
Ask HN: If doctors are right, why would you still research online? - mayi12345
Hi all,<p>I am recently building a healthcare platform for patients to receive better personalized medical info. One thing that I would like to ask general audience is that, why do so many patients (and their families) do their own research online [accordingly to Google, 70% of us do], even after the doctors tell them their <i>best</i> suggestion?<p>What triggers you to believe whatever info you receive online, vs. what your doctor told you to do?<p>Greatly appreciate your suggestion.
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mindcrime
_I am recently building a healthcare platform for patients to receive better
personalized medical info._

On a tangential (at best) note: The main thing I want in terms of online +
medical, is one place to access all of my medical records. Sadly, my GP uses
one EMR system, and the hospital and it's associated doctors (including my
cardiologist) use a different system, and it's painful - if not impossible -
to share data between the two. So if I wanted, for example, to get a graph of
my cholesterol numbers going back for the past year, I have to login to two
different systems, copy and paste the numbers into a spreadsheet, and then do
the analysis.

And FSM forbid I want to try and correlate those numbers with something from
Strava (which logs my activities) or Fitbit (which has my weight and bodyfat
%, etc.)

Unfortunately this is more of a political problem than anything, as the
various EMR vendors don't have much incentive to open up their systems with
APIs and data-export functionality. At least outfits like Strava and Fitbit do
(IIRC) have some API support, but getting the medical records bit is a real
challenge.

~~~
mayi12345
Thanks for your well-thought comments! I think one of the YC alums is already
doing that: [https://picnichealth.com/](https://picnichealth.com/).

What we are building is optimize the experience when you do info search. Such
as we want to help you find: how another bike racers who had heart surgery
make their decisions.

------
dragonwriter
> why do so many patients (and their families) do their own research online
> [accordingly to Google, 70% of us do], even after the doctors tell them
> their best suggestion?

Lots of reasons.

Some because they are socialized into trusting other -- often very unreliable
-- information sources, but you still can't get the actual treatments except
from a doctor. So they still go to doctors -- and try to get from them what
other sources have told them they need -- but don't actually particularly
trust the doctors.

Some do it because they recognize that doctors are fallible, _and_ have less
at stake in any decision than the patient -- some of these people also have
the skills and knowledge to be reasonably informed readers of things like
medical reference and research literature (even if they aren't practitioners)
and are active participants with their doctor in their own healthcare.

Some people just want to _understand_ the meaning of the medical jargon
they've gotten from their doctor.

There's probably a lot more reason for doing independent research even after
getting information from a doctor.

------
sjs382
Lots of reasons.

Because online research might prompt first-aid, before visiting a doctor.

Because we like to prepare ourselves before receiving (possibly terrible) news
from experts, to soften the blow.

Because we tend to reach for our smartphones in stressful situations.

Because doctors are fallible.

------
Nadya
Doctors are not infallible.

I often look for alternative answers online and get a second and even _third_
opinion from other doctors.

~~~
mindcrime
The book _How Doctors Think_ makes that point very explicit and provides some
useful tips for working with your doctor(s) to get the best treatment. I
highly recommend it to anybody and everybody, FWIW.

 _Doctors are not infallible._

Case in point: After having a heart-attack, my GP and my cardiologist have
both recommended I generally avoid taking Ibuprofen. Apparently it has some
possible negative cardiac implications. OK, so a while back I was at the ER
for some random pain, and the ER doctor said "take Ibuprofen". I told her that
my GP and cardiologist both said not to, due to the cardiac risk and she goes
"Oh, really? I didn't know anything about that. I'll have to go look that up.
Thanks for the tip".

So yeah, even doctors don't always know everything. I mean, really, how could
they? They're experts, sure, but their domain is too big, too vast, for any
one to know _all_ of it. It would be like expecting one of us to be an expert
in all of C, C++, D, COBOL, Julia, R, Erlang, Forth, Haskell, Java, SQL,
FORTRAN, Ada, Scala, and Clojure, AND know all about all of the latest
libraries as they come out, AND know all about all of the newest emerging
tools all the time. Nobody could possibly do that, and no one doctor can keep
up with everything going on with medicine.

