SELF-DIAGNOSIS AND ITS POTENTIAL PROBLEMSReceiving a doctor's diagnosis can be pretty scary. But basing decisions on your own self-diagnosis of a health problem can have frightening consequences Self-diagnosis is process in which a person experiencing a health problem attempts to identify its underlying cause and then experiments with treatment options to resolve it without consulting a physician. In the long run, this is an unwise decision.
Patients often come to my office after identifying problems with their eyes. Self-assessment, or being aware of how you feel, is a normal process that people engage in daily and when they are determining if they need to visit a doctor. It is a good thing. Some people take this a step further, combining advice from friends, information on the Internet and television – some of it reliable and some of it not – to develop their own self-diagnosis of the problem along with a treatment plan.
It can wind up costing more in the end, and, most important, it potentially can allow health problems like glaucoma to become worse. It really boils down to spheres of expertise and responsibility. No one knows how you feel better than you do. This is your sphere of expertise. As such, your responsibility is to regularly self-assess how you feel. When you recognize that something is wrong, this should bring you to a physician for help. As a physician, my sphere of expertise is figuring out what is wrong based upon information that you give to me (your self-assessment), performing a medical examination, and interpreting diagnostic tests. As such, I have a responsibility to listen to you, diagnose your health problem, and develop an individualized treatment plan for you. Many medical problems have overlapping symptoms, or at least what appear to be overlapping symptoms to the untrained eye. A physician is trained to distinguish between various possibilities and develop a treatment plan specifically targeted to the problem.
A friend of mine recently was on vacation in the Catskill mountain region of New York, driving on a two-lane mountain road. Her speed was below the posted limit, but she recently had been passed by a car that was moving at a much higher speed. As she drove past a side street, she noticed a police car parked behind a bush in her peripheral vision. His lights began flashing immediately and he pulled out onto the road with his siren blaring. Despite evidence to the contrary – she was driving under the speed limit and had been passed by someone that was not – my friend instantly assumed that the officer was going to issue her a speeding ticket. Full of anxiety, she pulled over to the side of the road only to see the police car pass her and stop the faster car in front of her. This story illustrates an important point. Most of the time our self-diagnosis is not very reliable. Patients routinely choose one of two extremes when self-diagnosing a health problem. They either settle on the worst diagnosis that they can imagine, like my friend with the police car, or they ignore the problem until it becomes so serious that it requires emergency medical intervention. In both instances, self-diagnosis can cause unnecessary anguish, cost, and discomfort. Additionally, for health problems like glaucoma, self-diagnosis and treatment potentially can have very serious consequences. Thus, it is best to see a doctor and let him or her diagnose your health problem. Remember. We’re talking about your eyes on this website. You might decide to delay visiting a physician if you have a cold, but do not take your eye health for granted. Many conditions of the eye don’t have any noticeable symptoms. For this reason, it is best to visit your eye-care professional regularly.
I recently had lunch with a colleague that is a Ph.D.-level research scientist. When our food arrived, he complained that the bowl of vegetable soup he had ordered was not filling and that he would be hungry again in an hour. When I suggested that he order something else to go with the soup, he sighed and said that he was trying to lose weight because his last cholesterol test had been pretty high. The medical term for high cholesterol is hypercholesterolemia.
Having abnormal cholesterol levels, in which a blood test has revealed that the various components of cholesterol are outside a specific range, is linked to glaucoma and is considered to be a significant risk factor for the development of coronary heart disease.
Being a physician, my interest was piqued. I asked if his doctor had prescribed anything to help lower his cholesterol. He said that she had not yet done so, but that it was the next step if he didn't lose some weight. As our conversation continued, I learned that, contrary to his belief, his physician actually had prescribed a treatment regimen. It was a program of diet and exercise designed to gradually lower his weight. This story raises an important issue. What is a doctor's prescription? A doctor's prescription can be in the form of an order to a pharmacist to dispense a particular type of medication to you in a specific dosage. This is the most common way that we think about a prescription. A doctor also can prescribe specific actions for you to take that do not involve medication. These actions are just as important to follow as taking your medication as prescribed. Unfortunately, patients have a tendency to view as optional anything that is not a medication in their treatment plan.
To illustrate the previous point, let's consider a patient that has been diagnosed with a lower respiratory bacterial infection. Her physician prescribes a treatment regiment consisting of 2-3 days of bed rest, drinking plenty of fluids, and a 10-day course of antibiotics. The patient returns home and lays down for a couple of hours, but the next day continues with her regular daily routine. She does not increase her fluid intake because she doesn't like having to make multiple trips to the bathroom. She does take the antibiotic.
