As a practicing clinician, I am regularly told by patients about what they have read on the internet. My clinical colleagues have referred to the internet as “Dr. Google.” Why do people give more weight and authority to something they have read on the internet than what we have discussed in the office?
I suspect this comes from a place of anxiety: If I knewthe answerto my worries, they would be solved, right? I don’t think so. In reality, I have found that the internet tends to confuse and distort far more than it educates. But then if it is in readable, printed form, then it has got to be right, right? Wrong I say.
Information from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), package inserts of medication side effects, what the latest study proves, and horror stories and gripes are all posted on the internet. Where are the success stories? Why do people focus more on what might go wrong that what did go right?
All in all, the consequence of such a plethora of information is usually more—not less— anxiety. As a result, people tend to hone in on the one negative thingthey read, rather than on the big picture. That’s precisely what anxiety makes us do! When people turn to Dr. Google for answers they are usually concerned about a problem. The internet is not only unhelpful, but potentially harmful for anyone concerned about their mental health.
There is such a thing as too much information or even the wrongtype of information. The internet tends to be riddled with mere lists of things. The information then completely loses context and is not helpful. For example, a tumor discovered in rats is listed plainly alongside dry mouth as a potential side effect. Can you guess which one is more common but is more talked about?
Even with a side effect such as hypotension (low blood pressure), there can be huge variation in its severity. On the simple end of the spectrum, it is just getting up slowly from a lying down position or drinking regular fluids while intravenous fluids need to be given in a hospital setting at the more severe end of the spectrum. Sometimes, merely lowering the dose of the medication is all that is required. Without a proper discussion with the treating physician as to how common or rare, as well as how severe the side effect usuallyis, a patient might otherwise be entirely dissuaded from even considering the particular medication—all out of an exaggerated fear of such a side effect. This is where the internet can cause far more harm than good.
These examples reiterate the main point: information that cannot be adequately explained to or digested by the patientis equivalent to a distortion of the truth. Earlier this year, a prominent political commentator posted DSM-5® criteria for Narcissistic Personality Disorder on his Twitter feed. He did so as a naïve ingester of that information. This is the exact opposite of the experience and training that is required to interpret and applythese criteria to one’s own patient.
I am not an expert in search engine optimization technology but I think the internet is getting it wrong. In my view, websites that post package inserts of medication that list rare side effects are because of defensive litigation motive rather than to properly educate the patient. People tend to believe other patients’ experiences and good patient experiences somehow don’t find their way onto the internet.
Unfortunately, stories with the most dramatic horror rather than the results of rigorously designed studies get the most traffic. Perhaps that is because study designs are hard to interpret and their findings tend to be dry, overdetailed, and riddled with terminology that the average person will not understand. Such studies rank lower on Google® searches or are only in specialized search engines such as Google Scholar®.
No matter what is written about a particular medication on the internet, nothing trumps the experience of a physician and patient actually going through the process of prescribing and taking of a medication. An experienced and prudent clinician will have to make a judgment call as to which medication is best for their patient, discuss the patient’s unique medical history and vulnerabilities, and start at a reasonably tolerable dose. Then, like any new venture in life, we wait and see what happens.
It may surprise you to know that, in the aftermath of the suicide and antidepressants controversy in the early 2000’s, the suicide rate jumped in subsequent years in adolescent patients. This was because physicians were more reluctant to prescribe antidepressants in this age group. From subsequent research that the media didn’t give publicity to, the original studies were found to be flawed in their design, thus generating false findings linking suicide and antidepressants. To date, not a single suicide has ever been proven to be caused by antidepressants.
For myself, and many other psychiatrists, we found ourselves having to explain this media debacle in order to undo the damage that the media perpetuated by jumping on the bandwagon. By the internet hijacking something that a public health issue was worsened in more ways than was ever intended.
Now when I advise my patients, I have told them to take what they read on the internet with a huge sack of salt, as it tends to lack credibility an educational resource. By virtue of its fragmented, list-driven, search engine design, the internet has turned into its own beast. One that alarms people to the point that whatever else is going on, anxiety should be at the top of their concerns. Beware of Dr. Google!