Interview - Dr Allan Zimet, AMA Treasurer, ABC Radio North Coast Afternoons - Patients do their own research via the internet

JOURNALIST: Are you the sort of patient that researches an illness once you've been diagnosed and then goes back to the doctor with an armful of questions and comments? Well, you could be considered irritating by your GP or specialist, that's according to the British Medical Journal.

According to a leader consumer advocate, Hilda Baskell*, patients who visit the doctor with too much information are becoming disliked.

I don't know about you, but I personally think it's our right to do our own research. I thought these days - the days rather, of accepting a doctor's diagnosis as gospel were well and truly over.

Dr Allan Zimet is from the AMA and has joined us for a chat this afternoon. Thanks for your time, doctor.

ZIMET: Good afternoon, Mike.

JOURNALIST: Doctor, are patients with their information, their own information, becoming irritating?

ZIMET: Oh, look, I don't think that they are. I think that there are lots of patients who are well-prepared for interviews, and that's always a good thing. I like people who come with a list of questions, who've thought about their illness. And I encourage all my patients to do that.

I'm an oncologist, which is a cancer specialist, and as you can well imagine there are lots of questions, lots of difficulties that they have and in fact a well prepared researched list of questions makes a difference.

JOURNALIST: An interesting story, my mother recently was diagnosed with possible

breast cancer, and she did a huge amount of research on the Internet and went back to see the oncologist with masses and masses of questions. And he said to her, after the end of the chat, 'I'm trying my best, really I am.' So I guess it's a matter of the situation. I mean some doctors might think that being bombarded with a million questions is putting them in a situation where maybe they're not trying hard enough.

ZIMET: I think there are a couple of issues, though. I think that now most doctors are well-trained and know lots of what's happening and some people come with the presumption, because they've done a little bit of Internet research, that they're now an expert on whatever condition. I'm sure your mother wasn't like that, but even so...

JOURNALIST: Well, I don't know about that stuff.

JOURNALIST: Is this the case of a little bit of information being dangerous?

ZIMET: I think there is a time when a little bit of information can be dangerous or not helpful to patients and their conditions, diagnosis and treatment. Look, I think most of the patients that I work with, and most doctors I know, regard it as a partnership. You know, you're wanting to help the patient get better. The patient wants to get better and you do whatever you can to help that.

JOURNALIST: Which is something which has been evolving over the last couple of decades really, hasn't it?

ZIMET: Absolutely.

JOURNALIST: Because once upon a time it was, 'I'm the doctor. I'm telling you what's wrong and that's just the way it's going to be.'

ZIMET: Oh, I think in the past doctors knew a lot more than patients and now people are a lot better informed. There's a lot more information out there. One has to be careful to make sure that one educates our patients so that they're able to filter out all the rubbish and use good treatments when appropriate.

JOURNALIST: Do you find some patients find some knowledge comforting, though? It gives them a sense of control?

ZIMET: Some people like to be in control and I think that that's very important to acknowledge that. That you're able to be in control, get all the information and work together in partnership with your GP or specialist.

JOURNALIST: With your colleagues, do you find that they are seeing more of a trend to question doctors more closely about their conclusions and why they've made them?

ZIMET: I think there is that trend and that's in society and we're seeing a lot more second opinions. People wanting to ask another doctor their opinion on the same matter. And some of these problems are very difficult and there can be two different opinions.

JOURNALIST: And professionally I guess it would be good to keep everybody on their toes?

ZIMET: Absolutely. Absolutely. Look, we're interested in curing - I'm interested in curing cancer. It doesn't matter to me how I do it. And I always look at the latest Internet sites and search them out.

JOURNALIST: How, from your perspective and your colleagues' perspective, do you deal with situations where a patient may have done a lot of Internet research and a lot of non-mainstream Internet research and looked at other complementary means of treating their illness, whether it be, well all sorts of things, yoga and things like that. Other ways of maybe treating their symptoms. I mean how do you deal with that situation as an oncologist?

ZIMET: Look, as an oncologist I think there are two things, one is that there are lots of good things that people can do dietwise and a wide variety of diet, a wide intake of diet which helps their cancer. I think the meditation relaxation is helpful and would encourage people to do that. I don't have to do any extra research for that.

It's when people come with an inch of paper that has a rare obscure treatment like shitaki mushrooms or shark fin cartilage or...

JOURNALIST: They may be getting desperate though?

ZIMET: Oh, they are. But what I tell them if I haven't heard of these treatments and it's going to take me an hour to read and to advise them, I'll tell them yes I'll I'd be happy to do that but they will need to pay for that. And it's not a Medicare rebatable item.

