Doctor's Orders: The Impact of Internet Diagnosis On a Consumerist Society

Written for my Critical Media Studies class during the Winter 2014 semester of my University career

 Introduction

The internet is shaping the way North Americans access medical attention. The increase in awareness of health and healthy practices has created an explosion of related information. So much, in fact, that it has become difficult to discern which sources are scientifically factual, and which are simply an opinion. The following pages will use the assessments of communications media theorists in establishing why the self-diagnosis phenomenon exists and its potentially negative impact on society. I will use Neil Postman’s theory of technological determinism to explain how an era of information is not necessarily beneficial for the public. Using Marshall McLuhan’s theory of how the medium is the message, I will explore the still relatively new medium of the internet, and how it affects the content and meaning of what it is portraying. Finally, I will use Henry Jenkin’s theory of media convergence to analyse how increased accessibility to medical information consequentially affects the general public, the medical community, and the relationship between the two.

According to a study done last year by the Pew Research Centre, 1 in 3 Americans have gone on the internet to diagnose a medical condition, with only 41% of those diagnoses actually requiring medical attention (Duggan and Fox, 2013). It is clear that the other 59% have access to medical information without really knowing what to do with it, and this leads to a kind of “Cyberchondria.” Cyberchondria is, as defined by Collins English Dictionary, “an unfounded anxiety concerning the state of one’s health, brought on by visiting health and medical websites” ("Cyberchondria | Define Cyberchondria at Dictionary.com", n.d., p. xx). While self-diagnosis can be effective for unremarkable conditions such as the common cold, the ramifications that come along with self-diagnosis also have a heavy impact on society as a whole.

What caused the shift?

“The most interesting kinds of scams reveal larger in sight about the way we live now " the things we desire the sources of our fears, the nature of our aspirations.”

- Carl Elliott

The current Western medical system relies heavily on an economic model of operation. Under this system, “medical services [are] treated just like any other commodity that can be efficiently produced and consumed under competitive market conditions” (Lupton, 1997). The notion of “shopping around” for a physician’s opinion, otherwise known as the infamous “second opinion, has become a common practice.

Likewise, doctors themselves have grown more distant, removing themselves from the traditionally caring doctor-patient role, and replacing it with a more capitalistic model of service provider and consumer. This shift is easily reflected in the longer wait times to see physicians, the preference of appointments over walk-in patients, regardless of the ailment, and in the shortened amount of time allotted for doctor-patient interactions. It is no longer about healthcare, but rather about how many people the clinic can get through its doors. While there is always a hegemonic aspect surrounding the power doctors have over their clientele, it has only increased in recent years in these modifications, determining whether a person is, or is not, ‘good enough’ to be seen by their physician.

Pharmacology has moved along a similar path of development. Despite society being constantly assaulted with advertisements for new cure-all drugs, the general public is only being given partial data and half-truths. Most of the time, “drugs are tested by the people who manufacture them, in poorly designed trials…. and analyzed using techniques which are flawed by design” (Goldacre, 2012).

Growing research-on-researching-methods shows that most industry-sponsored pharmaceutical studies are skewed toward the benefit of the treatment, while simultaneously disregarding the negative results in a practice called “funding bias.” The results of a 2003 study state that the studies sponsored by pharmaceutical companies have a higher likelihood of favouring the product being studied, as opposed to those products being studied and funded by other sources (Lexchin et. al., 2003). Due to this kind of bias, neither doctors nor their patients can be certain of the reliability of the drugs being dispensed to them.

It is the combination of these two factors that has fuelled a culture of mistrust of the medical community. This is especially prevalent among the younger generation; those who have grown up with access to information, and who grew into a strong sense of caution regarding the accountability of authority figures. Even if people still respect the practice of their doctors, they invariably believe that their childhood physicians far outdistanced those practicing in the present (Lupton, 1997). So, self-sufficiency has become the new digital trend, leading to the explosion of self-help and self-diagnosis websites that can be found today.

The dawn of cyberchondria

If a user were to search “self-diagnosis”, Google would spit out over 8 million results. Almost all of these results pertain to websites dedicated to aiding the general public in diagnosing everything from male-pattern baldness to cancer. These websites list off symptoms that commonly crop up in a number of ailments. Some sites, like WebMD, have an interactive software program embedded into their website that allows users to input their symptoms in order to produce a nameable condition.

