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

Andy

Andy

Retired committee member
From earlier in the year, I also think it was shared elsewhere at the time.
The worried well could be costing the NHS £56m in unnecessary tests and appointments, according to a recent estimate by Imperial College London. Many of these worried well are probably “cyberchondriacs” – people who’ve googled their symptoms and ended up in front of their GP, clutching a ream of internet evidence that they have a life-threatening disease.

If your skin is itchy (“pruritus”, in medicalspeak), it could be a sign that you have blood cancer. More likely, though, your skin is just a bit dry or that fancy new soap you bought doesn’t agree with you. Feeling a bit tired? Maybe you have anaemia or clinical depression. Or maybe you’ve just been working or partying too hard – or both.

If you have trouble sleeping, abdominal discomfort, dizziness or other common symptoms that can be interpreted in a variety of ways, you must decide whether to visit your doctor, change an aspect of your lifestyle (such as eating healthier or getting a better night’s sleep) or ignore your symptoms – at least for now.

You might fire up your laptop to see if there’s any information in the ether to help you decide on the best course of action. In all likelihood, though, it will only make your decision more difficult.
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https://theconversation.com/dear-worried-well-the-internet-is-not-your-friend-83762

Another patronising article, how dare patients actually educate themselves!
 
Yes, it's outrageous and yet at the same time it would seem patients are supposed to triage themselves. Do you:
1. Just need pharmacy advice
2. Need to call 111 for non emergency medical advice ( but they can't advise on medication)
3. Should you go to a walk in clinic for minor injuries and ailments?
4. Do you need to see your GP?
5. Do you need to go to A&E?

All very well if you have an idea about what s going on, but if it's something new very few people know what to do.
 
I worked as a community pharmacist and often was the unofficial triage. I had no diagnostic training and did not feel comfortable in this role but in many cases the answer was obvious. I think there should be st least rudimentary training since I was the only healthcare provider standing on the front lines.

There is a great need for this. While in the worst of my cfs I felt like I was having a stroke . Went to urgent care/ er a lot as a precaution then told by Medicare I went to urgent care too much. I only did this for a short period of time. I was/am a health care provider myself so I can only imagine how bad it can be for someone without experience/ training in healthcare.
 
A Qualitative Investigation of the Barriers to Help-seeking Among Members of the Public Presented with Symptoms of New-onset Rheumatoid Arthritis
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Gwenda Simons, Christian David Mallen, Kanta Kumar, Rebecca Jayne Stack and Karim Raza
The Journal of Rheumatology February 2015, jrheum.140913; DOI: https://doi.org/10.3899/jrheum.140913

Objective Treating patients with rheumatoid arthritis (RA) within 3 months of symptom onset leads to significantly improved clinical outcomes. However, many people with RA symptoms wait a long time before seeking medical attention. To develop effective health interventions to encourage people to seek help early, it is important to understand what the general public knows about RA, how they would react to the symptoms of RA, and what might delay help-seeking.

(empasis added)
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FFS :banghead:
 
Why on earth was this article published on the internet? Surely it should have been printed on a leaflet and handed out by pharmacists? Does the author (a psychologist surprise surprise) not see how she is undermining her own case by expecting patients to consult her helpful advice online? Disastrous choice of medium given her message, I'd say.
 
Luther Blissett said:
FFS :banghead:
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A friend of mine has fairly severe RA. Out of his family one parent and another sibling also have severe RA. He felt aches and pains but and thought he needed to rest up. So another couple of months went by before he consulted his GP.

His GP then faffed about with this and that before finally doing the blood tests needed. Finally, referring him to a rheumatologist at least 6 months after the initial consultation. Then there was another delay for the appt but luckily my pal had private cover, saw the consultant privately and is now on the proper meds.

