August 17, 2007, 4:36 pm

Looking For Stress in All the Wrong Places

apple

There is a lot going on in this ad, but what isn’t going on is communication!

The doctor is talking vitamins but is ready to incise and drain an apple.

He isn’t even looking at the patient…

…who isn’t even listening!

I guess the way to a patient’s heart is not holding up a piece of fruit and shouting “VITAMINS!”

Something tells me the guy-with-the-hat is a lost cause anyway.

He is too busy thinking about the twelve-inch juicy porterhouse steak, fried potatoes and buttered green beans he’s going to have for dinner!

******************************

They took away our internet access at work.

Not sure why. It was house-wide, not just the ER.

It was sure hard for the doc to look up a drug yesterday, he had to actually call a pharmacy at 0230 for the information.

I seem to remember looking stuff up in books.

I’ve use the ER computers to download detailed diabetes information in Spanish, or more thorough information on various diseases for my patients.

Okay. On the occasional slow night a Zuma game (or two) might have occurred.

Not that I ever participated.

FYI: don’t learn about Zuma, don’t download Zuma and don’t play Zuma. I downloaded it at home and it is so completely addicting it is scary.

Yes, it is that good bad.

******************************

I know patients use the internet to look up health information. It can be a great resource for them.

It can also scare the hell out of them.

*****

The triage patient says “I looked it up on the internet, and….”

A lightening bolt of dread strikes the heart.

You see, it is never “I looked it up on the internet and was highly reassured that it is not serious.”

It’s “I looked it up on the internet and I’m dying of liver cancer.”

I did not make that last sentence up.

*****

You can’t fault the patients here. They have access to information and knowledge that was unheard of just ten years ago.

In fact, the amount of information available on the internet is incomprehensible.

Ay, there’s the rub.

Patients have access to the information.

What they lack is context.

That lack of context leads to unnecessary anxiety and often an unnecessary emergency department visit.

*****

Rectal pain and some blood noted in the stool. Not an unusual combination of symptoms, but ones that might lead a person to seek medical advice.

The person who sat in front of me at triage complained of those two symptoms.

A fissure from straining? Possibly. A hemorrhoid? Maybe. A peri-rectal abcess?

Bingo!

No, the patient did not have a peri-rectal abscess but he thought he did. He had googled “rectal pain” and when he found peri-rectal abcess as a possible cause, he came to the ER.

No, excuse me, he ran to the ER.

I don’t fault him for coming to the ER! A peri-rectal abcess is extremely serious. He was frightened out of his wits, sitting there in the triage chair. Visibly shaking.

Seeing his fear, I asked him if he had ever had a peri-rectal abcess or knew someone who did. The answer was negative. But he knew all the potential complications of having one; he had just educated himself on the subject.

Through the internet.

*****

I did not belittle his perception of his problem. But… he didn’t have any pain right at the moment and he was sitting perfectly fine in the chair. No fever or chills. I’ve seen patients with peri-rectal abcesses and they are pretty sick, usually going to surgery right from the ER.

This guy was not sick.

His diagnosis: internal hemorrhoid.

He immediately relaxed, relieved that it was “only” a hemorrhoid.

*****

When I look up a cluster of symptoms on the internet, I don’t get anxious because I have the benefit of context – I know what I am seeing.

How scary is it to the average lay person? They gravitate to the most severe diagnosis they see on the web. They have no context, no experience to help them navigate the massive amounts of available information.

I wonder if the accompanying anxiety is worth the access to information.

********************

And that “patient” who thought he was dying of liver cancer?

It wasn’t a patient. It was my husband. He runs a bilirubin that is slightly above normal and decided to look it up.

He doesn’t have liver cancer.

13 Comments

  • Beastarzmom
    Beastarzmom

    August 17, 2007 at 5:38 pm

    Do you read Graham’s “Over My Med Body” http://www.grahamazon.com/ ? (specifically – http://www.grahamazon.com/2007/08/patients-should-not-control-their-medical-record/ )He has a little opinion about a very similar issue – that of patients accessing and documenting in their own medical record. It is definitely food for thought. Especially given these reactions, which happen all the time!


