Click and Cure

Neurologist Arthur Weiss is knowledgeable in his field, up-to-date on the literature, respected by colleagues, esteemed by his patients. Fun at a party, too. So perhaps he can be forgiven for sounding a bit testy about the people who, after a few clicks of the mouse, seem to view themselves as his partners in making a diagnosis and, in some instances, offering a treatment plan.

I checked all my symptoms on the Internet, they’ll tell him. I’ve had a stroke. I have a brain tumor. “And they’ll want to know why I’m giving them aspirin when Plavix is the latest drug,” he says, referring to a medication that reduces the risk of blood clots. “They confront you, and it’s not always easy to parry their questions. The information may be good, but it’s not relevant to their situation or they’re taking it out of context.”

Larry Newman, director of the Headache Institute at Roosevelt Hospital, feels Dr. Weiss’s pain. He recounts the story of a patient with daily headaches who, after surfing the Web, came up with a diagnosis of mad-cow disease. Then there was the patient Newman diagnosed with hemicrania continua, a rare type of headache. “She called the next day saying she had done a search on the Web and couldn’t find any mention of her headache,” Newman recalls. “She called me a quack, accused me of making the whole thing up to get her out of my office, and told me not to cash her check.”

Like managed care, the Internet is creating a power shift in medicine. “We talk doctor talk and we’ve had power because we controlled information,” says Patrick Kelly, a neurosurgeon at NYU Medical Center. “But the Internet removes the monopoly on information.

“It’s going to change medicine in much the same way the printing press changed the Catholic Church in the Middle Ages,” he adds. “Because of the Internet, medicine is going to become consumer-based like anything else, like buying a television set. Doctors aren’t going to be happy and hospitals aren’t going to be happy, but they’re going to have to learn to march to this different drummer.”

The difficulty, as many doctors will tell you, is running Internet interference. In much the way first-year medical students are certain they’ve got every disease in the book, these days, anyone with symptoms and a modem – ladies and gentlemen, start your search engines – can come up with diagnoses ranging from the mundane to the arcane. “Health-care information is one of the top areas of the Web, right up there with entertainment and pornography,” says Ted Shortliffe, chairman of the medical-informatics department at Columbia University College of Physicians and Surgeons. “While some areas have leveled off, I think the medical sites have increased.”

Quantity is, of course, not to be confused with quality. “People are prepared to say their grandmother is talking rubbish, but the Internet looks more reliable – especially if there are a lot of graphics and ads for Pampers,” says Daniel Cammerman, an Upper East Side pediatrician who recently treated a teenager who, after two days of surfing the Net, was convinced that his mononucleosis would result in a ruptured spleen and hepatitis. “That’s all the more reason you need to sit down with someone and spend more time than you otherwise might and try to educate them.”

Anne Moscona, chief of pediatric infectious diseases at Mount Sinai, recently dealt with a family whose 4-year-old was preparing for a liver transplant. “We wanted to make sure the child was fully vaccinated, because one of the main thing kids die of after transplantation is infection. The parents said they would get one or two but that they had been reading stuff on the Internet about a supposed link between vaccines and autism. Here were these parents willing to deal with the risk of a liver transplant to save their child, but they weren’t able to correctly weigh the benefit risk of vaccines.”

It’s not just patients who are trawling the Net for health information. Cammerman goes online daily for updates on drug recalls and the side effects of certain medications. Doctors regularly check medical Websites to stay up to speed on developments in the field.

The Web can mean the difference between life and death.. With the help of the Internet and e-mail, gastroenterologist Jonathan LaPook and three colleagues at Columbia-Presbyterian were able to diagnose and cure the baffling – and nearly fatal – illness of a couple who had recently vacationed in Ireland. Their elevated eosinophils, a type of white blood cell, pointed to several possible illnesses, including parasitic infection, trichinosis, vasculitis, and medication allergy. But none proved correct, and the couple kept getting sicker. Finally, after countless Medline searches and e-mails among doctors here and in Europe, the foursome’s attention turned to Fasciola hepatica, a liver parasite often contracted by eating infected watercress – which the wife had picked herself from a stream for sandwiches they’d shared on their recent trip. Bingo. Virtually unknown in the U.S., Fasciola is not part of our standard parasite blood panels; indeed, the diagnosis was confirmed, via e-mail, by a doctor in Paris who’d been sent blood samples.

Younger doctors like LaPook have grown up with the Internet and tend to be comfortable with it. “With any luck, I can help my patients filter, digest, and integrate the mountain of stuff out there,” he says. After the attack on the World Trade Center, LaPook reports, patients flooded him with questions about anthrax – sending him back to the Web. “In the wake of the terrorist attack,” he says, “doctors have a responsibility to gather and distill information efficiently in order to give our patients the proper perspective about various risks and issues.”

“I think it’s good overall that they are making themselves more knowledgeable through the Net,” says Noel Perin, a neurosurgeon at Roosevelt Hospital, who often directs anxious, confused patients to his own site. “It makes it easier for me not to have to start from scratch explaining a procedure. The days of doctors sitting there and saying ‘What I’m telling you is God’s own information’ are over.”

Click and Cure