*4.2. What Is the Potential Risk of Self-Diagnosis Due to the Explosion of Health Information during the COVID-19 Pandemic?*

This study found that 81% of the participants were concerned about the newness of the information they found and the year of the source. In terms of the professionalism of the source, 22% of the users believed that the author of the information they retrieved was an expert in the field. Meanwhile, 42% of the information retrieved mentioned the author's affiliation. However, 85% of the participants were dubious about the information they found on the internet, as its author was either anonymous, or they believed the author was not a professional. In fact, obtaining health-related information on the internet and diagnosing oneself based on it affects one's health-related behaviors, decisions, and actions. Sturiale et al. [4] found that there was a correlation between those who used the internet for work and those who had knowledge of both symptoms and their likely diagnosis before consultation, among patients. Patients who used the internet daily were more likely to request a consultation within six months of symptom onset. Additionally, those with anorectal diseases were more likely to have knowledge of their disease and symptoms before the visit. Hsu et al. [3] surveyed a sample of undergraduate students to explore their experiences with online health information and found that they retrieved health information related to their needs from the internet in order to prevent or maintain their health conditions. However, the prescriptions they retrieved online only offered reference answers, and sometimes inner doubts still lingered in their minds. Using the flu as an example, Myrick employed a naturalistic experiment to test the emotions of 380 Americans after retrieving information online, exploring the theoretical models that shaped cognition and behavior [13]. It was found that the study participants had difficulty retrieving information when they had a dubious attitude. Myrick further tested how to improve the skills required for the online health information retrieval process, observing that individuals had multiple emotions (fear, hope, satisfaction, interest, and motivation) after retrieving information, and the mediating effect of "social cognitive factors" affected their subsequent attitudes and behaviors. The positive emotions of interest and hope experienced during the online health information-seeking process positively influenced individuals' confidence and behavioral intentions.

The number of medical articles published on the internet increased significantly during the COVID-19 pandemic [28]; however, at the same time, the amount of fake news and disinformation skyrocketed to several dozen times the previous level [29]. As the internet booms and health information spreads, the World Wide Web has become a major source for the public to search for information about medical and health risks. In tandem with this boom, many health and disease-focused websites have emerged to provide the public with more immediate access to health information. Such sites provide information and resources for readers with medical conditions, assisting them with possible self-diagnostic references for certain symptoms and helping them decide whether to self-treat or consult a physician [30]. The use of the internet to retrieve health-related information is a behavioral manifestation of the individuals' search for peace of mind. However, the information available on the internet is not always accurate and reliable; therefore, it is important to promote individuals' online search skills to reduce uncertainty, worries, and anxiety, avoiding incorrect self-diagnosis. As individuals are exposed to the risks of online information technology, it is critical to understand how they use health information when they are inundated with it online [31]. A key strategy for managing health care surge is "forward triage"—the sorting of patients before they arrive at the emergency department (ED). Direct-to-consumer (or on-demand) telemedicine,

a 21st-century approach to forward triage that allows individuals to be efficiently screened, is both patient-centered and conducive to self-quarantine, protecting patients, clinicians, and the community from exposure to any infectious disease, such as COVID-19. Furthermore, it allows physicians and patients to communicate using smartphones or webcam-enabled computers, which may be beneficial during situations such as the COVID-19 pandemic [32]. Telemedicine, however, may not always be the go-to approach for physicians in Italy. For example, the utilization of telemedicine for the diagnosis of common proctologic conditions (e.g., hemorrhoidal disease, anal abscess and fistula, anal condylomas, and anal fissure) and functional pelvic floor disorders was generally considered inappropriate. Teleconsultation was instead deemed appropriate only for the diagnosis and management of pilonidal disease, revealing the boundaries of telemedicine in Italy. Therefore, infrastructures, logistics, and legality related to telemedicine need to be standardized [33].
