The Natural Connection

 When I was in the throes of my medical training at the end of the last Energy Crisis, I was given the peculiar advice to never allow a patient to see me look something up in a reference book. “Patients think that their doctor knows everything”, my instructors said. “Best not to confuse them. It doesn’t inspire confidence!” 

Medical residents were cautioned to keep their colossal medical textbooks out of the patient’s line of vision. We were advised to excuse ourselves from the room on the pretense of attending to the call of nature, or to perhaps blow our nose, if we needed to check a drug dose in the Physician Desk Reference or research the ten possible reasons for blood in the urine. “Good” medical students were often seeing popping in and out of patient exam rooms at my teaching hospital, blowing their noses in unison, crowded over the reference books. 

This strategy of patient care never made much sense to me. I wasn’t at all sure that I wanted to be perceived as a doctor with a weak bladder or incurable allergies, instead of a careful one. My patients did not seem to mind in the least when I simply excused myself and told the truth—“I need to look something up” Besides, I saved a lot on Kleenex. 

Over the past fifteen years, the ability of physicians to quickly research medical information by way of the Internet has made the previously ridiculous advice I was given as a student laughably obsolete. Now we are able to have high speed Internet connections in nearly every office and exam room. Some doctors tote their computers in their pockets, little Palm Pilots to help them navigate the increasingly complex web of medical information. No more blowing noses--our hands are too busy clicking the mouse. 

And for the first time in medical history, doctors are not alone in the hallways looking things up. Patients, with their own Internet connections, are looking over our shoulders and doing their own medical research. They come to office appointments armed with pages (and pages and pages and pages…) of information gleaned from the Internet concerning their symptoms and diagnoses. But how reliable is the Internet as a source of medical information for patients attempting to heal themselves? 

Recent surveys indicate that almost 100 million Americans go online in search of health information; and 70% of them say that what they find helps influence their medical treatment decisions. In order to evaluate the accessibility, quality, and readability of the health information available on the Internet, the California Healthcare Foundation commissioned the RAND Corporation to conduct a major study designed to determine if material available on the Internet is sufficiently complete and accurate to support patient decision-making.

 Reported in the May 23 issue of the Journal of the American Medical Association, the study addressed three questions: 

The study focused on four common conditions that consumers might search for information on the Internet (breast cancer, childhood asthma, depression, and obesity). Accessibility of data, and quality of data found on 14 search engines and 25 Web sites were evaluated by an independent panel of medical experts. 

The key findings of the panel were as follows: 

Consumers using English search engines have only a 1 in 5 chance of finding information that is relevant to their search. Search engines are not efficient. 

Information on the Internet is commercialized. About half of the information located by English-language search engines is of this nature. Commercial content can be expected to influence the quality of the information presented. 

Consumers often find incomplete answers to important questions; however, the information that is provided is generally accurate. It is not uncommon for a Web site to contain conflicting information on a clinical topic. 

Most Web-based health information will be difficult for the average consumer to understand. According to recent health literacy studies, the majority of many health consumer populations cannot understand material written at a 9th grade reading level However, half of the English-language materials on the Web are written at the college level, and all were at least a tenth-grade reading level. 

The researchers also found that it took an experienced Internet user about 15 minutes per web site to obtain useful information, and that it was necessary to view 4-6 sites for a given question to obtain accurate information. The extensive Internet library can become a sinkhole for time and energy, as anyone who has tried to muddle through it’s millions of pages will attest. 

All in all, in retrospect, I’m not sure if doctors and patients might find it more efficient to resort to the hallway nose blowing concerts while we “look things up” in the future. Kleenex, anyone? 

For a list of recommended consumer medical web sites, write to The Natural Connection, c/o Pauline Bellecci MD, PO BOX 777, Waycross, GA 31502 or contact us on our web site www.swampdocs.com

©2000-2003 Pauline M. Bellecci, MD