Oh what tangles the web can weave..
Internet-savvy patients are asking more informed questions – which can only be a good thing. However, when the internet also informs their answers, this is definitely not so good..
We’ve all done it: an unusual symptom prompting us to search the internet for a diagnosis. The problem is, whilst there are only a very limited array of potential symptoms, there are innumerable potential diagnoses, so every symptom counts in patients’ attempts to include/exclude various diagnoses.
A year or so ago, I experienced several episodes of excruciating cramps in my toes, associated with somewhat dramatic temporary web-like distortion. Despite, or perhaps because of my medical training, rather than simple dehydration or salt deficiency, I immediately feared MS. Within 15 minutes, despite my cramp-like symptoms being far from typical of the cramps associated with MS, I was suddenly equally aware of recent fatigue (of which I’d previously been unaware), plus a deterioration in my eyesight; which suddenly seemed greater than age-related. By the time I saw my GP, I rolled off an unwittingly contrived/exaggerated list of MS-related symptoms; which in combination naturally offered limited diagnostic possibilities. Fortunately, as I’d wanted her to consider, yet hopefully be able to exclude MS, I also told her what symptoms, typical of MS, I did not have. The potential onward referral to a Consultant Neurologist, and numerous associated expensive tests, was therefore fortunately reined back to a simple blood test.
As physiotherapists we, and other medical professionals, are increasingly finding our history taking skills put to the test by patients who are either consciously or subconsciously steering their answers towards the diagnosis they suspect or most fear. The potential dangers, plus financial implications of such patient-guided diagnoses are obvious. How to safeguard against this trend, worryingly, is not so. However, incorporating the direct question ‘What injury/condition do you believe you may have sustained/developed?’ into the subjective examination, might be a simple, but good place to start.