View Full Version : Concerning Dr. Google...
I went to my gastro yesterday (initial visit after 3 month wait). I've been terrified of various cancers (as we know is common with health anxiety).
He and I were going over my issues and he was writing everything and he stops.
He says "and have you been researching online?"
"yes"
He replies "It's not usually good to look health things up things online. Causes unnecessary anxiety." That was all that was said about the matter. Nothing more was said about online information.
We continue with the visit, including the exam. At the end of the visit he says.
"Now, if you experience any bleeding between now and your scope, it is most likely the hemorrhoids, but if it is worse or something else happens then call me and we will get your appointment moved up."
Then he looked at me and said
"Do...NOT... Google."
Sorta implies this is starting to become an issue for doctors as well as those with health anxiety, don't you think?
Yeah it certainly is. It's not just disease related conditions. I know of colleagues in community pharmacy who are seeing people coming in having read drug reviews online, petrified about their medication. Or they list some extraordinarily rare side effect, that nobody has heard of, and panic about that.
So yes Google is certainly becoming a real issue in all aspects of healthcare.
RadioGaGa, the funny thing about that is that sometimes these are the same people who have no problem taking some herbal supplement that does who know what. Since there isn't an official side effects list that comes with a bottle of say, turmeric, people don't worry about that.
MyNameIsTerry
31-03-19, 02:54
It can be useful but it's a lot about the person using it. If you are a HAer then it's a big no no straight away until you have sorted out your anxiety disorder(s).
Not being a HAer I cna use it because I am more likely to look away from the scary stuff it returns. But it can be useful in gaining some understanding of a condition as doctors are not always helpful in explaining things or have the time to do so. For instance, people sometimes raise threads panicking they have asthma yet the vast majority of us live normal lives...but GP's and "asthma clinics" are pretty pointless as they rarely bother to talk to you about how to manage your condition and just throw inhalers at you.
There are definitely a lot of bad points about it though and not just for those with HA. The internet in general. So much information and not all helpful or relevant.
Sparky16
Very well said! It would amaze you the amount of people that don't consider aspirin a 'real' drug. Or St John's wort, which interacts with basically everything.
Herbal does NOT mean safe!
MyNameIsTerry
31-03-19, 15:06
Sparky16Very well said! It would amaze you the amount of people that don't consider aspirin a 'real' drug. Or St John's wort, which interacts with basically everything.Herbal does NOT mean safe!
Like many things from vitamins & minerals to food. Better awareness is needed and common sense.
Better regulation is needed. The trouble is they tend to swing from lack of regulation to over the top banning of stuff so I'm not sure whether I would welcome more regulation :shrug:
From your point of view what do you make of the PIL's? Definitely scary to anxiety sufferers but how much do they influence the non anxious? In he past people probably didn't read beyond the usage instructions but now...
It can be useful but it's a lot about the person using it. If you are a HAer then it's a big no no straight away until you have sorted out your anxiety disorder(s).
Not being a HAer I cna use it because I am more likely to look away from the scary stuff it returns. But it can be useful in gaining some understanding of a condition as doctors are not always helpful in explaining things or have the time to do so. For instance, people sometimes raise threads panicking they have asthma yet the vast majority of us live normal lives...but GP's and "asthma clinics" are pretty pointless as they rarely bother to talk to you about how to manage your condition and just throw inhalers at you.
There are definitely a lot of bad points about it though and not just for those with HA. The internet in general. So much information and not all helpful or relevant.
This is such an amazing point. As an HAer in some level of recovery, symptom surfing on Google often lead to panic. Looking up vague problems and symptoms lead me to dark places.
But when I was diagnosed with a real, severe, and dangerous medical issue, Google was a godsend. I knew how dangerous it was, I knew what I was in for, and Google and the groups it lead me to brought me immeasurable peace of mind.
This event gave me real insight to how useful Google can be for genuine medical issues, but in the former case how bad it can be for suspected medical issues.
For instance, if one has diabetes, it is great. You could find recipes, guides for living with it, support groups etc. But if you only suspect you have diabetes, the result of a Google search leads to limb amputation, blindness and kidney failure. It is the same Google search with dramatically different results and reasoning behind it.
Pils are a bit like giving people a list of every illness they MAY encounter throughout their lifetime. So, for the anxiety sufferer it is certainly not good - then we have to be aware of the nocebo effect. e.g. People see a side effect, expect it and then 'develop' it.
