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In the previous Topic of the Month we described how
the Internet is dramatically altering the way patients
seek and obtain health information. In this piece, we
describe how the Internet is affecting patients, physicians,
and their relationship. Physicians should be aware of
the impact of this new mode of health education on their
patients, and they need to aid patients in navigating
through the information to choose the proper health
care option.
As patients learn how to access, research, and evaluate
medical information, the traditional information gap
between the patient and physician has begun to fade.
Patients become more capable of making choices regarding
their health care treatment options. The responsibility
of physicians is to discern each patient's sophistication
with the Internet and ability to search and evaluate
online health care information.
Responding to Patients
Information from the Internet complements, rather than
replaces, information provided by one's physician. Surveys
show that patients who use the Internet still prefer
to receive health and medical information from their
own physicians (Miller TE, 1998). When used appropriately,
a patient's computer research can actually save time
during an appointment and increase the effectiveness
of the physician's diagnosis.
Physicians may be apprehensive of patients bringing
stacks of printouts from their Internet research. They
should reasonably restrict the number of printouts they
will review for patients by asking them to prioritize
the materials.
Responding to patients' health-related inquiries is
a sensitive issue. Physicians should be careful not
to trivialize or dismiss any information that patients
gather. Instead, they should commend patients for trying
to learn about their medical conditions, allow patients
time to share or question what they've found, and respond
to the information without overreacting, even if the
information is flawed.
If patients favor a certain treatment based on what
they've read, then physicians need to provide additional
information and education on the options and implications
of the alternative treatment options. In explaining
the benefits, risks, and appropriateness of different
treatments, physicians can suggest websites that they
feel are credible and supportive. While counseling the
patient on treatment options, the physician should document
the discussion for future reference.
When a patient presents printouts to their physician,
the validity and quality of the information needs to
be assessed. George Lundberg, MD, Editor-in-Chief at
Medscape and CBS Healthwatch, recommends looking for
four core standards: the credentials of authors and
contributors, relevant copyright information, "website"
ownership disclosure, and the date of posting (Silberg,
Lundberg, JAMA, April 16, 1997). Guidelines to evaluate
health-related websites and health information include:
Health on the Net Foundation Code of Conduct (HONcode),
www.hon.ch/HONcode/Conduct.html,
Guidelines for Medical and Health Information Sites
on the Internet, www.ama-assn.org/ama/pub/category/1905.html,
eHealth Code of Ethics, www.ihealthcoalition.org/ethics/ehcode.html,
and Ethical Principles for Offering Internet Health
Services to Consumers, www.hiethics.org/Principles/index.asp.
Recommending Websites
Finding high quality, peer-reviewed information on the
Internet to recommend to patients may seem daunting
to many physicians. Sites developed by government agencies,
professional and voluntary associations, leading clinical
centers, and universities are useful places to refer
patients. Commercial sites, such as Medscape or drkoop.com,
also provide credible information. We have listed some
high quality sites below. (Items in the list of References
marked with an asterisk (*) contain reviews of websites
recommended for patients by the expert authors.)
Many different types of patient education resources
exist on the Internet. Websites often feature expert-moderated
frequently asked questions, or FAQs, where patients
can view responses to questions posted by others or
themselves. To improve a patient's understanding of
certain clinical terms, physicians can refer their patients
to several online glossaries, including drkoop.com,
www.drkoop.com/conditions/ency/index.html, or the Merriam
Webster Medical Dictionary, available at InteliHealth,
www.intelihealth.com/IH/.
Well-educated patients who are capable of critically
evaluating literature can be referred to specific online
journals, such as JAMA or the New England Journal of
Medicine, to access abstracts. If patients wish to search
a wide range of medical journals, their physician can
refer them to The National Library of Medicine's resource,
Pub Med, www.pubmed.gov. Patients can enter search terms
relating to their condition and examine abstracts from
the medical literature.
For physicians who treat patients with unusual and
rare medical conditions, the Internet can serve as an
extremely valuable resource. Support groups and information
not readily available in local medical communities may
exist. Physicians can search the Internet, interpret
the content and quality of selected websites, and inform
patients of valuable online resources during their next
visit or by e-mail.
The medical practice should determine which health
care professionals become involved with counseling patients
on the use of the Internet; for example, whether counseling
is restricted to physicians only. At this time there
are no national guidelines on how to counsel patients
regarding the Internet, who should do it, or what training
is required.
Physicians and their staff will have to evaluate their
particular patient population to ascertain common Internet
counseling needs. To assist patients' online searches,
physicians can establish printed information handouts
with reliable websites and criteria to help patients
evaluate information on Internet.
General Concerns
Existing financial and time constraints during a patient
visit limit the role of Internet counseling. Compensation
is one critical factor: managed care companies and insurers
have been reluctant to reimburse physicians and other
health care professionals for time spent educating patients
on the Internet. Payers need to determine whether the
extra time spent improves the quality of patient care
and reduces costs sufficiently to justify additional
compensation as a separate billable service for physicians
and health care professionals.
As health-related content on the Internet expands, physicians
must be increasingly attentive and receptive to patient's
efforts to educate themselves. Physicians need to communicate
effectively with their patients to help them make the
best use of online information.
Web Links for Physicians to Recommend to Patients
- Adam.com, www.adam.com
- American Academy of Child and Adolescent Psychiatry,
www.aacap.org/info_families
- American Academy of Family Physicians, www.familydoctor.org
- American Academy of Pediatrics, www.aap.org
- American Cancer Society, www.cancer.org
- American Diabetes Association, www.diabetes.org
- drkoop.com, www.drkoop.com
- HealthCentral.com, www.healthcentral.com/home/home.cfm
- KidsGrowth.com, www.kidsgrowth.com
- OnHealth, www.onhealth.com
- MEDline Plus (through the National Institutes of
Health), www.medlineplus.gov
- Medscape, www.medscape.com
- WebMD, www.wedmd.com
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