Physicians’ Perspective: Seeking Medical Information by Internet? Or Lost in Cyberspace? by Rick Bayer
Although estimates range from 20,000 to 2 million sites that deliver health information on the world wide web, it’s important to realize that the real change has occurred in access to technology rather than basic human nature. Therefore, making sense of health information (or any technical info) from the Internet requires peering through the Alice in Wonderland kaleidoscope of information and choosing only reliable sources. How do we do that?
To start, recall that the Internet is simply a vast network of computers sharing computer files. Although we have the power to access many bookstores’ worth of information, simply being on the Internet guarantees no more accurate or reliable info than if it was scribbled on a scratch pad or for sale at the supermarket checkout stand.
There is an old warning in retail: “let the buyer beware”. On the Internet, it is “let the viewer beware”. Armed with a healthy dose of skepticism and undazzled by those cool looking graphics, we must analyze a website for accurate health information.
To see what a first-rate medical information website can look like, consider Hillsboro-based Medscape www.medscape.com run by former editor of the Journal of the American Medical Association, George Lundberg, MD. Dr. Lundberg wrote a very interesting book last year titled Severed Trust: Why American Medicine Hasn’t Been Fixed (Basic Books 2000). His chapter “Mouse Calls for House Calls” discusses the Internet.
Since I use the Internet for information daily, own a small commercial-free website at www.omma1998.org and manage another at www.oregonpsr.org, I became very interested in Dr. Lundberg’s discussion of the validity of medical information obtainable from the World Wide Web.
I agree with Dr. Lundberg that we need to ask the same questions of Internet sources that we ask of newspapers, magazines, and other printed publications. These include: • Who wrote it and can you contact the writer or editor? • What is the source of the information? Where is the bibliography or reference material, and what credentials or experience make the writer an expert? • Who sponsors the website and where does the money come from to do this? Is it from advertisers who might withdraw ads if the results of a study are less than flattering? Is someone getting a kickback (like the infamous website by former Surgeon-General Everett Koop where the hospitals paid to get referrals from his site but there was no public disclosure)? • Why did this particular person make this website? What do they hope to achieve (making money? pursuing civic activism?)? • Finally, when was it written? Is the information still as accurate today as when it was written? Technology can change rapidly.
Neither Dr. Lundberg nor I would guarantee the accuracy or validity of information that is based solely on these questions. But if your website source can’t pass the above tests, then you should be very careful indeed about swallowing that information whole.
There are excellent medical sources available online and a favorite is PubMed at the National Library of Medicine at: www.ncbi.nlm.nih.gov/PubMed/. I also now subscribe to: www.harrisonsonline.com/ rather than use an internal medicine textbook made of paper. Now, when I read my textbook, it is always up to date and it links to references so I can read original articles or abstracts without waiting for the medical librarian to track down articles from a regional or national source. For those who’ve waited weeks for articles to arrive, the Internet can seem like magic.
In summary, it is possible to use the Internet to gain access to information more easily now than in the past. Nevertheless, all information must be checked for validity. Everyone should have a healthy degree of skepticism about any health information you read. Seek additional opinions if you are confused or unconvinced. To paraphrase Mark Twain, it is wiser to be ignorant and know it, than to think you know something that you really do not know.
When health problems are complex and you need more than an answer to one question, it is vitally important to have a person-to-person interaction with a healthcare provider. In addition to the physical exam, many clinicians use a “sixth sense” based on a patient’s body language, facial expression, and mood, which increases diagnostic accuracy. Such diagnostic accuracy diminishes when these clues are absent, as in over the telephone or Internet. Perhaps, understanding the new technology will remind us of the enduring value of old technology involving interpersonal “live” communication between you and your healthcare provider.
Rick Bayer, MD is a board certified internal medicine physician who lives in Portland, Oregon. Please respond to his column by contacting Alternatives.