There is something I need to tell readers: I am a recovered do-it-yourselfer. Now that I said it, let me clarify. By recovered I do not mean completely recovered. There are days, for example, where I find myself in a do-it-yourself megastore, at Menards or just across U.S. 41, at Lowe's. There, I wander seemingly aimless through the different departments and along the aisles.
I take stock of tools that may become handy, replacement parts, missing screws and lonely nails, appliances and raw materials. I smell the scent of cut wood at the lumber department, and that of fresh flowers in the garden section. I observe the droves of patrons and I try to see who is still a devoted do-it-yourselfer and who is a fellow almost-recovered do-it-yourselfer, just like me.
This self-reflection did not appear out of the grey skies of Marquette on a cloudy autumn day. It is a result of my encounters with a few patients of mine who themselves are do-it-yourselfers. I call them the doc-it-yourselfers, for they decided to cut the middle man (the doctor) and to confront their maladies, at least partially, on their own.
Shahar Madjar, M.D.
Technology is almost all-ready for the do-it-yourself medical revolution. Medical information has never been so approachable, so transparent, so searchable. And doc-it-yourselfers take advantage. They Google their symptoms. They self-diagnose. They search for solutions, for treatments. They come to their appointments ready, armed with a list of questions and answers they downloaded from the internet. They are active participants in their medical care. Is there anything wrong with that?
In an attempt to address that question, I visited the symptom-checker tool of the Mayo Clinic. It is a paradise for doc-it-yourselfers. To test it, I clicked on headache, then I checked moderate to severe, around face or forehead, is sudden, less than a few minutes, gradually becomes more frequent, worsened by chewing, relieved by lying down in the dark, and accompanied by change in personality, behavior, or mental status. And when I pressed on find causes, I found out that should I have had such a headache, I would most likely be suffering from a brain tumor, or migraine, trigeminal neuralgia, encephalitis, giant cell arteritis, cluster headaches, tension headaches, or TMJ disorder. I immediately realized that if I had used this website for its intended purpose - to self diagnose as a layperson, I would most likely develop another set of symptoms - chest pain, palpitations, and fear of death. (Would that be consistent with a heart attack? I was afraid to check.)
Self diagnosis is not limited to the realm of the internet though. Given the opportunity to self-diagnose, patients will gladly skip the middle-man. A study by J. C. Donofrio from the Department of Emergency Medicine in Rhode Island looked at 50 women with symptoms suggestive of a urinary tract infection. Eighty-two percent of the women thought they had a urinary tract infection. Sixty percent preferred, if given a choice, to buy over-the-counter antibiotics instead of seeing a doctor. Thirty percent were able to identify a specific antibiotic they would take. But only 61 percent of the women who were self-diagnosed as having a urinary tract infection, actually had one. The authors concluded that "women should be encouraged to seek medical attention to confirm the diagnosis."
Meanwhile in New Zealand, a 48-year-old man searched his symptoms online. He decided that he had a renal stone and treated himself with pain medications. After 10 days, and after his symptoms did not improve, he consulted his family doctor and convinced him that his diagnosis is that of a kidney stone. Two weeks later, once his symptoms got even worse, he paid a visit to the Emergency Department where he was diagnosed (this time correctly) with missed appendicitis complicated by severe perforation (which could be life-threatening). "When formulating a differential diagnosis," the authors who described the case wrote, "extreme care must be taken not to be unduly influenced by a patient's self-diagnostic conclusion."
The other day, I diagnosed a leaky faucet in my kitchen. My initial instinct was to cut the middle man, search the internet for solutions, pull out my toolbox, make several trips to the do-it-yourself megastore, and learn, on the fly, the secrets of plumbing. Instead, I reflected on what I have learned about doc-it-yourselfers, self-diagnosis, and self-help. I picked up the phone and called a professional plumber.
Editor's note: Dr. Shahar Madjar is a urologist at Bell Hospital in Ishpeming. Read and comment on prior columns by Dr. Madjar at DrMadjar.com.