------
mindcrime
This isn't an either / or situation. I don't go do medical research online
because I don't believe what my doctor tells me. Hell, in the case of my GP,
he _tells_ me to go online and look for stuff.

Why? Well just think about it and do the math. Let's start by talking about a
GP / Family Doctor, not a specialist. A GP treats both kids and adults, and
deals with, effectively, every possible condition a person could have - from
ingrown toenails to cancer. There's just no way one person could be completely
knowledgeable on all of the latest research and thinking on every one of those
topics. A family doctor most likely optimizes for the common case, by being
very knowledgeable about the really common / obvious stuff... which means the
less common your condition, the less likely your doctor is to be really
informed.

In a similar vein, think about how many patients your GP has, and how many
different diseases, syndromes and conditions she has to think about / deal
with, all the time. Let's say you see the doctor once every 3 months... do you
think she is going to remember every detail that you told her last time,
without mentally conflating something with something influenced by another
patient. The book _How Doctors Think_ talks a lot about how cognitive biases
like "availability bias" affect doctors.

Given all that, you'd be nuts to go in with a mindset that "the doctor is
always totally informed, and always right". And even if we were talking about
a specialist instead of a GP, the same basic reasoning applies, just with
slightly different details.

 _What triggers you to believe whatever info you receive online, vs. what your
doctor told you to do?_

Again, it isn't that I believe what I read online more than what my doctor
says. It's about knowing that doctors don't know everything, are subject to
biases, and can't be 100% totally attentive to any one patient, because of
conflicting demands. So I go online, read stuff, and if I find something
interesting, I go back and talk to my doctor(s) about it. Sometime that leads
one of them to say "You know what, let me do some more reading on that and get
back to you" or whatever. Or sometimes it leads to "I really hadn't thought
about that, but that's not a bad idea".

Case in point: I had a heart-attack, so I now see a cardiologist. He
prescribed me the full array of modern prescription drugs that "the canon"
tells a cardiologist to give a patient post-MI. But I did some reading on
various dietary supplements that are (purportedly) beneficial, and went to him
and said "Hey doc, let me run through this list of stuff with you and see what
you think." On almost all of them his response was "as far as I know, there
isn't enough evidence to say one way or the other. Feel free to take it, but I
can't promise it will help you, or that it won't hurt you." OK, that's
expected. But when I mentioned fish-oil, his face kinda lit up and he goes
"Oooh, yeah, you should probably be taking that". And so it's now officially
on my chart as something I am supposed to take, right alongside my other meds.
Would he have thought of that if I hadn't mentioned it? Maybe, eventually.
Maybe not. But I'm glad we talked about it, because the more I read, the more
convinced I am that fish-oil has some very strong benefits. That fact that a
cardiologist agrees that I should be taking it lends to my confidence that it
is beneficial.

Another anecdote for you: I take a drug called Metoprolol, after having the
MI. From what I can tell, most cardiologists (mine included) generally plan to
put any patient who has an MI on that drug (or a similar one) for the rest of
their lives. Now I could just accept that and leave it be, but here's the
thing. Because I went online and read up on it, I know that it hurts your
cardiovascular performance (in terms of running, biking, etc.) by a
significant margin (10% or more). I am a competitive bicycle racer, so that's
bad. I also found out that there's some really recent research showing that
there's no mortality benefit to treating post-MI patients with Metoprolol more
than one year after their MI. So all of this lead to me talking to my
cardiologist and saying "can we talk about dropping the Metoprolol after a
year". Now it hasn't been a year yet, and we haven't made a decision yet, but
the point is, I have to live my life, and I want to have the most informed
conversations I can with the doctors, based on all of the different parameters
in play. And if I didn't do things like going online and reading up on drugs,
etc., I'd be flying blind.

