Thursday, September 8, 2011

Score One for the Internet

The other day I was at the clinic to have blood drawn for some tests. I told the young lady poking me with a needle that the blood culture had to be done for 21 days rather than the usual 3 days in order to detect brucellosis. She said that she saw brucella on the order but nothing about 30 days. I insisted that it was necessary, because brucella is hard to detect. I had read that on the internet. She had never heard of brucella, but she went to ask the the microbiologist. When she returned, she said, "Score one for the internet. We would have thrown out the culture after 3 days."

There are only 200 cases of brucellosis in the US. The point is that health care can be improved if the public is educated about how to do internet research properly. My own doctor has never seen a case, although he learned about the disease in medical school. Doctors find patient research on the internet to be annoying, but when done right, patients can contribute to their own diagnosis.

What would you say are the key features of useful amateur internet research?


Ira Glickstein said...

Joel, thanks for showing the value of citizen medical researchers like yourself who take responsibility for learning about possible diseases to which they or their loved ones may be subject, and, -in your case- informing the medical professionals of what you found.

I never heard of Brucellosis, but it seems nasty, and related to contact with domesticated animals. What might you have been doing in that regard?

Here is some info I found at the National Institutes of Health:

Brucellosis is also known as: Rock fever; Cyprus fever; Undulant fever; Gibraltar fever; Malta fever; Mediterranean fever.

Brucellosis is an infectious disease caused by contact with animals carrying bacteria called Brucella.

Causes, incidence, and risk factors

Brucella can infect cattle, goats, camels, dogs, and pigs. The bacteria can spread to humans if you come in contact with infected meat or the placenta of infected animals, or if you eat or drink unpasteurized milk or cheese.

Brucellosis is rare in the United States, with approximately 100 - 200 cases each year.

People working in jobs requiring frequent contact with animals or meat -- such as slaughterhouse workers, farmers, and veterinarians -- are at high risk.

Good luck Joel, and I hope the test comes out negative.

Ira Glickstein

joel said...

I don't hope the test is negative. It would explain a lot of "undulent" fevers that I've had during my life. I had contact with a goat imported from Morocco to Paris and also ate lots of "artisanal" goat cheese while in France. Detecting Brucellosis is a very iffy thing even when it's a likely candidate. My point is that with all our national discussion of health expense, there has been no discussion of what part the patient might play in cutting costs. I believe there is an important potential. Diagnosis and misdiagnosis is a very significant cost. Also, my doctor's office has a sign that says, "Don't hesitant to ask your doctor if he/she has washed his/her hands."

Ira Glickstein said...

Good luck Joel and I hope you get the test result that explains your symptoms.

Looking at the larger picture, is it clear that patient participation and self-research will actually reduce costs? I think most of the info on the Web is well-intentioned and basically correct, but some is slanted towards some alternative medicine interests and other stuff is dead wrong. You and I and other readers of this Blog are probably better suited to interpret the correct information and reject the incorrect, but is that true of the general population?

Could self-research lead to hypochondria? I remember hearing that certain medical-related TV drama programs would trigger some viewers to go to their doctors and report symptoms of the particular disease of that week.

You've probably heard of the sign at the auto repair shop that says:

Labor charge - $50/hour
If you watch - $75/hour
If you help - $100/hour

I would ever actually ask my nurse or doctor if he or she had washed his or her hands between the last patient and me. If he or she had, they would probably think I was a busybody, and, if they hadn't, they would probably lie about it. So, the only way to be sure is to insist on watching them wash their hands.

Ira Glickstein

joel said...

Hypochondria is a popular argument among physicians who want to maintain their position against the rabble. It is the reason why I say that the public needs to be educated about how to make proper use of the internet. Internt forums, for instance, are not an appropriate source of information. No matter what you are for or against , you can find a forum which supports your point of view. However, scholarly papers are a valid source of information that may be made accessible to the public.
We can take breast self-examination as an example of public medical education that actually makes a difference. It's fascinating to see how experts are divided over whether or not women should be educated and encouraged to use self-examination. In Canada, an odd argument against education is that it causes more biopsies to be performed and therefore more expense to a publicly funded medical system. (see