The problem with this process lies in the example mentioned above. Diagnosis websites offer an entirely objective analysis, pairing symptoms to conditions. They disregard their “patient’s” previous medical history, as well as attributing factors such as the environment or stressors. The “symptom checker” then spits out every condition that could have that symptomatology.

This is a fairly ineffective method of diagnosis, as it leaves the user with a dizzying list to choose from, and tends to leave the user far more terrified about what they might have than when they began. As determined in a 2012 study out of Hong Kong, “such symptom-matching exercises may lead consumers to overestimate the likelihood of getting a serious disease because they focus on their symptoms while ignoring the very low likelihood that their symptoms are related to any serious illness” (Denfeng and Sengupta, 2012).

What does media have to do with it?

In his book Amusing Ourselves to Death, Neil Postman suggests that different forms of public discourse “…regulate and even dictate what kinds of content can issue from such forms” (Postman, 2005 p. 6). The internet, as it is, has become the largest form of public discourse known to mankind. It supplies those who have an internet connection with information that would have otherwise been restricted to specific fields and academics thirty years ago. Anyone can access this information, if they know how and where to look, and that has led to innumerable informants jockeying for popular opinion. This leads to a sea of information that internet users have to sift through, oftentimes leading to indeterminate results. Not every source of information is legitimate, although several try to make themselves seem so. This convolutes the information pool further, as it is extremely difficult to discern opinion from fact.

In his 1990 speech entitled Informing Ourselves to Death, Postman explains that although there is a greater access to information than ever before, that access does not necessarily resolve the problem. Rather, information gatherers become overloaded with the amount of information available to them, most of which “comes indiscriminately,” and is “directed at no one in particular” (Postman, 1990). Internet users do not necessarily know how to handle this influx. For every piece of legitimate information, there are at least six illegitimate sources disproving it.

Medical information, due to its popularity, is the worst culprit. It has become nearly impossible to sort the facts from opinion, with “experts” approving and disproving theories almost as quickly as they are published. This quagmire renders querier’s “information immune system” useless; they are no longer capable of filtering through the information being directed at them, and instead allow it to pass over in waves, readily believing almost everything the faceless “experts” say. As Postman points out, “we don’t know what information is relevant, and what information is irrelevant to our lives…. We don’t know how to filter it out; we don’t know how to reduce it…. We suffer from a kind of cultural AIDS” (Postman, 1990).

Those who have begun to rely upon the internet for their medical information and diagnoses are losing the mediating factor provided in a personal interaction between doctor and patient. As mentioned before, medical websites simply match symptoms to ailments; the human factor of checking the patient is removed. Using the internet to seek out answers on something as personal as health renders the query itself useless; even if all of the answers are there on the web, “[the web] cannot tell us what questions are worth asking” (Postman, 1990).

How does the internet affect it?

With each new medium of communication created, the social and cultural construct surrounding that medium changes to adapt. When the internet became available for public use, a whole new window of opportunity opens up in relation to how people communicated with one another. Suddenly, the whole world was open to easier communication; “it is the medium that shapes and controls the scale and form of human association and action” (McLuhan, 2009, p. 23). Not only is there the new possibility of worldwide correspondence, but the base of information widened exponentially, allowing foreign researches to add to the wealth of information already. For instance, in this paper alone, there are sources from Australia, America, Great Britain and China. Even more incredible, the internet made all of this information available to the general public.

The accessibility of the internet has granted an open forum in most cases, as “the ‘content’ of any medium is always another medium” (McLuhan, 2009, p. 23). This forum provides the general public with the means to express their opinions and receive outside opinions on topics they are interested in. Within the sphere of the circulation of medical information, the respondents to medical queries no longer need to have a pertinent academic degree to pose their opinions. Relative to the forum in question, anyone can and usually does provide their own insight to the questioner. McLuhan would refer to this as the “message” of a medium altering the pace and pattern of human affairs that it is introduced into. (2009, p. 23)

Such openness can be both helpful and harmful. On the one hand, it can be helpful in that users of medical information websites can find others in similar circumstances, and if required, gain a kind of support-group or community. However, as mentioned in the previous section of this paper, most of the time, people have difficulty sorting through the information they receive. If a user follows through on the wrong information that they found on the internet, it could cause serious damage. Oftentimes when this occurs, it is difficult to find the people behind the forum username to blame, and so, the technology itself is blamed in their stead. However, “we are too prone to make technological instruments the scapegoats for the sins of those who wield them” (McLuhan, 2005, p. 24).

