Simon Crompton
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You may have noticed that Dilbert, the cubicle-dwelling office worker that I created in 1989, doesn't have a mouth. At first, I didn't see any significance to this. But now I wonder whether the way I drew him forecast my future.
A few years after I launched Dilbert, I contracted a neurological movement disorder that caused involuntary muscle spasms in my drawing hand, and only my drawing hand. I'd look at my fingers and tell them to do one thing, and they'd do jagged things instead. It was focal dystonia, more commonly known as severe writer's cramp, brought on by overuse of the hand. My doctors managed to provide a diagnosis quite quickly but couldn't provide a cure, apart from changing my job, which was unthinkable.
At first I sidestepped the problem by drawing with my left hand. Meanwhile, I continually practised touching pen to paper with my right hand, pulling back just before the spasms started. I did this for months, gradually building up the time I could last before a spasm until one day, somewhat suddenly, I got back full function in my hand.
About ten years later I overused my drawing hand again and the problem returned. As a quick fix I found I could draw directly to a special computer monitor using a stylus, which changed the way I drew just enough to avoid triggering spasms. The spasms stopped, and since 2003 Dilbert has been drawn on the computer (in about half the time it used to take). Then in spring 2005 I lost my voice. It started with my usual seasonal asthma and allergy, and developed into what I thought was laryngitis. The best I could manage was a hoarse whisper, but it went on for months. My doctors suspected bronchitis and then acid reflux, and then an ENT specialist said he could find no growths and that everything was structurally OK. The doctors were checking for the conditions that were the most likely culprits. But they were baffled.
I was beginning to despair. I can't tell you how lonely having no voice makes you feel. It's like being a ghost in the room because you can't participate in anything socially. Then, about six months after I'd first lost my voice, I woke up wondering if my speech problem might be related in some way to my hand problem. So I typed “voice dystonia” into Google and up popped a link to a video of a person speaking in a damaged voice that I immediately recognised as the same as mine. The search had taken me straight to a page that identified the condition as something called spasmodic dysphonia, which is, as it happens, a vocal form of dystonia. It's where the vocal cords clench, making you unable to speak.
I told my wife and doctor that I thought I'd found what I had, and they were sceptical. But I found my way to a specialist in that condition, who confirmed that I had it. Unfortunately, I still couldn't find a cure. The specialist tried the standard treatment, Botox shots to the vocal cords, which forcibly relaxes them. This was unpleasant and had limited success. I also spent a week with a voice expert, trying a voice training technique that had cured some. It helped, but I was far from fixed.
My cure came via the internet. About a year ago I started using Google alerts to tell me whenever someone mentioned Dilbert, me, or anything about spasmodic dysphonia on the internet. Then, six months ago I got an alert with a link to an obscure medical publication with a report about an even more obscure surgical procedure for fixing spasmodic dysphonia, developed in Japan. I took that information to my doctor, who thought it wouldn't be right for me but referred me to an expert at Stanford University who might know more, who, in turn, recommended a different type of surgery being conducted by an expert surgeon at UCLA. This surgery had a good track record, especially recently.
The operation wasn't pleasant. It involved opening up the neck, cutting the nerves linking the brain to the vocal cords and splicing in nerves from another area of my neck. But I was desperate and I went ahead.
Within four months my voice was back to normal, and it remains good. I never would have found that path without Google alerts. It makes me wonder how far the Dr Google trend can go and what impact that can have on society's medical costs. I have used the internet dozens of times to diagnose various minor medical problems: if you have a mole or a bite or some toe fungus, you can compare it with internet pictures, and ask what type it is, and whether it's dangerous. I particularly use WebMD, which allows you to check your symptoms.
It makes sense that we should use the internet more to diagnose our problems and to find treatments because a doctor has only so much time in a day, and there's no way one doctor can be an expert in everything. Doctors are always going to be much better at spotting and treating things they see every week than those they'll see three times in their career.
Obviously there are plenty of examples when seeing a doctor is better than using your own flawed judgment plus the internet. But aren't there just as many or more cases where using the internet gives you a better result?
We're not talking about emergency room or trauma situations where a doctor is obviously the best solution. I'm talking about all the trips to see the doctor when you essentially say: “Something hurts. What is my problem? Do you have a pill for that?” If the problem is uncommon, as with my spasmodic dysphonia, maybe Google or WebMD can do a better (faster, cheaper) job than a doctor, especially if you can call up videos of people with identical symptoms. Are you any worse than your doctor at looking at high-definition pictures of a skin problem and comparing it to your own skin problem?
