Daddy Issues

The subject line read: “Is this supposed to be happening?” It was time-stamped 1 a.m. The anxious sender, my father. Two things became imminently clear: my father had been “prepping” for a colonoscopy, and he had taken 4x the recommended amount of laxative. It was a regimen that no sane physician would prescribe. In fact, no sane physician had. My dad, in his infinite wisdom, had “consulted” Google. The rest, as they say, is history.

My dad isn’t the only one looking for answers online. In a 2013 Pew survey, nearly 59% of U.S. adults had looked online for health information in the previous year. Moreover, roughly a third of adults had admitted to using the internet to diagnose themselves or someone they knew. The internet and social media are, for better or worse, permanent fixtures in the purveyance of health news. Though sometimes the internet get things right, often enough, it’s also home for “alternative” health facts. Thankfully, clinicians can use the same tools to fight misinformation.

The Double-Edged Sword

Web-based media offer little in the way of oversight. Online “health” information can, ironically, be unhealthy. In a recent study in AJRCCM, researchers queried Google, Yahoo, and Bing on idiopathic pulmonary fibrosis. In total, 181 websites were reviewed. The result was that online information was incomplete, inaccurate, and outdated. In fact, a large proportion of websites advocated for chronic use of azathioprine and corticosteroid, a practice which recent data suggests could be harmful.

The epitome of misinformation can be captured poignantly through the online anti-vaccination movement. In a 2010 Vaccine study, Google was queried for the following terms: “vaccine, vaccination, and immunization.” The result was that “disingenuous information” was found in 10 out of 11 anti-vaccination websites analyzed. While superficially credible, even going as far as using “.vaccination” and “.org” URLs, these sites proffered statements like:

• “Just because you give somebody a vaccine, and perhaps get an antibody reaction, doesn’t mean a thing. The only true antibodies, of course, are those you get naturally.” (http://www.whale.to/vaccines/antibody.html)
• “Vaccines are biological poisons, harmful to health, and a contributing factor in childhood illness.” (http://www.vaclib.org/sites/debate/about.html)

Help Me Doc

What many patients need and what doctors can provide is guidance through the minefield. Offering good online resources in concert with counseling is important, especially with office visits becoming increasingly shortened.

Many EMRs and government agencies have patient-centric handouts that cover a variety of maladies. These leaflets can be effective. A BMJ meta-analysis found that information leaflets were effective in reducing antibiotic prescriptions by general practitioners. Additionally, while Google remains the preferred search modality amongst patients, a JAMA study demonstrated that a significant number of patients will follow health links posted on office posters. If you aren’t utilizing leaflets, handouts, or posters, you may be missing an opportunity to increase your patient’s health literacy.

But what about social media? Can resources like Twitter and Facebook be effective health tools? It depends. When it comes to modifying behavior, social media may not be a panacea. In fact, it appears to be only modestly effective. However, some research shows patients actually use social media primarily for increasing knowledge, exchanging advice, and for garnering social support. Case in point, many participants in the Twitter community Breast Cancer Social Media (#BCSM) reported improved anxiety. Moreover, participation resulted in increased self-advocacy, with 31% of people seeking a second opinion or bringing additional information to the attention of their primary treatment team.

I am not a techie; my Galaxy S3 would concur. Nonetheless, I’ve seen the benefit of social media during my tenure with ABC News. As a member of the “Medical Unit,” I made my foray into Twitter, serving as a panelist for Dr. Besser’s Twitter chat (@abcDrBchat). Our topics included rare diseases and colon cancer. With the help of distinguished guests like the National Organization for Rare Disorders and the American Gastroenterology Association, we orchestrated several 1-hour long Twitter sessions, addressing patient-centered questions. As a result, patients bonded, financial and social resources were shared, and awareness was amplified. (The rare disease chat garnered 23.5 million potential impressions). The cherry on top was a tweet from a participant informing us that our dialogue had persuaded her to get a colonoscopy.

While news outlets are progressively turning to social media, their bread and butter remains television. But is local television news an adequate source of health news? The short answer is probably not. In a study examining 1,863 news stories, only 10% focused on health topics, with 45% lasting less than 30 seconds. This certainly is not enough time to offer nuance. Though it’s an important topic, try finding a news story on bowel disease airing during the dinner hour; you’ll probably strike out.

Assessment and Plan

Healthcare-seeking patients have to navigate a sea of “alternative facts.” Fortunately, we can and should help steer the ship. The trick is having a stockpile of good resources at your disposal. Remember, well-designed handouts/leaflets can improve health outcomes, so start your collection now. For those abstaining from social media, now might be the time to dip your toes in the water. Though tweeting isn’t everyone’s cup of tea, knowing the platform can help when referring patients to reputable online healthcare agencies and advocacy groups. In certain instances, social media has been shown to quell illness-related anxiety and empower patients to take action.

If you don’t like the health news permeating cyberspace, the landscape is ripe for change, so lace up your sneakers and get to it.

— —

Weston Bettner, MD, is an internist in Baltimore, MD and a 2016–17 Doximity Fellow.