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QZ&A

If people realized how little doctors knew, they’d be very scared

By Katherine Ellen Foley

Lisa Sanders is an internal medicine specialist who realizes that sometimes, even doctors don’t have all the answers. “When medicine looks to you and says, ‘I’ve got nothing,’ then you should feel free to look for yourself,” she said.

And plenty of people do: Numerous websites like WebMD or HealthLine provide people with possible reasons for their symptoms. Many crowd-source their diagnosis if they think it will help. Sometimes, though, web resources are less than reliable, and cause patients undue anxiety for illnesses they don’t have or—more dangerously—discourage them from visiting a doctor when they should.

Quartz caught up with Sanders to ask about her diagnosis in the digital age. When she’s not seeing patients or teaching at the Yale School of Medicine, Sanders writes the “Think Like a Doctor” column for the New York Times, which appears online each week and in the monthly magazine. It was also the inspiration for the TV show “House.” The following is edited and condensed for clarity.

Quartz: What role do you think the internet has for people seeking answers to their medical problems?

Sanders: We have always diagnosed ourselves, even before the internet. We always try to figure out what’s going on with our own bodies, and I think that’s completely reasonable. When we run through our own resources, what do we do? We ask our mom, we ask our friends, and it’s only when none of those have satisfying answers, or when you’re too sick to have that kind of luxury of time that we turn to doctors. I think that’s completely appropriate.

Does the internet help patients who disagree with their doctors’ diagnoses? 

Oh my God, if people realize how little people knew—actually knew—they’d be a lot [more scared] than they are now.

When I started medical school [after a career in journalism], I thought, “Oh my God, if people realize how little people knew—actually knew—they’d be a lot [more scared] than they are now, and maybe take better care of themselves.”  

We like to give them impression that if you have questions, we have answers. But actually, there’s a lot of wiggle room in that…If you put on one plate all the stuff we know, and on another all the stuff we know we don’t know…I think it’s about equal. And I think everyone in medicine recognizes that there’s a huge dollop of stuff we have no idea about. 

Really, we’re just at the beginning. We talk about medicine as if it’s thousands of years old, and sure, medicine has been around for thousands of years, but we didn’t know anything until the 20th century. Penicillin wasn’t used until after World War II!

How do you feel about patients using the internet to diagnose themselves?

I think if they get it right, terrific! Certainly, there are people who will recognize a disease the same way doctors do. They know this disease, they’ve encountered it before. I think what gets difficult is when you think that you can diagnose things just from looking it up on the internet. Sometimes you can, but sometimes you can’t.

One of the hardest things you learn in training as a doctor is that most of the stuff you learn in medical school is kind of useful background noise, but it doesn’t tell you anything about the patient in the bed.

One of the hardest things you learn in training as a doctor is that most of the stuff you learn in medical school is kind of useful background noise, but it doesn’t tell you anything about the patient in the bed. Sometimes they look like the way they do in the book, but far too often they don’t and you have to be able to understand what’s going on enough to figure it out. There’s a reason that after four years of medical school, everyone has at least three years of training, and usually more.

At what point do you think patients should see their physician? 

Most people that we see, either we know what’s going on with them, and we give them something and they get better, or there’s this minority of people who—either we know what’s going on with them or we don’t—they get worse. So going to the doctor gives you at least the possibility of getting better reliably.

The doctor knows a lot about bodies and diseases, but the patient actually [is] the exclusive expert on their body and their diseases.

I’m not against doctors. I think doctors are really, really important. But it’s teamwork. It’s me and the patient together, facing whatever problem [the patient] has. It’s not the doctor telling the patient, or the patient telling the doctor. If there’s not a collaboration, you’ve got nothing. The doctor knows a lot about bodies and diseases, but the patient actually [is] the exclusive expert on their body and their diseases. And if you don’t work together, it might turn out fine. But the best way to do it is to collaborate.

I do have a population of patients that feel frustrated because they have symptoms that nobody can tell them the cause of. Sometimes I can help them figure it out…but sometimes not. 

What do you tell a patient when you don’t know what is ailing them? 

We have this catch all phrase called “medically unexplained symptoms.” I would say that the way patients hear it (and it’s probably not an accident), is that “whatever you have is not in your body”—it’s not explainable by medical systems. But what we don’t hear in that phrase—what doctors don’t hear in that phrase—is “medically unexplained by me.”

Just because you don’t know the answer doesn’t mean that there is no answer. Patients have their own experience, and it’s very hard to use logic to get past people’s experiences, and probably appropriately so.

I’m not saying that every symptom that every person feels is caused by something that’s happening in their arm. But I do think that patients and doctors forget that the brain is also a part of the body, and also part of medicine. People do feel pain from things that are not diseases.

How do you offer treatment for these patients?

Actually, caring about people? That’s important.

You talk as if the only treatment we have are drugs. But actually, caring about people? That’s important. It turns out that that may be the most important part of it. It’s not an antibiotic, it won’t help you if you’re septic…but for a lot of these problems that are just the annoying problems of everyday life, caring about somebody, asking them about it, asking about how it affects their lives, and being there for them—and maybe coming up with solutions—but actually just being there for somebody is actually really important…And it’s one that I don’t think gets nearly enough attention in actual medicine.

To me, it’s just about education. It’s a cliche, but doctor does mean “teacher“ and it is an important part of what we do. It’s our job to help people understand their bodies to the best that we understand them.

And just because we think that someone is doing the wrong thing—we have to listen and hear what they think. If they say “this makes me feel better,” I’m first going to say “Tell me about it.” Then if it makes them feel better and I can’t see that it’s hurting them, what do I have to say about it?

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