Carlos was accustomed to dealing with stress and deadlines. As a systems engineer he lived a life of details and constant interruptions, but this new project seemed to be pushing him to the edge of his patience. The headaches started a few weeks earlier and were affecting his ability to concentrate on his work. At times he felt that the pressure behind his eyes would push them out of their sockets.
Carlos decided to take a short break from his work and he entered "headaches" into his computer's search engine. In less than a second it found over 34 million hits, providing him with more information than he could ever read, so he decided to open a few of the more familiar-looking sites.
After 10-15 minutes he found himself searching "brain tumors" and being confronted with another 4 million sites. What impressed him most was that there were some very bad brain tumors that could kill him in less than a year. As his throat tightened and his heart started to race, he decided to head home and do a little more online "research" into what was certainly a serious problem.
At first glance you might think that Carlos was overreacting and that you would never respond in such an illogical fashion. Think again. The Pew Internet and American Life Project reported that 80 percent of all American Internet users, or 113 million people, searched for health-related information in a single year. The Internet is a terrific source of valuable health information, but the study revealed that the individuals using it did not discriminate as to the quality of the sites they visited or the great variation that exists from one site to another. Like Carlos, they could put in a common symptom and come up with a serious illness.
Just about everyone is familiar with the term hypochondriac, a condition that has existed for as long as man has been aware of the relationship between symptoms and illness. Famous hypochondriacs have included Adolf Hitler, Tennessee Williams and Howard Hughes.
Hypochondriasis is the fear of a serious illness that continues despite the reassurance of physicians and testing. These fears and anxieties about illness may become debilitating and interfere with daily life. In the past people, would go from doctor to doctor seeking an answer, but now many people never see a physician and rely solely upon online information. For hypochondriacs and the "worried well," the Internet is fertile ground to escalate their concerns. This interaction of excessive anxiety brought on by the use of online health information has been coined "cyberchondria."
How Does It Happen?
In 2008, Microsoft published the results of a large study that looked at how people search the Internet for health related information. They looked at 40 million page samples for three common symptoms -- headaches, muscle twitches and chest pain. What they found was that search engines, unlike physicians, do not understand "diagnostic reasoning" and therefore do not discriminate between common benign disorders and less common serious problems.
The ranking and appearance on a search page is not in the order of how likely it is to be that individual's problem. A physician will consider many variables such as a person's age, past history, associated medical problems and symptoms, while factoring in the level of anxiety, depression or other emotional problems. The Internet is impersonal and does not currently take these other factors into account.
An Internet search for a common symptom like headaches would over represent serious problems. While migraine and tension headaches are much more common than a brain tumor, an online search can take one down the same path that Carlos traveled.
The Microsoft study confirmed that searching can lead to an escalation of symptoms and become a transformation of benign symptoms into concerns about more serious illnesses. A person's anxiety over his headaches leads to an Internet search that takes him to a discussion of brain tumors. Both the search and the anxiety can escalate as the person spends more time searching for information about brain tumors.
The focus is now on more serious conditions and the person has been diverted from the much more common and probable diagnosis of migraine. By the time Carlos arrives at his doctor's office, a stack of search printouts under his arm, he will demand an MRI scan and additional testing to allay his fears of a brain tumor.
Refining Search Engines
A better understanding of medical anxiety caused by the Internet, should lead to better search engines. The Microsoft study concluded that, "Beyond the potential problems with the quality of medical content ... we believe that Cyberchondria is based more centrally on intrinsic problems with the implicit use of Web search as a diagnostic engine."
In their study, 75 percent of the people surveyed had at least once interpreted the ranking of web search results as indicating the likelihood of a disease. Benign muscle twitches quickly become Lou Gehrig's disease and the person's anxiety escalates as quickly as the search engine spits out new results.
Laymen and even physicians will ignore the "base rate" or low probability of a rare disorder and may immediately assume that their symptoms are due to a serious condition, ignoring the very low probability. The large amount of information on the Internet about serious and rare illnesses can make that information readily available to laymen to interpret without the benefit of medical advice.
What Should You Do?
• Become an informed user of search engines and be aware that the ranking on the page does not necessarily correlate with the quality of the information or the frequency of the disease.
• Ask yourself, "how much time do I spend searching health related materials and looking for a diagnosis?" You may be a cyberchondriac.
• If you find yourself stuck in a search of serious or rare diseases -- stop searching and get a medical opinion.
• The Internet is a source of a great deal of useful information, but many times it is best to use the Internet in partnership with your physician.
• Talk with your physician and tell her what is making you anxious, but be willing to accept that it may be something simple or something for which there is no clear cut explanation.
Finally, I see many patients who I tell, "Your symptoms fall in a category I call 'life's unexplained events' and we will just have to wait for awhile and see what happens." Sometimes, not giving symptoms a name is better than embracing the wrong diagnosis that you found on the Internet.
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