Where to go for medical advice on the Web.
The approach you recommend is perfectly sensible. The MEDLINEplus database is responsible. The information it provides is accurate. And everything comes in nicely digestible morsels. I do not doubt that most people will find the essentials of what they're looking for here. I, too, will probably send patients its way.
But as you suspected, it does not exactly entice my palate. This is the boiled chicken of medical information. Now, there are a lot of boiled chicken purveyors out there, and I suppose I should spend a little time sorting through them. Like you, I did some searching on stuff in my specialty (general surgery). I tried a common symptom (abdominal pain), a common diagnosis (hernia), and something obscure (cholangiocarcinoma). And most of the popular sites did fine. This wasn't that surprising because I discovered that half the sites I looked at carried the exact same material on these topics--literally word for word: MEDLINEplus, drkoop.com, and MyWebMD all directed me to the medical encyclopedia from some outfit called adam.com. As for other sites, I found OnHealth.com and YourHealth.com to have reasonably good information, although vaguer, and both flunked my obscurity test.
The one really lousy site I checked was healthAtoZ.com. Plug in hernia and you're given links to five different clinics promising to fix you up real cheap. I clicked on one link and got a photo of some guy who looked suspiciously like Dr. Nick Riviera. (He's the doctor on The Simpsons, from Hollywood Upstairs Medical School, who says things like "You need a complete nosectomy" and "The gloves came free with my toilet brush." This guy kills me.)
When all the sorting is said and done, though, we're still stuck, at best, with boiled chicken. Surely sites can do better than sketchy info and pablum advice. ("If the abdominal pain is severe, you should see your doctor.")
In "The Fray," Mr. Horace E. Hood kindly directs us to a site I've never used before called PDR.net (registration required). The "Family Guide" it provides there seemed quite good. What I liked about it more than most sites is that it tells you fairly precisely how to make things go as well as possible. If you're getting outpatient hernia surgery, for example, it tells you: Don't wear your contact lenses; do check about taking your heart medicines; and afterwards, if you're sore, try an ice pack. These are the kinds of things doctors are always forgetting to tell patients.
This goes some of the way toward what I am interested in. Still, the potential of the Internet to transform people's medical care is so much greater than what I've seen out there. Couldn't there be something a little more intelligent or useful? How about an online service to find the best doctors for people with serious diseases (and not one that steers you to the doctors who bought and paid for it)? Or maybe a site that gives you not just the encyclopedia entry on hernia surgery but, say, a good essay from a patient or two on what it was really like?
The nearest thing we have right now are the online discussion groups for people with specific conditions or problems. With your leading concern about bad information floating around, I wonder what you think of them. They roil with rumor and tales out of school. (The New York Observer recently carried a story about a discussion group based entirely around the merits and demerits of one apparently quite attractive Manhattan internist named Brian Meehan. They dubbed him the Hot Doc.) And it certainly does not seem easy to find the right group for what you are looking for. (Short of doing a Yahoo search for, say, a halitosis discussion group, I have no clue where else to look.) But when my patients have found one, it seems like they have gotten far more interesting and useful information from them, even if they have to take some of it with a grain of salt.
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).