  • […] continues at Kim brought to you by diabetes.medtrials.info and […]


  • Marijke
    Marijke

    August 17, 2007 at 6:52 pm

    I hear you! I often have to explain to people how to check for information and not to freak out because the drug they’re taking lists seven pages of side effects. Ok, slight exaggeration, but you know what I mean.


  • TC
    TC

    August 17, 2007 at 8:53 pm

    Remember in nursing school we’d all be convinced we had whatever disorder we were studying. I guess I’m not really incensed at people looking up info on the internets like some are. I think people are going to look for things to worry about whether it’s the evening news or whatever.

    My real beef is with the internet thing. We haven’t had access to it for ages at the hospital. It’s bad enough I have to punch a timeclock. And the residents have internet in their rooms. But I guess one too many nurses looked up porn or did some shopping. Or the Zuma. Now it’s totally banned, like we’re bad high school kids instead of professionals. I hate it! How many times I wish I had the internet to look up some strange syndrome or drug my patient is taking. It totally irks me.

    p.s. I’m more of a snood fan myself.


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  • AlisonH
    AlisonH

    August 17, 2007 at 10:24 pm

    If I’m ever your patient, tell you what, I’ll loan you my Sidekick phone and you can go squint at the tiny screen. It’s slow at downloading, but if that’s all there’s gonna be… (And in a hospital setting! I can’t believe they did that!)


  • Liana
    Liana

    August 18, 2007 at 9:41 am

    I saw a guy in the ER whose reason for coming in was “I think I’m infested with the African eye worm loa loa.”

    Hooray for google.


  • TLL
    TLL

    August 18, 2007 at 10:47 am

    I agree, it can get completely out of hand. My daughter has a fever of unknown origin (>104) off and on for the last 5 weeks, so I’ve been doing my own internet research. OMG she has Typhoid fever!! Wait, no, she doesn’t have any of the other signs. OMG she has Hodgkin’s lymphoma! Wait, no, she’s had clean blood work, including a blood smear. I decided I was doing more harm than good, so I’m going to let her Dr. obsess over it instead of me.

    On a side note, a good friend diagnosed herself with Cushing’s a while ago, the Dr. wouldn’t believe her, said it must be something else. A year later, she finally convinces her Dr. to let her have an MRI (I think), sure enough, her pituitary is one large tumor. Her surgeon told her that she would have died shortly if she didn’t have it removed when she did. So, maybe sometimes it can be a good thing.


  • Fallen Angels
    Fallen Angels

    August 18, 2007 at 11:19 am

    OMG!! ZUMA is so, so, so GOOD (bad)! I love that game and have to actually set a timer when I play so that I can be reminded that break time is over…must go back to studying.


  • Peggikaye
    Peggikaye

    August 18, 2007 at 11:24 am

    it’s a catch 22 for those of us with chronic illness … I have lupus and myashtenia gravis.

    I get a new symptom …and I go looking before I head to the doctor *whew!* it’s a lupus symptom!

    I am NOT going running to the doctor every time a new ache, pain or weird symptom crops up! There simply is just too many when you have systemic lupus!!!! Add myasthenia gravis to the mix and your whole body goes banana’s.

    If it’s listed as part of the lupus, then I know to wait till my next appointment.

    The internet is a God send to those of us with our heads planted firmly on our shoulders and our feet on the ground.


  • Caroline
    Caroline

    August 18, 2007 at 5:49 pm

    I am pretty sure I have a new disease every day, yes, but I’m a nursing student. I love that patients are trying to educate themselves but I can see how it could get out of hand. Had a friend who was certain her Mom had normal pressure hydrocephalus. She may or she may not, but my friend is terrified. Not good…


  • Nurse Betty
    Nurse Betty

    August 20, 2007 at 11:54 am

    I’m more of a Mahjong fan, myself. 🙂

    Why on earth can’t your hospital just filter website access? The IT dept. can easily set up a network firewall to block sites with tags like “Adult”, “Shopping” or “Games”, or even set up very specific access ONLY to UpToDate, Medscape, ePocrates and so on. Blocking ALL internet access is both lazy and a bad idea.


  • Ken
    Ken

    December 11, 2007 at 2:46 am

    Sometimes the internet is the only way a patient can get the whole truth after being lied to by some of people in the medical community!


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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