So all very well to come out with this stuff , but to see a GP as a non emergency appt can takes weeks in itself etc etc
 
If I knew what my symptoms meant I would not need to see a doctor to have him/her interpret them for me. That is sort of the whole point. Not speaking about the cited study but just very generally, calculating costs based on which tests were unnecessary with the power of hindsight is meaningless unless you can somehow know if a test is necessary before you do it, and if you can, this is sort of on the GPs ordering this stuff to appease worried patients (which is probably a bit unprofessional). So yes, of course it is stupid to assume you have blood cancer because your skin itches after purchasing a new soap and without any complementary hints I would assume a doc doesn't immediately call for the full checkup that would be necessary to rule out everything that google could find. But to be able to properly do this, there was this thing GPs apparently sometimes still had to have to be able to do their jobs properly, in the before-time, the long, long ago.. It was called 'enough time for a proper anamnesis' or something.

Personally, I only know one guy who routinely goes to the doc for every little thing he worries about. Anecdote may be really limited in what it can tell us about populations, but the kicker to this story is that this one guy had an uncommon form of cancer, probably for a while before anyone figured it out. It is difficult to say if he was doctor-shopping around because he felt unwell due to the cancer and did not get proper attention in the first place, or if his general health anxiety ended up saving his life out of coincidence - however, I'd say we can take from this that being results-oriented when calculating costs divided in necessary and unnecessary can be misleading.

Now, if anyone wants to move on and take apart the cited study done by Per Fink et al, better brain function than I can presently supply would be necessary, but frankly, from the little I know about statistics it should be pretty difficult to make meaningful statements about the underlying population without a very very large amount of good data selected via a process that minimizes bias here. Naturally, one cannot go about it the way I mentioned above and just look for tests that did not find anything in people who also meet the definition of severe Health anxiety because this does not mean there really was no need for the tests in the first place - being anxious probably does not come with the side effect of being impervious to disease. Looking at the paper and taking this sentence at face value: 'We wanted to compare patients with Health anxiety or DSM-IV Hypochondriasis with patients having a well-defined medical condition according to their FPs[...]', coupled with the assumption that the authors succeeded in doing what they set out to, would give us a number (regarding unnecessary health care utilization) for people who do have the severe anxiety but no other condition. It may be of theoretical interest to know this number, but unless we can somehow figure out who the otherwise healthy people with Health anxiety are, this does not translate into better medical practice. I would wager that health is not a static thing even for people who are diagnosed with psychiatric conditions, so again we cannot just figure out who the otherwise healthy people under the anxious ones are, but we would have to find a process to determine at every point in time if testing is needed for a particular person, again leading back to my former point about GPs needing enough time to do proper anamnesis. There is a chance that this might be a bit easier to do with people who are anxious since they will tend to be aware of things that average people miss if it is possible to account for them possibly exaggerating, but that is a minor point. The major point is that being aware of a patients psychiatric condition (or any other health condition, really) should never ever make the care this person receives worse - it should be taken into account and after factoring it in the care should be the same. Jumping from the theoretical number of £s that a psychiatric condition costs due to possibly not effective primary care for that condition to whatever it is the author of the article in the OP is getting at looks 'a bit questionable'.
 
Andy said:
From earlier in the year, I also think it was shared elsewhere at the time.

https://theconversation.com/dear-worried-well-the-internet-is-not-your-friend-83762

Another patronising article, how dare patients actually educate themselves!
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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?
 
@TiredSam @rgn007

Also make sure pwme are not swept up into 8, they are prescribed B12 when recommended by Consultants, they are investigated for heart issues when they have heart symptoms and not left to deteriorate, nor told that ( many) people with ME are mad when visiting a cardiologist with heart symptoms.
 
Hi @rgn007 & welcome!

I sympathise with much of what you say. However, I would rather see people being penalized for making appointments and not keeping them - especially if they do this more than once.

I think many of the situations you describe might be eased by education and maybe someone taking the time to explain why another test or whatever is not necessary.

The 10 minute appointment slot may not always be enough for the patient to feel that they have been heard and understood - even if they have been.

The difficulties of seeing the same GP (for those who prefer it) can lead to a lack of faith or trust.

