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Dispelling myths, and managing patient self-diagnosis in independent optometry


Doctor, I see floaters in my vision. I think I have a retinal detachment!

I don’t need an exam because I did a screening online.

I put a moist teabag on my eye so it would heal faster.

I know I can’t have glaucoma because I smoke pot every day.

Did I get your attention with that last one? The truth is, these are all statements I’ve personally heard from patients. Welcome to the world of the Internet and self-diagnosis.

According to Pew Research Center’s Internet and American Life Project, more than one-third of U.S. adults use the Internet to diagnose medical conditions. This includes people who look up information for someone else, but this probably accounts for the patient who thinks they have worms in their corneas because that’s what their Aunt Marge found on a Google search. The patient disagrees with Aunt Marge, certain that the problem is a contact lens that floated behind his eye.

Joking aside, problems from self-diagnosis are no laughing matter (although I must admit the pot comment caused me to audibly laugh). We do live in a world where information is extremely accessible. The problem with this reality is that much of this information, especially medical information, is often inaccurate, misleading, or simply does not provide enough context to come close to replacing a diagnosis from a trained professional. How many patients presenting for an exam with recent floaters expressed concern about losing their vision because they read something online? How many of those floater patients actually lost their vision? Information gleaned from the Internet causes many people to jump to the worse case scenario. Unfortunately, fear can be paralyzing and cause some people to avoid going to a doctor altogether.

The good news: According to the above referenced study, out of the people who go online for medical information, 46 percent said what they found online led them to believe they needed help from a medical professional. The bad news: Of the same group, 38 percent said they thought they could treat it at home. And while not every condition is an emergency, consider that less than half of the patients in the study said that a doctor confirmed their self-diagnosis. Only 1% claimed talking to a medical professional was “inconclusive.”

Enter social media, where suddenly anyone with a smartphone and a Facebook account can pretend to be a doctor. Why didn’t you come in sooner? Because a guy I’m Facebook friends with told me I was fine. I haven’t seen him since high school, but I recall him being smart at the time.

It’s time to get in front of this issue docs! Below are a few suggestions.

  • Educate your patients on reliable online medical resources. Evaluate sites carefully for bias and conflict of interest. Be sure the information is current (less than three years old) and check the author’s credentials to make sure the information is written by a health professional. If the patient is going to search online anyway, which is not a bad thing, make sure they are receiving accurate and reliable information.
  • Make yourself more accessible. It’s hard to fault patients for seeking outside help when they can’t get in to see you until after Thanksgiving (I’m writing this in September). For years, access to doctors was mostly confined to scheduled exam times. Maybe it’s time to rethink that? Are you available via HIPAA compliant email or other digital communications? I won’t get ahead of myself, but as telemedicine becomes more mainstream alternative forms of communication are likely to become much more common. Many of these inquiries will likely lead to in-office exams.
  • Reassure your patients that most eye conditions are treatable and do not lead to permanent vision loss if treated, preferably earlier than later. Putting off seeing a doctor due to anxiety over the diagnosis is understandable, but also unwise. When it comes to self-diagnosis, one of my least favorite things to tell patients was, “I wish you had come in earlier.”
  • Share stories. We probably all have at least a few stories of patients who opted to allow Dr. Google to treat their condition and the outcome was less than satisfactory. Maybe even tragic? Stories are powerful, relatable and memorable. Patients need to understand that this is not simply a doctor being overly cautious. Vision damage from self-(mis)diagnosis and postponed treatment is a real possibility.
  • Be patient. Admit it, when a patient opens with “I was looking online,” you brace yourself for the worst. You’re ready to shoot down the very next word that comes out of their mouth! Instead, use the opportunity to focus on breathing exercises and happy thoughts as the patient recounts an article they read on how standing on one leg can cure glaucoma. Don’t be immediately dismissive or annoyed (at least not visibly). The patient is not a doctor. The patient should leave your office feeling much wiser, not belittled.

Often times, better communication goes a long way to divert patients from an overreliance on self-diagnosis. And while I poked a little fun at some of my previous patients, let me now turn the table on myself. In my 2nd year of optometry school we leaned about brain tumors and how one of the symptoms was “the worst headache of your life.” Guess who got the worst headache of his life 2 weeks later? Guess who spent the next couple weeks at Barnes & Noble Bookstore (early Internet days) pouring through medical references?

I’ve been there, and there’s a good chance you’ve been there too. Be empathetic. Be understanding. But don’t miss an opportunity to educate.

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Steve Vargo

Steve Vargo

Steve Vargo, OD, MBA is a 1998 graduate of Illinois College of Optometry. After working in clinical optometric practice for several years, Dr. Vargo pursued his passion for practice management by earning his Masters of Business Administration (MBA) degree from the University of Phoenix in 2008. A published author and speaker with 15 years of clinical experience, he serves as IDOC’s Optometric Practice Management Consultant. Dr. Vargo advises optometric alliance members in all areas of practice management and optometric office operations.