Where to go for medical advice on the Web.
I agree with your point, Atul, that getting accurate information on the Web doesn't necessarily mean that the information will be used appropriately. In the case of my patients there were probably two reasons for why this happened: a) The information was true but incomplete, and b) it was not well interpreted. Now, even if we corrected the objective part of the equation, it would still be difficult to ensure for the latter, more subjective part. Obviously our patients don't bring the same degree of education and experience to the table as we do and therefore may well miss the major message in some cases and critical nuances in others. I suspect for some it might be as confusing as the beginning of clinical rotations in medical school was for me; I knew lots of facts, or pieces to the puzzle, but I couldn't quite connect them to make out the big picture. I really don't know how this problem can be circumvented, and I'm sure some patients will be better at digesting medical details than others will be. But what we certainly can do is direct patients to sites with the best and most comprehensive information.
I recently read the results of a Harris Poll conducted a year ago that showed that more than 60 million Americans had gone online for health information in the previous 12 months and that the majority had done so to look up specific medical conditions. This makes sense to me. It also raises the question: How? How are people navigating through the vast jungle of information on the World Wide Web to find what they're looking for?
I'm afraid that many of them, including perhaps my patients Mr. Psoriasis and Mrs. Mohs, start by visiting their favorite search engine, be it Yahoo!, Lycos, or Alta Vista, and plug in a topic. Now, that, I'm sure you'd agree, is a big mistake. Such a search is bound to generate thousands of items of varying quality that are listed in no apparent logical order. For example, I went to Alta Vista and searched in the medicine section for "acne." Of the first 10 entries (of 100-plus), seven were useless. They included a commercial site (4Acne) that gave a brief discussion of the condition, unattributed and undated, followed by a display of a proprietary line of acne products containing algae; a pharmaceutical company that specializes in skin-care products (Dermik); a private dermatologist who practices in Walnut Creek, Calif., and offers Botox for wrinkles but little time (and space on his Web site) for acne patients; and the Middleton Cosmetic Laser Center in Toronto, which promises to find you the best place in town when you visit for a Visage Rejuvenation treatment. Fortunately, two academic dermatology centers that provided accurate and substantiated information on--would you believe, the sought after subject--made it to the Alta Vista top 10. Still, I wouldn't recommend that patients go this route; not only is it often a waste of time, but it can also be difficult for the layperson to distinguish the wheat from the chaff.
Instead, my advice would be to go to a more targeted search engine or Web site devoted exclusively to medical information. These sites can be divided into those providing comprehensive information (e.g., government-run sites like the National Library of Medicine and commercial, for-profit sites like drkoop.com, WebMD, OnHealth.com, or Medscape) and those with narrower focuses (e.g., academic institutions like the University of Pennsylvania's OncoLink for cancer patients, physician organizations like the American Academy of Dermatology's Web page for patients with skin diseases, and support groups like the National Alopecia Areata Foundation). I would start in the former category and proceed directly to the National Library of Medicine, a division of the National Institutes of Health.
No question this site is ideal for the purist seeking information on a specific medical topic. Unlike many of the commercial Web sites mentioned above, there's nothing to distract you: no breaking medical news, advertisements for a new drug, or gimmicky displays to calculate your percentage of body fat. Also for cynics like myself, you needn't constantly worry about hidden agendas (how much influence, say, do the sponsors of the commercial sites, typically large pharmaceutical companies, have on the way information is presented?). At the National Library of Medicine's Web page, one can easily click on the "Health Information" section and find MEDLINEplus, a database that, unlike its scientific parent MEDLINE, is designed for the public. I did a search on acne that generated a comprehensive but readily understandable review of the condition, the many different treatments being offered, a link to current clinical trials, and a section on support groups. The discussions were written by physicians at the NIH or members of official organizations like the American Academy of Dermatology whose names and titles were listed; the date it was posted was given at the end. And for the more intrepid patients who prefer their information undiluted, they can go into MEDLINE and download all the current scientific literature on the subject in question.
I'm curious what you think of this site, Atul, though I have a sneaky suspicion from your earlier comments that it may have a soporific effect on you. Perhaps not the best reading material after the graveyard shift in the E.R. But boring as it may be, it's definitely accessible, accurate, and beyond reproach. In fact, I may well mention the address to Mr. Psoriasis the next time I see him.
This week, two doctors evaluate medical information sites on the Web. Atul Gawande is a surgical resident and a staff writer for The New Yorker. David Biro is a dermatologist and the author of One Hundred Days: My Unexpected Journey From Doctor to Patient (click here to buy it).