick. Thankfully, most self-diagnosis websites put some disclaimer like" do not use this website to diagnosis yourself" in small letters on the bottom of the page, but let's be honest...how many people actually read the fine print. When these patients present complaining of "worsening leukemia unrelieved by iron pills," however, it then falls on us as physicians to not only try and explain to the patient that they don't have the "disease," but also to try and heal the emotional wounds that the "disease" left on the patient's psyche. Knowledge is power, there can be no doubt about that, but we have to make sure that that power is used to heal, and not to cause harm.

And now for the disability quotes of the day:

Me: "So why did you stop working?"
Dude: "I was working an on-call job, and they just stopped calling."

Me: "Using a 0-10 scale, with zero being no pain, and ten being shot, stabbed, lit on fire and run over by a truck - all at the same time - what would your pain be?"
Man: "That all happened to me once time, but they also threw me off a building. Yep, life is hard as a bum."

Careful what you read,
-DD