The new doctor

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10804235_xl_PPPatients are increasingly turning first to the internet when dealing with health issues, but as John Burfitt writes, Dr Google can confuse truth with conspiracy.

Stories traded between dentists of the extreme cases of patients diagnosing themselves by Dr Google are surprising, unusual and in some cases, hilarious.

Run a Google search on the topic of Dr Google and watch the horror stories roll in, such as the patients who ‘diagnosed’ cancer from symptoms associated with infected toenails and acne on the arm.

The dental cases about Dr Google are not much better, with claims including that root canal therapy will cause cancer, rubbing teeth with strawberries will whiten them, and that pregnant women should avoid the dentist’s chair.

About a decade ago, a British newspaper dubbed the phenomenon ‘cyberchondria’—a term that has now entered the medical lexicon. But rather than providing just funny tales to trade, it has become a point of serious concern for practitioners. Patients are accessing more information than ever about health conditions from a wide range of sources—from the Australian Dental Association’s website through to random conspiracy blogs.

The information age that arrived with the digital revolution means that patients can make their own conclusions about all the possible reasons behind those sore gums or discoloured teeth. And in doing so, they can often misdiagnose common ailments or feel empowered to challenge well-researched clinical trials or medically based opinion.

The process adds weight to the adage of British poet Alexander Pope that ‘a little learning is a dangerous thing’.

“What we are seeing with all of this is a complete generational shift,” says Adelaide practitioner Dr Peter Alldritt, chair of the Australian Dental Association’s Oral Health Committee. “In our parents’ era, it was always a case of ‘doctor knows best’ and it would never cross a patient’s mind to go anywhere but a doctor for medical advice.

“But with so much information now available, we are in a world where people no longer assume what they are told is best and will do their own research, either before or after an appointment.”

Among the more extreme scenarios presented to Dr Alldritt by some well-read patients is that root canal therapy is linked to pathology in the body and must be avoided, and often pregnant women are misinformed about the safety of dental procedures during pregnancy.
Then there was the patient who informed Dr Alldritt that implants don’t work and he should not consider them.

“I have piles of medical research that proves implants can be very successful and root canals are a great treatment option, but if you are dealing with a pessimistic patient who has spent a little too much time online, then you have to be ready for that,” he says.

“Then you need to explain what they are saying is not evidence-based at all and that you can only make recommendations based on scientific fact. There is a level of educating the patients that needs to be adopted.”

One of the main concerns stemming from random online research by patients that Dr Michael Foley, director of the Brisbane Dental Hospital and member of the Australian Dental Association’s Oral Health Committee, encounters is about the safety of water fluoridation.

There are myriad easily-found online reports linking fluoridation in drinking water and cancer, with some of the more extreme theories including the claim that the process originated with Nazi Germany’s attempt to control society.

“In our parent’s era, it was always a case of ‘doctor knows best’ and it would never cross a patient’s mind to go anywhere but a doctor for medical advice.” Dr Peter Alldritt, Australian Dental Association

“I shake my head in disbelief at that one, but it is a theory I have heard again and again,” Dr Foley says. “Often, patients who come out with that have an agenda and have spent a lot of time looking for those particular outcomes, but I just say to them there is simply no real evidence to support those claims.”

Dr Foley says one of the best ways to combat misinformation is to instead direct patients to reliable online resources containing accurate and up-to-date research, such as the websites for the Australian Dental Association, Australian Medical Association and American Dental Association.

“Having all that information out there is by and large a great thing, and I do encourage my patients to read up on their conditions, but there is also a lot of rubbish out there,” he says. “Issues arise as health professionals know how to sort the wheat from the chaff with misinformation, but patients have not had that kind of training and can be easily convinced of what they find. I just try to add a dose of reality and common sense to those situations.”

Common sense is the first tool Dr Nick Sheptooha says he reaches for when dealing with some patients in his Brisbane practice who arrive having already spent too long with Dr Google. He cites the case of the patient certain they had a problem with gum disease, when the reality was they had a piece of popcorn stuck between their teeth and had not flossed properly.

“If their diagnosis is wrong or way off the mark, I spend time on the camera and show them what is actually happening in their mouth and let them see the reality of what they are dealing with rather than letting their imagination run wild,” he says.

“I find if they can see the difference between something that is healthy and something that is not, then that makes the point. I will always encourage people to take an interest and be informed about their dental wellbeing, but directing them to the best place to get real information can solve some problems for yourself later on.”

It’s this point that Melbourne dental management consultant Julie Parker says makes up the core of her philosophy about dentists adopting a process that goes beyond maintenance and includes a more active role in educating patients.

“My theory is to embrace a more educated and more health-responsible public and play an active role in guiding them to better care for themselves,” she says. “Dental providers treat patients for the maintenance of their oral health, and part of this care is to educate patients—it always has been. In fact, it has been a challenge in days past to motivate dental patients to care more about their oral health. A more educated society has better chances of thriving.”

It’s important to make Dr Google work for you too—learn how to put your practice at the top of Google’s list with SEO.

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