Pain, a Limp and Winkle Picker’s Disease

Doctors who treat themselves may have fools for patients, but they look like geniuses compared with a reporter who tried to diagnose herself via the Internet.

It seemed so simple. I Googled “foot pain,” and up came two sites with neat little pictures of feet, arrows pointing to various parts and instructions to “click where it hurts.” I clicked and, voila! both sites said my pain — on the top and side of the foot, around the big toe — was probably from a bunion or gout.

Gout? Hmmph. What came to mind was Henry VIII, the movie version, hugely fat and grotesque on his throne, bellowing about his toe. As for bunions, weren’t they from pointy shoes, high heels, a family history? I had none of those. This wasn’t quite adding up.

This outstanding medical reporter totally missed her diagnosis using Google.  Diagnosis requires a better understanding of epidemiology, physical exam and then history than most internet searches have.

Now this episode probably caused no major problems.  The story goes on to discuss her ongoing battle with hallux limitus.  She has used the internet to make a decision on possible elective surgery.

One problem that she illuminates comes from patients who write about their bad experiences with a treatment.  I have previously written about the risks of Plavix (clopidrel).  Now family members who have a loved one who has a bad bleed while on Plavix write a comment on this blog.  This comment section could dissuade patients who really need Plavix to not take the drug.

Plavix represents a great example of the complexity of modern medicine.  Here is a drug with significant benefits (especially for patients who have drug eluting stents).  However, the drug also has some bad side effects (including intracerebral bleeding).  The risk benefit ratio clearly comes on the side of taking Plavix, but there is a significant risk.

Now the excellent physician would explain this to his/her patients when prescribing Plavix.  We often prescribe so many medications that discussions about their indication and their risks and benefits would take a long time.  I understand why patients resort to the web to find information.  Too many web sites do not present a balanced view of risks and benefits, and too many physicians do not take the time.

We need new models of patient care which include enough time and information access for these complex issues.  As I understand the patient centered medical home, that is an underlying principle upon which it is based.

Related posts:

1. Problems with Plavix
2. Plavix, lawyers and externalities
3. Denise Grady on lessons learned from Tim Russert’s death
4. What caused the pancreatitis?
5. My daily rant on pharmaceutical reps

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