It's hard to say, but probably yes.
Again, it's hard to say, but probably yes.
Probably yes. This is another form of self-diagnosis. The patient has decided to adhere to part of her doctor's prescription, but not all of it. Instead her self-diagnosis has rendered fluid intake and rest as having less importance than taking the antibiotic. However, the elements of the prescribed treatment plan were designed to work together to achieve a fast recovery with minimum discomfort. Let's return to our patient. Her prescribed treatment regimen included a 10-day course of antibiotics. But she is feeling better after taking the medication for three days and stops using it.
Possibly, but she significantly has increased her risk for relapse (return of the infection). If relapse occurs, the infecting bacteria likely will be resistant to the antibiotic and her condition will be more difficult to treat.
Definitely yes, if she relapses.
Definitely yes, if she relapses. Again, the patient has engaged in a process of self-diagnosis, a decision that has put her at risk for serious health consequences. For this reason, it is important that you both understand all of the directions that a doctor gives to you (your prescribed treatment plan) while you still are in his or her office and follow those directions once you are home.
Returning to the original story, my colleague's physician had prescribed a regimen of diet and exercise in an effort to lower his cholesterol. He was to have another cholesterol test at a nearby clinic in six weeks to monitor his progress and then was scheduled to return to his doctor for further consultation, at which time the decision whether or not to place him on a medication regimen would be made. I asked when he was supposed to take the follow-up cholesterol test. Imagine my astonishment when he told me that the test date was nearly one year ago! It seems that he had been playing a cat and mouse game with his doctor throughout the past year. She would write an order for a cholesterol test. He then would pretend to have lost it or state that he had been busy and allowed the date for the order to expire. Believe it or not, this is another example of self-diagnosis. This colleague had made the decision that the situation was not as serious as his doctor was telling him and believed that he could delay taking the test until he had met his weight-loss goal. The problem with this strategy was that he hadn't followed his doctor's prescribed diet and exercise regimen either and weighed about the same as he had when his hypercholesterolemia was first diagnosed more than a year ago.
A little more probing with this colleague revealed that his self-diagnosis had led to distorted thinking about his health problem, which in turn had led to some very unwise decisions. First, he didn't really feel bad, so he self-diagnosed his problem to be less serious than his doctor had indicated. Second, he was terrified at the prospect of taking medication to lower his cholesterol, believing that once he started he would have to take it for the rest of his life. The fear of taking cholesterol medication was so great that he was willing to do almost anything, including risk his own health status, to avoid it. I finally was able to help him to look at his situation from a different perspective. First, many chronic conditions such as high cholesterol and glaucoma can go unnoticed for years by the patient. They often do not present symptoms until the situation is serious or in some instances catastrophic. Self-diagnosis can lead to downplaying the importance of the health problem or denying that it exists. This is what happened with my colleague. With respect to his fear of taking cholesterol medication, there was a simple alternative to his self-diagnosis. I suggested that he could take the medication and at the same time follow his doctor's diet and exercise treatment regimen. If it leads to weight loss, chances are his doctor would be able to at least lower the dosage of the medication and perhaps even eliminate it entirely. In fact, taking the medication might actually provide the motivation to lose the weight once and for all. Most important, even if he didn't reach his weight-loss goals, as was the case over the past year, the medication still would provide him with the health protection of lowering his cholesterol. As you can see, health problems resulting from self-diagnosis are not restricted to people of lower economic status and education. His self-diagnosis resulted in a lack of communication with his doctor. He had concerns about taking cholesterol medication that he did not share with her. Consequently she could not address his fear within the context of presenting him with healthy options. Instead, she likely assumed that he had anxiety about taking the test and probably focused on developing strategies to get him to take it, unwittingly participating in his cat and mouse game. The result was that his high cholesterol went unchecked for more than a year. It is important that patients avoid engaging in self-diagnosis, particularly for diseases like glaucoma. Good health is your most precious resource. For this reason, only trust it to a physician with expert qualifications to help you to manage it. A number of visitors have written to me asking for recommendations pertaining to eye-care products and books for obtaining more information. I have joined with Amazon.com to create a dependable resource for books and products. You can find these materials at the Eye-Care Store.
Return from Self-diagnosis to Glaucoma Diagnosis
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This usually is not a good thing. 
Will this patient get well? 
This colleague is a research scientist with a reasonably good income! 
