Dr. Duncan Phillips has a hectic pediatric surgical practice at WakeMed hospital, and it's only getting busier.
What's generating much business is the inevitable mash-up of young patients and the Internet.
"They diagnose themselves," Phillips said, estimating he has at least one youngster a week who pinpointed his or her own medical problem after running a Google search.
The diagnoses are, of course, confirmed by real doctors, but the impetus is increasingly coming from the child. The trend is part of a national wave in which health consumers consult the Internet for medical advice.
Eighty-percent of Internet users have looked online for health information, and many report that their findings have had a significant effect on their lives, according to the Pew Research Center's Internet & American Life Project.
For youngsters who have grown up online, the Internet can provide a discreet, nonjudgmental answer to health concerns. The Pew report found 31 percent of teens who are online get health, dieting or physical fitness information from the Internet.
Mitchell Cook, a 17-year-old from Raleigh, N.C., said he became self-conscious three years ago when his chest plate seemed to dent inward.
He Googled "sunken chest," and discovered a condition called pectus excavatum, in which the sternum caves in. In addition to goofy videos on YouTube showing teens eating cereal from their indentations, the search yielded helpful explanations of the condition, which can cause heart and lung problems.
"I was relieved when I found out I could get it fixed," Mitchell said.
He called his parents to the computer.
"This is what I have," his mother, Mimi, recalls him telling her.
She said she hadn't noticed the indentation, which at the time was mild and didn't warrant surgery. But the condition can get worse as a child grows. Armed with that knowledge, the family asked Mitchell's pediatrician about it, and consulted Phillips, who took a wait-and-see approach.
Then last spring, Mitchell began having trouble breathing as the bone began pressing on his heart. The problem escalated through the summer, even as he trained to run a distance relay in Oregon with friends.
"We were definitely very concerned," Mimi Cook said.
Finally on Dec. 17, he had surgery at WakeMed in which Phillips implanted two metal bars across Mitchell's chest, immediately correcting the indentation. The bars will be removed in two years when his body no longer needs the support.
"I'm happy I went through it," Mitchell said.
Another young patient, Jack Goras of Greensboro, N.C., also had the pectus excavatum surgery earlier in December after diagnosing himself from an Internet search.
"I had trouble breathing and dizziness," Jack said, adding he was glad to put a name to his condition.
Phillips said Jack and Mitchell are typical of his young patients who discover significant health conditions online. Most are inquisitive boys and girls who have ready access to the Internet. Some even take cell-phone photographs of what concerns them, asking their doctors to diagnose from the snapshot.
Phillips said the prospect of youngsters using the Internet for medical inquiries is a positive development, particularly as adolescents become increasingly private and self-conscious when their bodies change. According to the Pew research, 17 percent of teens online said they used the Internet to gather information about health topics that are hard to discuss with others.
"I think it's great," Phillips said. "It's just an interesting phenomenon. Kids making their own diagnoses and teaching their parents -- that's something I didn't anticipate in medical school in 1982."