Wednesday, December 16, 2009

Doctors should be advocating against patients' digital exclusion, not scare-mongering.

This post in an edited version of my comment on KevinMD's post on "Patients using internet health information without physician guidance".
I’m a doctor. I’m a GP (family doctor) in Wales, UK and I teach medical students. I work in a deprived area and I wish that many more of my patients, rather than less, accessed information that could help them be more healthy. But many of my patients do not have easy access to the internet. This impacts on their health in many ways. One that is less often considered is that digital exclusion leads to reduced income.

Recently there was a post on StoryTellERdoc about “Grim Google”. This related the story of a young, healthy man who presented in ER with bright, red rectal bleeding convinced he had bowel carcinoma because he had googled his symptoms and saw that this was a possibility. The story itself and most of the comments are quite scathing. But is this the appropriate response to this episode?

In the UK we know that despite universal access to healthcare we still have differences in cancer survival rates between areas, with patients in well-off areas living longer. This may partly be due to delay in diagnosis.

With regards to late-stage diagnosis of colorectal cancer, research in 1996 in the US showed that patients living in areas of low socio-economic status (SES) were significantly more likely to be diagnosed at a late stage compared to those living in areas of high SES. You may think that times have changed, but more recent research in Denmark- covering 1996-2004- shows that older, wealthier patients, and younger more highly educated patients are less likely to be diagnosed with rectal cancer at a late stage.

So a simple story that seems to illustrate the fallacy of patients trying to diagnose themselves online, may instead represent the awareness and health behaviours which mean that those with the know-how feel empowered to seek care for what could be life-threatening symptoms.

We should be encouraging more of our patients to access health information, especially those who will find access harder. In fact we should be advocating against digital exclusion because its influence as a cause of health inequalities may increase in coming years.

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