Ryan, a long-standing patient of mine, had become a “frequent flyer” in his old age. If he wasn't calling my office, his wife was calling on his behalf. He wasn't a hypochondriac; he did have legitimate medical problems, including severe bouts of diverticulitis. But his complaints were usually multiple, and this particular month they seemed mostly innocuous.
“What is it this time?” I asked my office manager.
“He says he has air bubbles in his urine,” she said.
“Now that could be significant,” I thought. Some time ago I had a patient who complained of passing gas through his urethra. He wound up with a colovesical fistula, an uncommon complication of chronic diverticulitis that results in an open connection between the colon and the bladder.
When Ryan and Jana came in, I proudly said, “I think I know what's wrong with Ryan.” I was strutting my stuff, having made the diagnosis from a mere phone call, without talking to or examining my patient.
“Yeah,” Jana said, “he has a colovesical fistula.”
“How did you know that, Jana?” I asked.
“Easy,” Jana said, “I just Googled ‘farting through penis’ and it showed up.”
“Did it tell you how to fix it too?” I joked.
It wasn't the first time one of my patients (or their companion) had gone to a search engine for a diagnosis or treatment options, nor would it be the last. It sometimes frustrates me to have to deal with what patients come up with in their internet searches. When it's right on, it can make me feel dispensable. When it's inaccurate, I have to spend time correcting misinformation (but the effort is worth it in the long run). Sometimes all it takes is for me to pull up a review article from UpToDate or American Family Physician, and perhaps send them a link or PDF, which most patients appreciate. The key is to avoid getting defensive or drawn into a debate, and instead just focus on the facts and move on.
When I was a medical student, my attending kept a huge file cabinet full of medical literature culled from peer-reviewed journals. We would go to it whenever we needed cutting-edge information. Today, all that information and more can fit in the palm of our hand. Patients have similar access to medical information, but they don't have our training and experience, which allow us to separate the good information from the bad. Thanks to the internet, we are now truly their partners in care, but I like to think we are the senior partners!