Last week, a man in his early 40s reached the outpatient department of Nepal Mental Hospital in Lagankhel to seek the doctor’s advice on the excessive feeling of fear all the time over trivial issues.

The patient, according to the doctors, said that he was worried about his financial condition, which currently is not in a bad shape but could turn worse anytime soon.

“He was worried about the adverse impact on the family if his financial situation turned worse,” said Dr Basudev Karki, a consultant psychiatrist at the hospital. “He was kind of overwhelmed with what could happen.”

Upon inquiry, Karki said he found out the patient had not been taking the prescribed dosage of medicine.

“He had apparently checked online, surfed various internet sites to find out about the medicine. He was concerned about the side effects mentioned in the websites,” Karki told the Post. “Subsequently, he decreased the dosage on his own without consulting the doctors.”

The easy availability of the internet often prompts people to google their medical conditions and seek online advice, which can have negative consequences, experts say. While they do not outright reject the idea, they do lay stress on exercising caution.

According to experts, excessive use of the internet for medical advice could lead to hypochondria (or hypochondriasis), also known as anxiety illness disorder. Hypochondriasis is a preoccupation with disease that persists despite repeated assurance to the patients that they are in good health.

“It’s the educated ones who usually tend to seek medical advice online. And once they start reading online materials, it’s like a trip down the rabbit hole. A zillion types of articles are available there,” said Karki. “When they start relying more on the internet than on the doctors, problems start arising.”

According to the Pew Research Centre, a US-based organisation that studies issues, attitudes and trends, at least three-quarters of all internet users look for health information online. One in nine people with a high-speed connection do health research on a typical day. And 75 percent of online patients with a chronic problem told the researchers that “their last health search affected a decision about how to treat an illness or condition,” according to a Pew Report.

In Nepal, no data is available on people seeking online medical advice. As far as the internet is concerned, as of mid-January, there were 47 million internet subscribers in the country.

But the trend of googling medical conditions, according to experts, must be high in the urban centres and among the educated lot as those with no or little understanding of English, the language in which the information is available, cannot decipher what they are reading.

People living with chronic conditions are more likely than others to tap into every health information resource available to them, online and offline.

Doctors say every medicine has certain side effects, and if one starts taking medicine or deciding on dosages without consulting doctors, this could lead to further complications. But the problem is even bigger—it often starts with a wrong diagnosis. The internet often makes people mistake a common cold for a bacterial infection (common cold is caused by a virus and antibiotics will not respond to it), or an abdominal cramp for appendicitis or a chest pain like heartburn for angina or heart attack.

Research suggests that online symptom checkers are almost always wrong. Hence, experts say over-googling for symptoms is risky.

Doctors say there are several instances of people even completely stopping medication of blood pressure and diabetes due to fear of the side effects and switching to unproven home remedies of the said problems found on the internet.

“Even before doctors could assess the symptoms, patients often come up with their opinion on what kinds of tests they need to take based on online materials they have read,” said Dr Sher Bahadur Pun of Sukraraj Tropical and Infectious Disease Hospital. “Some even want doctors to prescribe certain tests, which on most occasions are completely unnecessary.”

The major risk of seeking medical advice on the internet is one either overestimates the symptoms and starts taking wrong medication

or underestimates them thereby not visiting the doctor or relying on self-treatment, which may lead the condition to worsen.

Even if people seeking online medical advice may not develop hypochondria, their constant worry about their condition may result in unnecessary fears that may snatch away their peace of mind, the term for which is cyberchondria.

Doctors say some patients who obsessively check the internet even ask them to prescribe medicines of particular brands. Many often tend to take antibiotics without consulting the physician and discontinue without completing the full dose, which comes with great risks.

“Chances of microbial resistance will be high if one does not complete the full course of an antibiotic drug,” said Pun. “Relying on the internet more than the doctors is a risky affair.”

When the Covid-19 pandemic gripped the country in March 2020, prompting authorities to enforce restrictions, people turned to digital means for help not only for the coronavirus infection but also for other health problems, which was also a global phenomenon.

To discourage the trend of over-relying on materials available in the internet and lessen its adverse effects, Nepal Medical Council had even issued a telemedicine guideline.

The guideline allows medical practitioners to provide healthcare services to patients with the help of technologies.

Dr Bhagwan Koirala, chairman of the council, says checking the internet for conditions and symptoms itself is not wrong but people must refrain from starting their self-treatment.

“Patients must not make decisions on their own on the basis of materials they read on the internet,” Koirala, who is also a consultant cardiologist, told the Post. “The final decision on the medications must be made by authorised medical practitioners.”

According to Koriala, people should not forget the fundamental fact that only a specialist can offer the right decision when it comes to symptoms, intensity of the condition and the medicine required.

“People often approach me with symptoms they read on the internet,” said Koirala, “which actually are not actual symptoms but an outcome of fear.”