Dr. Google

You don’t have to read medblogs for long to learn that doctors do not appreciate it when patients research symptoms on the internet, then show up for an appointment with printouts.  Irritating the person who’s supposed to be helping us isn’t a good idea, so it makes sense to not take printouts to appointments.

That doesn’t mean patients can’t read reliable websites (Up-to-Date and Mayo Clinic are good places to start).  It just means that we ought not tell the doctor how to do his/her job.  It goes over much better if we don’t provide a diagnosis; patients provide symptoms and let the doctor come up with a diagnosis.  At least that’s what the medblogs say.

But what if the doctor’s diagnosis is wrong?

I’ve written before about the red sores that my rheumatologist and family physician thought might be psoriasis, but my dermatologist diagnosed as nummular dermatitis.  Those &#%$ spots show up if I miss one of my cimzia/mtx injections, and take a couple months to go away — unless I dig into my stash of prednisone, in which case they are gone in a couple weeks.  It’s obviously something related to the RA, but what?

Well, recently I googled another symptom (completely unrelated, I thought) that has plagued me for well over a year.  I find it bothersome, but not something I’d dream of making an appointment about. It certainly would never come up in the course of conversation at the doctor’s office.  However, in reading the differential diagnosis for that symptom, up popped vasculitis.  Really?  Others with RA have mentioned vasculitis, but I didn’t know much about it, so started reading.  The articles include photographs of red sores, mainly on the legs, that look very much like what my dermatologist said is something completely different. Reading about vasculitis is frightening, so I hope that’s not what this is.  But I need to know.

At my next appointment, I think I will ask if it’s possible that those red blotches all over my skin could be vasculitis instead of nummular dermatitis. The trick is finding out without annoying my doctors.

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4 thoughts on “Dr. Google

  1. This is always a problem and while I remind myself that doctors know more about medicine, I’m the one who knows most about my body. I never take in printouts but I always arm myself with information beforehand so I can at least ask intelligent questions, like, “Do you think it might be XYZ because when I do this, that happens.” I used to get these really weird rashes that the dermatologist said was allergies and the allergist said it wasn’t but that prednisone cleared up. They’ve stopped altogether since I’ve been on RA drugs. Like you, since then I wondered if it wasn’t vasculitis. It’s certainly worth a discussion. (It was great meeting you and your husband in Boston! Hope you guys have a wonderful holiday season.)

  2. I’d think any smart doctor would be glad that their intelligent patient tried to educate herself, rather than accept her fate in ignorance. But that’s just me. I hope your doctor will be nice about answering your questions and explain his or her reasoning. Vasculitis as a co-morbidity of RA is serious. I hope Dr. Google’s diagnosis is wrong.

    On another note: HI! It’s good to hear from you again! I’ve missed your “voice.” It’s always a gentle dose of calm and reason. I hope you’re feeling okay, and I’m sending a hug winging north just for you. 😉

  3. Great post and thought provoking, as usual, Socks. As a curious Family Physician, I welcome patient ideas, theories, and input about their health. It’s a nice shortcut in a complex process. i have a concept called “prove the patient right” in developing the differential diagnosis that relates to the patient’s problem(s). I’ve written about the differential diagnosis in Family Medicine several times on my blog (www.DrSynonymous.blogspot.com), often using a mnemonic SPIT. What is Serious, Probable, Interesting, and Treatable that may be causing the problem(s)? . The Interesting one is the patient’s theory, which we then process as the most important item on the list. I enjoy this shortcut. Caution: There is a tension between Working and Caring in the doctor’s office. The work that has to get done may have a rhythm that precludes openness to patient input during certain steps in the diagnostic and therapeutic process. Honoring that rhythm and engaging during the caring times will enable better patient input. If the doctor doesn’t seem to care, addres them by their name which takes them out of trance, giving an opening to provide input. (I’m always surprised to read about my colleagues who don’t seem to be having fun with the practice of medicine). apj

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