Diagnosis Solved! How to Solve a Medical Mystery

Meet Lisa Sanders, MD, the real-life doctor behind the hit series House. As technical adviser to the show, author of The New York Times Magazine's "Diagnosis" column, and practicing internist at Yale University School of Medicine, Dr. Sanders knows a thing or two about medical mysteries. We caught up with her recently to talk about sleuthing your own symptoms and separating fact from fiction when doing health research online.
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There's an overwhelming amount of health information available today. Should patients try to wade through it and research their symptoms, or should they just leave it to their doctor?

I would rather patients come in with a stack of 300 printouts from the Internet than say, "I don't know" when I ask them how they feel. Or I'll ask, "What medicines are you taking?" And they'll respond, "I don't know. I take a red one and a blue one and a capsule." When I see those patients my heart breaks because they don't know what's going on with their health, and they don't even realize it's their job to know.

Yes, I'm an advocate of using any and all available resources. The Internet is very useful simply because it lets you learn stuff. Knowledge is a powerful thing; it gives you a sense of command.

A lot of doctors wish their patients would just shut up and do what they say. But that's not really useful because then patients don't learn how to take responsibility for their own health. You have to be part of a team. I'm like the coach that helps you understand what's going on. But in the end, you're the one that has to fix the problem. And the more you know, and the more active role you play in your health, the better off you'll be.

How can people Google their health concerns and find information that's credible and useful?

If you're going to sleuth your symptoms, you have to be smart about it. If you Google the word headache, you're going to get 50 million hits and most of them aren't going to be useful. First you should find reliable sites. The National Institutes of Health site has very reliable information that lets you look up symptoms. The Mayo Clinic and Harvard University sites do as well. Those are some reputable sites that I use, but of course they're not the only ones. I'd say in general, you should get to know a place before you trust its content. Find out where they get the information and how they're supported. If they're supported by advertising dollars, that's fine, but you need to pay close attention to how much and in what context the advertisers are featured.

Now, sometimes you do need to dig for information outside of where you'd normally look, and Google is great at that. But if you only rely on the first few things that come up, you're going to get a lot of bad information. The trick is to be as specific as possible. Your doctor can help with this. A lot of times you go to the doctor with a symptom and all you leave with is the doctor's acknowledgment of the symptom. Maybe you don't get a diagnosis, but you might get a better name for that symptom. For example, let's say you have some pain in your shoulder. Your doctor might be able to tell you the name of the specific shoulder muscle that hurts, and then you can go home and research stretches for that particular muscle. Or you might go in with a rash. Your doctor might prescribe you a cream or something, but he or she probably won't mention the type of rash you have. So you've got to ask him what exactly is going on? When he says, "Oh, it's leukocytoclastic vasculitis," that may mean nothing to you. But get him to write it down so you can Google it when you get home. Then you can read about it all you want.

Continued on page 2:  Less Obvious Symptoms


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