Webical diagnoses

The internet is no substitute for a medical professional

When I got sick a couple of weeks ago, my first instinct was not to call the doctor. Nor was it to crawl out of bed and into line at McGill Drop-in Clinic before 8 a.m. Instead, the first place I looked was WebMD. And I am probably not the only one.

WebMD is a website that offers a multitude of services. It provides in-depth information on a variety of both common and obscure diseases. It offers information on drugs and supplements. It has a “Healthy Living” section with diet information. But, what WebMD is perhaps most famous for is its symptom checker. This tool is straightforward: the individual essentially tells the website what hurts on a diagram of the body, and in what way. The tool’s algorithm will churn its cogs and, for any given mix of specific symptoms, produce a list of possible ailments sorted by relevance.

WebMD was created in 1995, but did not become successful as a search engine and information hub until 2003. After that, growth of this and other health search engines and self-diagnosis tools was so rapid that by 2008 Microsoft dedicated an entire research study to the emergence of “cyberchondriacs”. Amelie Quesnel-Vallee, an associate professor of Medical Sociology at McGill, explained in an email to The Daily that this phenomenon is a result of these tools’ attempts at exhaustiveness, which leads to a listing of conditions “from the mundane and widespread to the serious and extremely rare.”

It is this diversity of possibilities that, to put it bluntly, freaks people out. Even if you know you probably have the common cold, it is easy to suspect that you may have one of the more dire diseases that appear further down the list. For some, this is enough to send them to the doctor’s office seeking confirmation or, hopefully, negation. Pierre-Paul Tellier, coordinator of Student Health Services at McGill said that this can sometimes come as an annoyance to doctors, who “want to know what their [patients’] symptoms are, not what disease they think they have.”

WebMD is not the only virtual diagnosis tool, nor is it the only site culpable of encouraging these cyberchondriac tendencies and the ensuing trips to the doctor’s office. The very design of these sites makes these effects unavoidable. The distinction between a meaningful and a meaningless symptom is not one that a computer algorithm can determine.

Furthermore, Quesnel-Vallee noted that “because of liability, these websites tend to tell you there might be a problem when there is no problem.” This tendency, she said, leads to “more, not fewer physician visits.” While WebMD’s mission is to “streamline administrative and clinical processes,” it has actually accomplished the opposite, increasing the burden on already understaffed and inefficient health services.

“As individuals, we know when we are out of sorts. However, what we are ill-equipped to answer is the extent to which that individual deviation from our own baseline is clinically significant or not,” Quesnel-Vallee said.
Obviously, WedMD and other such websites are a poor substitute for proper medical attention, so why use them at all? WebMD is in the top 200 most trafficked websites in the United States and in the top 600 in Canada. It could be that many in our society are lacking what Quesnel-Vallee calls “a long-lasting relationship with a good primary care physician.” Certainly this is the case for students, many of whom are living alone and away from home. Dr. Tellier also suggested that impatience may be a reason for the popularity of these sites, saying “This is a way they can get answers right away when they are anxious.”

A slightly more psychological analysis of sociological trends points to the growth of our unwillingness to blindly accept decisions made by others – even if they have authority. We live in a society where so much of what we do is self-monitored and where we have so much control over the ways in which we lead our lives. It is natural for us to want greater control over that which is closest to us – our bodies.

And using online symptom checkers gives control to the individual; not only can you check symptoms on your own time, without the hassle of making an appointment (in fact, WebMD’s symptom checker is available as a Blackberry and IPhone app for on-the-go diagnosis), but you can also control which symptoms the most emphasis is placed on. Using an online tool the moment you feel under the weather can be empowering – but Quesnel-Vallee has noted this can actually lead to more worry than relief.

But, after all, an ounce of prevention is worth a pound of cure, and, as such, these sites also offer health education in addition to their purported clinical services. They are information hubs for all things medical. Many of these sites have valiant intentions: FamilyDoctor’s mission statement states that articles are written at “a grade eight reading level to make information understandable and accessible to all users.” Despite this, equal access of information is still not a reality. In fact, one of Quesnel-Vallee’s students here at McGill found that “individuals who seek health information on the internet are usually better educated to begin with, and are more health-oriented.” That is, the populations that already know a significant amount about healthy lifestyles and disease prevention are the same populations that have access to, and are familiar with, informational health sites. On the other hand, “the populations most likely to benefit from this additional information may not be getting it,” Quesnel-Vallee said.

It is possible, that with time, these sites can grow to become what they were meant to be – a means of offering clarity of information and efficient medical support. But, for now, it is clear that they have not achieved either the goals set out for them by their creators, nor have they merited the trust placed in them by their consumers. While these websites offer a quick and easy substitute for medical attention, these diagnoses are a long shot from being accurate or reliable. A better alternative may be telephone services such as Telesante Quebec, 8-1-1. They are quick and easy but are slightly more flexible – and less encouraging of paranoia – than websites. In a futuristic world, an online tool might accurately and reliably diagnose a single disease from a list of symptoms, but today that ability remains in the hands of trained doctors and nurses. That being said, WebMD and websites of the like cannot magically reform their online diagnosis tools overnight. Instead, we as consumers should always keep this distinction between online tool and medical specialist – a caveat emptor of sorts – in our minds when we seek out these speedy solutions to our day-to-day ailments.