Re-educating the self-educated

January 1, 2007

National report - Chances are good that patients in dermatologists' offices have done research on what they have - or think they have - or what they need to have done or think they need to have done.

A lot of patients' searching is done via the maze of information available on the Web.

That is good and bad news for doctors.

Proactive patients

"A lot of people will use the internet for symptoms that they want to look up prior to their coming in.

"They also use it to become more informed on particular diagnoses or about treatment options," Dr. Rubin tells Dermatology Times.

Dr. Rubin says that this can be a good thing.

"Better educated patients are more likely to comply with treatment plans and follow-up surveillance," he says. "The downside is that there can be a lot of misinformation; so, it can raise expectations that are not appropriate."

Flip side of the coin

Patricia K. Farris, M.D., a dermatologist who practices in New Orleans and is a clinical assistant professor in the department of dermatology at Tulane University, says the plethora of information available today frustrates her and her patients.

"The internet has given patients access to copious amounts of medical information about which they have no frame of reference to use or evaluate it," Dr. Farris says. "Medications are one example. Patients look up drugs online and they read about these rare side effects. They will say, 'I went on a blog and heard this....' It is surreal."

Dr. Farris makes the analogy of her going online to look up something about investments and investing $100,000 of her money based on an internet blog.

"It is really that preposterous," she says.

Tempering self-diagnostics

Allaying patients' fears takes a good amount of explanation, according to Dr. Farris.

"I tell patients we always weigh the risks and benefits of medications before we prescribe them. When it is appropriate, I will tell the patient that I have prescribed a specific drug many times and have never seen the side effect they heard about online," Dr. Farris says.

Dermatologists and other physicians might end up spending part of the appointment talking patients out of a bogus diagnosis - then, explaining what they do have.

"In dermatology, people come in with a facial rash and think they have lupus or they have some rash on their body and think they have Lyme disease," she says.

This misinformation is especially prevalent with treatments that are not approved by the United States Food and Drug Administration (FDA), which puts pressure on physicians because clinical evidence of efficacy might be lacking. Dr. Rubin says that he often hears patients tout the use of garlic or red yeast rice to reduce cholesterol and heart disease. But, he says, there are no good randomized controlled studies or outcome data as to how efficacious or safe these options are.

"I tell them exactly that," Dr. Rubin says. "I tell them that the things that I am prescribing to them are FDA approved and are backed by studies and outcomes data. We know possible side effects."

Dr. Rubin tells patients that what they buy over-the-counter may not be regulated; so, claims are questionable. When patients come in anxious about an off-base self diagnosis he explores how they arrived at that decision or conclusion. Then, he talks about the reality of the situation.