Common problems, too, may become as easy to diagnose yourself as by going to the doctor. I'm imagining someday that you can buy a home kit that takes a picture down your ear or throat and puts it on your computer for easy comparison to stock medical pictures. If WebMD asks the same questions online that your doctor will ask in person, an intelligent person is going to get an answer there rather than visit a doctor. The doctor won't be so pushed for time as a result, and the patient won't have to wait so long to get an answer - and timing in health matters a lot.
The hard part is weeding out the con artists and drug companies when you do your search, but you have to compare the costs and benefits. In the US, huge numbers of people don't have healthcare. Sure, sometimes the information on the internet will be wrong, but that can still be better than no medical help at all. I don't think it will be too long until Google is your new doctor.
Scott Adams's new book Dilbert 2.0 (Andrew McNeel, £50) is available for £45, free p&p. Phone 0845 2712134; timesonline.co.uk/booksfirst. www.dilbert.com
Should you use the internet to get health advice?
5 pros
1. Your GP is a generalist, not an expert. The internet provides a vast array of specialised expertise and Googling can tap you in to that.
2. It also helps you to access patients' expertise,allowing you to compare symptoms/experiences. Each article provides clues and search words to explore, allowing you to burrow deep.
3. A study in the British Medical Journal found that self-diagnosis via the internet can be reasonably accurate; 15 out of 26 people studied came up with the correct diagnosis.4. Googling makes sense because only you know how you feel. Good doctors recognise that you can help them, especially in finding treatments for conditions they may know little about.
5. The growing sophistication of internet tools (alerts, advanced searches) and internet users' increasingly sharp bullshit detectors, means that trawling for health information is not the minefield it once was. Soon we'll be able to sort search results even more rigorously, and tailor them to our own health record.
5 cons
1. Diagnosis is tricky. Comparing your rash with an online photograph is likely to lead you up the wrong track because appearance provides only 10 per cent of the information needed to provide a diagnosis. No two people suffer the same condition in the same way.
2. Doctors take into account your appearance, history, state of mind, words, etc, in making a diagnosis. No computerised symptom checker (such as those provided in www.WebMD.com or NHS Choices, www.nhs.uk) will equal a complex professional assessment.
3. Many websites have an interest in misleading you. Some masquerade as patient information or self-diagnosis sites, when, in fact, they are marketing drugs, supplements or treatments.
4. The internet feeds itself. Myths get repeated over and over again, simply because one website copies information from another.
5. The British Medical Association has warned that consumers should not seek online advice from doctors, because if something goes wrong they have little protection or follow-up.
5 tips
1. Don't take anything you find on the internet at face value; check against other sources before believing anything.
2. Look for reliable sources of information. The most obvious are charities or health organisations you've heard of. Look for clues about whether the information is from a cranky source: blogs, discussion boards and websites with names such as “toothpastekills. com” are less likely to be coolly scientific than websites from educational bodies ending in ac.uk or government bodies ending in gov.uk. But the latter are less likely to yield anything new.
3. Consult your doctor before acting on anything you find on the internet.
4. Don't underestimate the value of talking to people. The internet is a good starting point, but doctors and charity helplines will help you to put what you've found in context. If your doctor refuses to talk, it may be time to find another doctor.
5. Know your technology. If you use advanced search features, you're more likely to find the information you need.
SIMON CROMPTON
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Doctors are far over-rated, plumbers have a greater impact on human health yet are far less respected or renumerated. The only time plumbers are respected is when the toilet backs up. And people listen to our advice only when it's free and not much then, in that I guess I'm sympathetic to doctors.
Edward Berezowski, Buffalo, United States
Google came to my rescue. At the time I did not equate an inocuous blow to my ribs with a swelling on the vas deference of my testicle? It baffled the quacks but with Google's help I managed to avoid uncessary expense, anxiety and hazzle. Thumbs up for Google!
alekc , London, UK
I diagnosed myself with Multiple Sclerosis over 10 years ago with the internet.. the optic neuroligist was whispering "optic neuritis" but wouldn't give me any other information. I googled it and found MS all over the place. If I hadn't, I would've had the shock of my life when the Dr said "MS"
Carrie, SLO, USA
I spent 16 years in periodic excruciating agony (often triggered by exercise but not always), cause repeatedly misdiagnosed. FINALLY a doctor was capable of uttering the words "I don't know" and I was referred to specialist. Testicular torsion. Had access to the Internet been available...<sigh>
Pierre Joseph, Avignon, France
Without WebMD and google, I would not have known that the extended deja vu symptoms and headache I had were actually manifestations of a growing brain tumour. My GP had no clue, only by self referral to a Neurologist and my own information as backup was I diagnosed and cured.
C Shanks, Mission Valley, USA