There's a bit of debate surrounding this with the drug finasteride, which can lead to a syndrome called Post Finasteride Syndrome. You can read into it, but there's certainly hot debate about the validity/''realness'' of it. Most case reports come from people using the 1mg dose for male pattern baldness... Rather than the 5mg dose for prostate hyperplasia
On the other hand, if we have a drug which causes a headache as a side effect, for example, and someone with HA develops a headache whilst taking it, their anxiety might make them think 'brain tjmour', but then they check the PIL and see it listed as a side effect, hopefully reassuring them
Definitely more public education is needed, because people not considering aspirin (an example) a real drug can cause issues.... As to how we go about this, I'm not sure as we're already in a cash strapped NHS!
Would also say re pils, they can also be a pain in the backside to remember about. Obviously if you're giving an OP, the pil is included, but if you're breaking a pack down, you always have to remember to actually include one. Which can be a nightmare if someone has used the last photocopy, hasn't replaced it, and you have to go onto EMC to print a new one out lol
The majority don't read them, some will for various reasons. But it's that one time you forget, and a complaint will arrive. Obviously if you're telling someone to take a drug, they have a right to know what side effects may occur, so probably there's no real argument against giving them - certainly not an overruling one.
Finally home at the desk top and this discussion actually made me bring this up in work today :roflmao:
The problem as well is what people hear from their neighbours/friends/family/colleagues etc. One quarter of people prescribed SSRIs will not actually get their script dispensed from the pharmacy OR take more than the first dose. Factors contributing to this are, as I said, what they hear from neighbours/friends etc. My mother for example doesn't have health anxiety, but she will avoid reading the PIL on the rare occasion she is given a medication. This is because, and I quote, "I'd rather not know what the side effects are". Other people want to know, which is fair enough, but as I said with the anxiety sufferer, this can increase their anxiety and cause the nocebo effect.
Here's an interesting study on the link between Finasteride and the nocebo effect. (https://www.ncbi.nlm.nih.gov/pubmed/17655657)
Although a small study, there was a much larger study involving several different classes of drugs (and I think Finasteride as well) which found the rate of ED increased 10-fold when patients were told to expect it. I was told of the latter by a colleague this morning, so don't quote me on the exact figures.
Another common problem is the hypertensive. It's called "the silent killer" for a reason e.g. you generally don't know you have HTN, unless you have a hypertensive crisis. Then, people get prescribed medication for it, but because they "feel fine" they stop taking it, or because they take Furosemide at night (when they shouldn't, it should be the morning) and they end up getting up to urinate all night, and their doctor or pharmacist failed to mention "take in the morning".
Then of course there are the scare stories in the Daily Mail/The Sun. 'Nuff said.
There are "the five rights" of medication:
* Right patient - is this Joe Bloggs and not Jimmy from the bed across the bay?
* Right route - do they need IV/SC/PO
* Right dose - renal impairment? Hepatic impairment? etc
* Right time - e.g. Furosemide in the morning not night or critical list medication (e.g. Parkinsons)
* Right medication - e.g. have they selected the correct medication (selecting Paracetamol instead of Pregabalin, confirmation bias)
The right route cannot be emphasised enough IMHO, as what a patient is being given will affect their concordance. Say, for example, we have a patient with oesophageal cancer - is it really wise to give them large tablets? Probably not (although, a lot of the time, they can cope). So check if swallowing difficulties are present. Capecitabine, which is given for several cancers including oesophageal, comes in two forms - 150mg and 500mg. And, having handled these tablets many times, the 500mg are substantial (as 500mg are). As such, dissolving instructions are supplied.
Clear instructions should be given as well - e.g. a reducing course of prednisolone, which can be complicated, especially to an 80 year old with COPD. Counsel, explain (for example) their dose is reducing by 5mg every third day, and have a carer/relative present. Steroid card is given. Written instructions should be clear.
An 80 year old lives alone and has angina - they live in a 2 storey house. They should be given a minimum of TWO GTN sprays. Why? To keep one upstairs, and one downstairs should an attack strike and they can get to it in ample time. Three would be well within acceptable limits as well, to keep in their pocket or handbag, should they be out and about.
Skillets: Say we're dispensing Temozolomide in hospital for patients with GBM. There's likely to be "polypharmacy" going on e.g. Ondansetron for nausea, dexamethasone for swelling, omeprazole for the steroid, Bisacodyl/Docusate for constipation etc. So a lot of skillets and a lot of meds. Temozolomide rarely goes out at just one strength, unless the patient is very petite. As such one strength (e.g. 20mg) will be put in a smaller skillet and the other strength (say 100mg) will be put in a much larger skillet to avoid the "did I take that already?" confusion. We'll try to "mix" the skillet sizes around as much as possible. This applies to most cancer patients, not just those with brain cancer. But obviously with brain cancer they're at increased risk of confusion.
There are so many ways in which concordance with medication can be affected. I could go on all night. But patient concordance is not just the patient's responsibility - it is the healthcare professional's as well.
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