How does it all come together?

According to Jenkins, media convergence is the process of “[altering] the relationship between existing technologies, industries, markets, genres and audiences” (Jenkins, 2004). The process occurs with media consumers, rather than with the media itself, through their interactions with others, impacting how media itself is consumed. The internet, naturally, is the pinnacle of media convergence, from its birth to the modern moment, as it and its content are always inherently changing with those who use it.

The way that the internet has broken down barriers between people is staggering. It has allowed for the birth of a culture in which the general public can participate more fully in their own lives, leaving less up to those who would otherwise have a hegemonic grip on their fates (e.g., medicine, law, etc.) Now, with the help of an internet connection, the general public can do research to inform themselves on any topic, so as not to walk into a situation blindly. A sort of “collective intelligence” has grown, as the general public begins “fighting for the right to participate more fully in their culture, [and] to control the flow of media in their lives” (Jenkins, 2004).

In the medical community, media convergence can be both a blessing and a curse. “On the one hand, convergence represents an expanding opportunity…. Since content that succeeds in one sector can expand its market reach across other platforms. On the other hand, convergence represents a risk, since most of these media fear a fragmentation of their markets” (Jenkins, 2004). Despite being able to offer more information online, including contact information on a clinic’s private webpage, there is the risk that doctors can lose patients. This loss can either be to competing physicians, or patients removing themselves from the medical system entirely under the assumption that they can take care of themselves with the information that they acquire on the internet.

Patients are affected too. The internet provides not only an information medium, but also a place for others to review and assess those they interact with. Through the internet, patients can learn about the history of their physicians, of certain practices, which practices are closer, etc. While these do not necessarily seem negative, there is always the potential for unfortunate circumstances to arise that would spur patients away from their doctors or away from the medical community entirely.

Conclusion

Using the internet to self-diagnose is a double-edged sword. Although it can certainly provide medical queriers with the information they need, it falls short in supplying the necessary mediation that is required during diagnosis, as many ailments share symptoms. It takes a physician to properly diagnose an ailment, because of the contributing factors that the internet does not take into account (e.g., previous history, environmental stressors, diet, etc.) Granted, not all doctors take the time to actually look over these dynamics either; however at least with a human being, it can be brought to the doctor’s attention.

Through the lenses of Postman, McLuhan and Jenkins, I have analyzed the effects that internet self-diagnosis can have upon Western culture. With Postman, I argued that due to the vast influx of information received on a daily basis, information consumers no longer have the ability to filter out what is relevant vs. what is irrelevant. The same is true when trying to assess medical information, which is even more convoluted due to such influences as funding bias. Postman emphasizes that technology cannot show those who use it how to ask the right questions, even though it simultaneously supplies all the answers.

Using McLuhan’s infamous “the medium is the message” theory, I pointed out that the society and culture surrounding a new medium is shaped upon the introduction of that medium. The internet made much more information available to the public, and in doing so, it reshaped the way the public accessed and utilized that information. Public forums provide a place for people to transfer ideas and give support; however they are also capable of supplying misguiding information, which could become dangerous in extenuating circumstances.

Finally, I used Jenkin’s convergence theory to examine the way that the internet has broken down the barriers between the public and their physicians. Access to more information is simply the tip of the iceberg; doctors are capable of reaching out to their patients in more ways than ever, through social media and websites. However, patients can also use the internet to “shop around” for doctors, determine their history, and even remove themselves completely using information attained online, which creates a tension in the already strained doctor-patient relationship.

The internet is not a cure-all. While using the internet to research symptoms and determining what you might have is a good way of becoming more active your own life, it is in no way an acceptable replacement for seeking proper medical attention when it is required. There must be a balance between both in-person medical attention and informing oneself of the possibilities. If this does not happen, then Western culture will further descend into a state of sick cyberchondria.

Author's Note

References
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