JOURNALIST: Oh, well that's a fairly strong way of doing it?

ZIMET: No, it's a fairly, you know, correct way of doing it. If you want people to spend time to do things properly there's a - it's a cost. It's an extra hour out of my day.

JOURNALIST: Do you and your colleagues spend much time looking at some of the alternative treatments on the Internet and maybe sifting through some of those things and picking up things that may be of value?

ZIMET: Look, I work at a major cancer institution in Melbourne, and as well as in private practice, and we're constantly looking at new treatments, different treatments. We're interested in curing cancer. We don't have all the answers yet, but we're getting there.

JOURNALIST: Is there also a concern too about complementary medicines? I'm sorry to harp on about complementary medicines, but I just wanted to talk about the risks involved with taking complementary medicines with prescribed drugs and not telling your doctor?

ZIMET: Look, I think there are some risks. Some of the things will cause increased risk of bleeding. Some of the vitamins will interact with chemotherapy drugs, and I think the patients that I want to work with are those who want to work in partnership, not those who want to go off and do their own thing and me not knowing what they're doing. We've got to work together to achieve the best result, so I think people should always tell their doctor.

JOURNALIST: All right. So it's a matter of communication both ways?

ZIMET: Absolutely.

JOURNALIST: But don't bombard your specialist or doctor with reams and reams of Internet printouts?

ZIMET: You can, but expect them to look at different ways of making sure they read it properly and give you the best information?

JOURNALIST: Doctor, thank you very much for your time.

ZIMET: Okay, thanks.

JOURNALIST: Dr Allan Zimet from the Australian Medical Association. And I'd be interested in hearing your thoughts on that interview. If you are the sort of person who does go to your doctor or specialist with reams of information and 101 questions I'd love to hear from you. 6566 2100.

Theresa has called in from Port Macquarie. Hi, Theresa.

THERESA: Hi, how are you?

(CALLER)

JOURNALIST: Very well, thank you.

THERESA: You've got to be sensible with what research you do, but what matters that it just comforts the GP and mainly GPs because they're the gatekeepers to the specialists. If you have a condition - in our own family like my mother's cardiomyopathy was misdiagnosed as depression until it was advanced. My sister in law has died from cervical cancer, which was misdiagnosed as menopause and she was told to go home and get over it. I have another very close relative who is in remission from breast cancer who was also basically fobbed off.

And they'd started doing their own research but in some cases it was too late. But if they had actually had access to the Internet when all this happened. Sometimes GPs, as well meaning as they would like to be, assume that there is nothing wrong first. And maybe, you know, sometimes they don't go hard enough. You know, if someone comes back and they know there is something really wrong, to be told you're menopausal when you're in basically a stage four with cervical cancer, that's pretty horrific. So she's starting to do her research.

JOURNALIST: Yes, it is pretty horrific too. But, at the same time, I mean we all really do have a personal responsibility to get a second opinion on these things, though, don't we?

THERESA: Well, yes. Well that's the thing. But I mean depending on where you live if you live in a country town and you go to the same doctor's surgery and there's two or three doctors they all know each other, it becomes - you become a nuisance. To become well informed, to be what they call a 'bad patient' it sometimes saves your life.

JOURNALIST: It'd be interesting to read your own personal file some time, wouldn't it?

THERESA: Well, you do have a right to actually and most people aren't aware of that. You now have a right to have a look at all your own personal files.

JOURNALIST: That's right. There was a big fuss about that a couple of years ago, wasn't there?

THERESA: And to see what comments they've made like in some cases negative comments are made because you want to become well informed and that stays on your record and that's - that can come against you at times.

Also there are a lot of new unusual sort of diseases that are said to be coming to the fore more, super infections in the stomach and things like that, which your local GP cannot be aware of because there's so much. But I don't think as long as you're sensible about it and you research...

JOURNALIST: They may not have the time to do the research themselves?

THERESA: Well, if you research sort of credible sites and maybe in America and stuff like that like they're was a little bit ahead of us in some ways. Their medical associations are a little bit more accepting of newer things. It's becoming that way and it'll flow onto Australia, but I mean we still in Australia sometimes prescribe drugs, that are outlawed in America, 10 years later.

JOURNALIST: And vice versa.

THERESA: Yeah.

JOURNALIST: Thank you very much for your call.

THERESA: Okay.

JOURNALIST: And one of the other interesting sidelines to that, Theresa was just saying Internet sites in America tend to be a bit more advanced. But after speaking to a doctor a couple of weeks ago, one thing that I really noticed is that the doctors, in particular the medical fraternity in Europe, tend to be a lot more advanced when it comes to complementary and alternative means of therapy. So maybe Europe is the place to go.

ENDS