Are you a cyberchondriac?

By June Cheong

If you constantly fear for your health and you trawl the Internet obsessively for health information, you may be a cyberchondriac.

Cyberchondriacs is a term that has been concocted to describe Web-savvy individuals who go online to learn about the symptoms they are experiencing and end up feeling even more anxious about the state of their health.


Dr Chng Shih Kiat, a family physician at Raffles Medical, said: 'The Internet provides easy access to a wealth of information. Hence, it's normal for people to seek information on their health on the Internet.

'Such information can sometimes be very scary as they can paint a very grim picture. This will then generate a lot of anxiety for the patient.'

Last November, Microsoft researchers Ryan White and Eric Horvitz released the results of a study on health-related Web searches. It revealed that people tended to look only at the first few search engine results.

The study also found that such results were random at best and, at worst, biased towards serious conditions like heart attacks and Lou Gehrig's disease.

Out of 5,000 people who took part in the final portion of the study, a fifth said they considered the ranking of search results as an important factor in indicating the likelihood of them having a particular illness.

People also often self-diagnosed based on what they found online and quickly believed in the worst-case scenarios for themselves.

Meanwhile, the fastest-rising health-related search terms on Google Singapore in 2008 included eczema, cancer, insomnia and stress.

Beware information found online

Last August, a separate poll of more than 1,000 adults in the United States by independent opinion poll The Harris Poll found that 86 per cent of those surveyed reported a belief that the information they found online was reliable.

Such unquestioning trust in the Internet and its contents have doctors here worried.

Mr Daniel Koh, a psychologist at private counselling clinic Insights-tse, said: 'When used properly and rationally, the Internet can be a good source of information.

'However, some websites may not be regulated and a person can be frightened by such sites blowing issues out of proportion. If you type in common symptoms like headache, you can get search results about brain tumours.'

Dr Chng said: 'What is important is to educate the public that not all websites are dependable or trustworthy and hence information available online should not be taken as the gospel truth.'

Asked why it is harmful for people to self-diagnose, DrMadeleine Chew from mobile clinic MW Medical said: 'In medicine, there is no fixed formula. You may have symptoms A, B and C but that doesn't equal to having condition D.

'When people read up on symptoms online, they often look only at the obvious things. As doctors, we're trained to look at other possibilities before coming up with the diagnosis.'

Indeed, the Internet has been both bosom buddy and tormentor to freelance writer Zhao Yanfen, 31.

She suspected that she had developed facial nerve palsy after she was given an anaesthesia injection during a visit to the dentist in March 2005. She developed migraines and blurred vision and the corner of her left eye and the left side of her mouth started to droop.

Worried, she Googled her symptoms and got so distressed by what she found that she visited a neurologist, who was referred by a general practitioner, thrice.

She even sent a compilation of daily photos of herself pulling various facial expressions to foreign oromaxillofacial experts.

She said: 'Every night for three months, I was on facial nerve palsy forums or Googling the condition. I got very depressed.'

However, she also found comfort in the Internet as she felt the forums were her 'best friends'.

'They gave me a sense of perspective because I read about people who have lived with the condition for 20 years and are still cheerful. They offered me a kind of emotional solace.'

Doctors put things in perspective

Medical experts Mind Your Body spoke to emphasised the need for cyberchondriacs to have an open, honest discussion with their doctors.

On cyberchondriacs, Dr Lim Lian Arn, a specialist in orthopaedic surgery at Raffles Hospital, said: 'The best approach is to hear them out and then tell them objectively what they have and need and to put their Internet-derived ideas in perspective.'

Dr Chew added: 'You have to listen to them and ask why they have come to their conclusions. Very often it's an underlying reason or story they believe that you have to debunk. Family history or even friends' experiences can affect the way cyberchondriacs think.'

This was the case for administrative assistant Chloe Lim (not her real name), 25.

She suffered pains in her stomach area in 2007 and surfed the Internet for explanations of her symptoms. She concluded that she had either liver cancer or a liver infection. Her mother had died from cancer of the gall bladder two years ago and her father died of lung cancer four years ago. Their dying from cancer made her more aware of death.

She said: 'I was quite scared I would be diagnosed with cancer. I got more scared and worried after reading stuff online.'

Luckily for her, she followed up by visiting a general practitioner. Her condition turned out to be a fatty liver, which refers to the build-up of excess fat in the liver cells.

On her doctor's advice, Ms Lim decided to turn her life around and began to eat more healthily, loading up on vegetables and avoiding all fried foods. She also started cycling, playing badminton and swimming at least once a week.

Dr Chng said: 'Most cyberchondriacs can be helped by just proper explanation of their illnesses by their doctors. But sometimes, investigations are necessary and occasionally even a referral to a specialist for further assessment may be needed.'

While Ms Zhao turned out not to have facial nerve palsy as she had feared, the facial muscles on the left side of her face were indeed found to be less responsive after a battery of tests that she had insisted on and which her neurologist had resisted.

She spent $2,500 in all on drugs and diagnostic tests, including an MRI scan.

She said: 'After the tests, the neurologist said I was right and that the left side of my face was less responsive but he didn't know why.'

She turned back to Google and found in medical journals online that the steroid prednisolone was effective in treating some cases of facial nerve palsy.

She went back to her neurologist to obtain a prescription and he eventually relented after he failed to dissuade her. Her condition stabilised soon after, she claimed.

Asked why she returned repeatedly to the bosom of the Internet, Ms Zhao said: 'When your doctor keeps telling you he can't find anything wrong, that's when you look online.'

Dr Chew summed up the doctors' stand: 'The best thing a doctor can do is to take that literature that the patients have and go through what strikes fear in them.

'This process often takes more than one session. After a while, the patient will come to realise that the doctor cares for him and will believe that the doctor's advice matters.'

Self-diagnosis can be harmful

Everyone is concerned about his health but when does justified concern spill over into excessive fear?

Dr Madeleine Chew from mobile clinic MW Medical said:

'If you find yourself getting more and more anxious after reading up online, stop. Instead, go to your doctor and tell him your concerns.'

Mind Your Body helps you figure out if your gnawing anxiety is normal or simply a bad case of Web-induced worry.

Do you feel more anxious after researching medical conditions online?

Mr Daniel Koh, a psychologist from private counselling clinic Insights-tse, cautioned that the information on websites may not be correlated to the prevalence of a disease.

'A person may assess himself based on such unreliable information, thus making him more anxious and worried and wanting to find out even more.'

Dr Chew added that gathering information online is healthy so long as people go to their doctors to ask them about what they have found.

Do you doubt your doctor's diagnosis?

Dr Chng Shih Kiat, a family physician at Raffles Medical, said that when the patient has a lot of anxiety associated with the symptoms, he may conduct investigations so that patients may see for themselves that their results are normal.

Dr Chew added: 'The era where doctors are seen as father or mother figures is ebbing. There should be a more consultative approach now.'

Do you jump to conclusions about your condition after surfing the Internet for explanations?

Dr Chng said that a symptom that a patient has does not equate to having a particular disease.

'For example, weight loss does not lead to a diagnosis of cancer. It can be the result of many other conditions such as thyroid disease,' he explained.

'Hence, self-diagnosis can be harmful and most of the time it is inaccurate.'


This article was first published in Mind Your Body, The Straits Times on Jan 8, 2009.


http://health.asiaone.com/Health/Wel...ry20090109-113...

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