HOW DO YOU TREAT PATIENTS WHO LEARN IT ALL FROM THE INTERNET?

MANY YEARS ago, a new patient told my technician she was pregnant. My technician was perplexed by the announcement, as the patient was elderly.

When I entered the exam room, I asked the patient how she found out about her pregnancy. She quickly put my hand on her neck. “Do you feel that?” she asked. My fingers could, indeed, feel a strong pulse. “That’s the baby’s heartbeat!” the patient said emphatically. “In fact, I think it might be twins because I can feel it on both sides.” She made an inaccurate self-diagnosis — something we, as optometrists, often encounter.

Some common examples: A mother declares, “My son has pink eye,” but the diagnosis is allergic conjunctivitis. Another patient presents, panicked, “I see bright flashing lights. I know I’m having a retinal detachment.” The truth: It’s an ocular migraine.

Patients who have dry eye disease (DED) often incorrectly self-diagnose the condition, prompting the wrong self-treatment and, in turn, a worsening of their true condition. Often, it is only when their self-prescribing doesn’t work, that they seek an eye care provider.

Unfortunately, optometrists may have themselves to blame for this self-diagnosis, as so many of these patients are either under- or misdiagnosed.

Here, I discuss the reason self-diagnosis has become a pervasive problem and the four ways you can overcome it:

REASON

While self-diagnosis has always existed, it took on gargantuan proportions when the Internet became available.

Specifically, users could now conduct searches on their symptoms and, with a few clicks, convince themselves of a specific diagnosis.

Armed with medical training from Google University, some of these home-schooled “doctors” try to steer their doctor’s diagnosis toward their own.

OVERCOMING IT

The four ways you can conquer self-diagnosis:

1. Get out the filter. The patient’s case history will tell the true story. Filter through his or her hyperbole to arrive at the correct diagnosis.
2. Reveal deficiencies. Explain and show self-diagnosing patients that the Internet is a fallible resource. Feel free to use this example:
   When entering “40-year-old woman with gradual blurred vision,” the following possible diagnoses come back from WebMD’s symptom checker: nearsightedness, diabetes, glaucoma, eye injury, presbyopia, macular degeneration, pink eye, transient ischemic attack (mini-stroke), ocular migraine, astigmatism, benzodiazepine (a class of psycho-active drugs) abuse, cryptococcosis, epilepsy, foreign body, acute angle closure, pseudohypoparathyroidism and retinal detachment. Note that DED did not make the list, even though it is typically the No. 1 cause (after forgetting to put on your glasses).
3. Explain diagnostic testing. If a patient is standing his or her ground with a self-diagnosis, utilize point-of-care testing, and explain both the testing and the results to the patient. That said, no one likes a “know-it-all,” so handle the delivery of test results with care:
   “Mrs. Smith, I can tell that your frustrated by your symptoms. Naturally, that frustration makes you research your complaint. Our testing, like when your primary care doctor does lab testing, reveals dry eye disease, which can mimic several other conditions, such as those you’ve found on the Internet.”
4. Agree to disagree. Differing with a patient on diagnosis can cause resistance and poor compliance, at best, and a rift between doctor and patient, at worst. Triangulate the problem so that it is no longer “between” doctor and patient, but a common challenge faced together:
   “Mr. Jones, we have a common goal. We both want you to enjoy comfortable, clear vision for years to come. In order to tackle dry eye disease, I’d like to partner with you in working on this problem. Dry eye disease can be an ever-changing puzzle, but if we work together, I think we can find a solution. Are you willing to work with me?”

WORKING TOGETHER

Self-diagnosis is often inaccurate and can reduce exam efficiency, but it needn’t come between doctor and patient. Instead, use it as an opportunity to reinforce your diagnostic skills, provide patient education on the limitations of the Internet and team up with the patient to devise a plan to treat DED. Turns out, there is an “eye” in “team.” OM

DR. HAUSER provides clinical care for patients at TearWell: Advance Dry Eye Treatment Center and the Advanced Care and The Eye Center at Southern College of Optometry. She is a consultant, speaker or board member for: Akorn, Alcon, Allergan, BioTeck, BioTissue, Lumenis, NovaBay, Paragon Vision Sciences, Rysurg, TearLab, TearScience, Shire, Science Based Health and DryEyeCoach.com . To comment, visit tinyurl.com/OMComment .