Patients don't always understand the system and so can make unreasonable demands without realising the issue. Even in making appointments different practices have different systems in p!ace and good receptionists will explain the system and be helpful but bad ones don't.

The truth is the health service is a complex beast to engage. So I would educate first.

The problem with being discerning can be where do you stop....It could be the thin end of the wedge in preventing people who genuinely need it accessing it because of the behaviour of other people.
 
The other side of this coin is people who don't seek help when they should.

Someone very close and dear to me had a history of gastric and digestion problems. They had a lot of heartburn etc. They would have good phases and bad phases and that was "normal" for them.

Then they had a couple of bad days with heartburn etc. They took their usual remedies with no great effect. Not terribly unusual. Then they dropped dead. Literally.

It turns out that they had probably been having smaller warning heart attacks and attributing them to heartburn. They were otherwise seemingly fit and active.

I guess it's possible they would have died even if they had sought help - but we'll never know.
 
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I recently found out that according to my medical notes I repeatedly miss appointments, in one sense this is true, in another it is not. In the last 25+ years I have "missed" precisely one appointment, due to being asleep at the stated time due to taking the extremely sedating meds my GP had recently prescribed.

Every single other appointment which I have not attended, all of which were made by the surgery, not by me, I have either phoned to cancel/postpone, had someone else phone, or filled in and sent/had sent the "I will not be attending, stop sending me these appointments" slip at the bottom of all appointment letters. Normally giving at least a weeks notice, in several cases over a months notice.

But in every case, according to my medical notes, I missed the appointment, without notice, please inform the patient that the surgery must be notified.......

So.....simply because someone's notes say they are frequently missing appointments.....doesn't mean it's so.
 
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Wonko said:
So.....simply because someone's notes say they are frequently missing appointments.....doesn't mean it's so.
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Well that is certainly true. I know I have found relatively small errors in my notes. Other peoples test results etc

I know others who have had some fairly serious mistakes - some notes from a stranger mixed in with theirs, diagnosis of addiction, surgery they'd never had.

The lady who lives across the road from me had the GP query her elder!y mother's reluctance to be examined. He mentioned that there was no mention of any recent psychiatric appointments. My neighbour asked why he thought there would be. It turns out that according to her notes she spent 3 months in a secure psych ward - not true, she'd never been diagnosed with mental health issues of been referred.

Not only are there obvious health risks to having the wrong notes but also these mix ups could be damaging when seeking support for benefits or claiming insurance. I could easily see someone claiming that you were failing to engage and comply @ Wonko. Even though that is completely untrue.
 
Hi, @rgn007, welcome to the forum. It's good to have someone with your experience and perspective joining us. I can see your perspective on all those 'demanding' patients. I think it is largely down to education - a lot of those things you list may seem obvious to you with your medical knowledge and experience, but for many people the body is a complete mystery, and every little thing is scary.

Do you have a solution?

My surgery has telephone consultations which you can book by phone and get a phone call back the same day from a GP. I'm sure this saves a lot of appointments, and for me, being housebound, it's a godsend. I only found this service existed by chance - as I did also the repeat prescription procedure, and the fact that some chemists do home deliveries to the housebound. I think doctors surgeries could do more to educate patients on how best to use, and not overuse or misuse, the different services available.
 
Wow, sort of self-contradictory, isn't it? On the one hand, we shouldn't be bothering our doctors with our health questions. On the other, we shouldn't be trying to answer those questions ourselves either. Well, which is it? Should we try to get some useful information ourselves? Or rush straight to our doctor for the answer to every health question? You can't have it both ways.

Medical doublespeak is getting manic. One side of the face is imploring us to outsource all responsibility for heath care to the properly qualified people. "See your doctor if symptoms persist!". The other side of the face is telling us to bugger off with our questions, we're hassling them too much.

But its reassuring that none of the commenters agreed with the article. :thumbup: Some people trying to be pretentiously clever, but none really agreeing.
 
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