A Boon for Medical Education

The Internet can be an invaluable resource for physicians, medical students and patients alike, if used with the proper safeguards in place.

NO LONGER JUST THE DOMAIN of the technologically-savvy or the research-minded, the Internet has become a global forum for the exchange of ideas and information, not the least of which is health care and medicine. Furthermore, consistent with the recent explosion of interest in the Internet and the World Wide Web has been the rapid growth of medically-related web sites.

With literally thousands of sites devoted to disseminating "medical information," from private individuals' pages to government-sponsored sites, information from personal anecdotes to the results of randomized, double-blind clinical trials is readily available to the novice "surfer." The ease and reduced cost of accessing the Internet makes such information available to physicians, medical students, and patients.

The Internet can be an invaluable tool for medical education. For example, physicians can use select, reliable web sites to research the results of the latest clinical trials, learn about the new players in a class of drugs, read journals and textbooks online, earn CME credits online, or learn how to run a successful practice.

For medical students, add to this list the ability to view pathology slides and specimens online, practice online written examinations, or view entire course lecture notes from any home computer connected to the Internet.

Patients can gain a heightened awareness of their disease process, research new therapies on the horizon, and even communicate with their physicians via email, all allowing a patient to feel empowered against a disease process. Finally, any individual can benefit from easy access to information that falls under the rubric of preventative medicine.

The obvious drawback to the dissemination and retrieval of such health-related information over the "information superhighway" is quality control. The inability to monitor the quality of all sites, and further the inability to decipher which sites are reliable and which are akin to quackery, makes the use of Internet-acquired information a risky business. It is often the anxious and non-medically educated patient who, in a blind attempt to understand a disease that he or she, a friend or family member suffers from, falls prey to inaccurate and unnecessary information.

It is obviously easier for a health professional to scrutinize and evaluate the content of various web sites, even if arrived upon via a random Internet search. For the layperson, however, this is a much more difficult and serious task. Thus, the significant problem of reliability of the mass of available information on the Internet begs for proactive physician involvement.

As the Internet and World Wide Web become easier and more affordable to access, more and more patients will look to this resource for information. The future will hold more patients who present to physicians' offices with "online diagnoses," comprehensive alternative treatment plans or hysteria generated by misinformation.

Physicians must intervene to prevent such adverse effects of this misinformation and ensure that the layperson has access to reliable, accurate medical information. At the local level, for example, individual physicians can have a list of sites which they have reviewed and can recommend to patients. The physician can then set a priori "ground rules" for patients based on this list of sites for discussing Internet-generated health information at routine office visits.

Furthermore, a diligent quality control committee of physicians should ultimately review and place a "seal of approval" upon a select few reliable sites. Thus, physicians and patients alike could go directly to accurate and reliable sites, cutting out unreviewed "garbage" sites. The CMA could take such a lead in California and, similarly, the AMA nationally.

Meanwhile, the safest recommendation regarding reliable web-based health information is to look to one of the various popular sites compiled below. This list is based upon recommendations of the author, medical student colleagues' at the UC Davis School of Medicine, and local physicians. The list has been divided into sites geared toward physicians and medical students, as well as a select few sites appropriate for patients and other laypersons.

Among the myriad sites purporting to offer medically-relevant and accurate information to health professionals are a few that are noteworthy:

1. Medscape (www.medscape.com): This searchable site aimed at medical professionals and students offers news relevant to a particular specialty of choice, specialty conference bulletins, and weekly patient-based quizzes. A useful "Patient Resources" page provides links to general information for patients on various procedures, such as colonoscopy, which can be printed or referenced for patients. An excellent free informational site.
   
   
2. MDConsult (www.mdconsult.com): This is a unique site for medical professionals which, for a fee, provides access to complete textbooks online from various specialties and primary care, several complete journals, access to MEDLINE, as well as hundreds of patient education handouts. This site touts itself as "the premiere online medical information service" and offers a free 10-day trial.
   
   
3. The Journal of The American Medical Association (JAMA) (jama.ama-assn.org): JAMA as well as Archives online and searchable. One particularly interesting link presents the theme topics of upcoming issues of JAMA. This site also provides links to MSJAMA, the online journal for medical students.
   
   
4. The New England Journal of Medicine (www.nejm.org): For the annual subscriber's fee, one can read the full text of the current issue of the New England Journal as well as search the archives of past issues for full text articles and use MEDLINE. The site also hosts an educational page for primary care physicians to earn CME credits for completing online home-study programs.
   
   
5. Harrison's Online (www.harrisonsonline.com): This site offers a searchable, updated, Harrison's Principles of Internal Medicine online for a subscriber's fee.
   
   
6. Medsite (www.medsite.com): This site is a medical bookstore and supply store for health professionals where one can purchase textbooks, stethoscopes, etc. The free site also offers a journal tracking service as well as an online personal calendar.
   
   
7. (crc.ucdmc.ucdavis.edu): This is a site available to physicians affiliated with the UC Davis Medical Center and provides a list of UCDMC's drug formulary as well as links to Harrison's Online, MEDLINE, etc.
   
   
8. Internet Grateful Med (igm.nlm.nih.gov): This publicly-accessible site from the National Library of Medicine offers free access to MEDLINE via PubMed.
   
   
9. American Academy of Family Physicians (www.aafp.org): This site offers free access to the complete American Family Physician journal online, helpful information for medical students and residents, as well as a link to a patient-oriented affiliated site. The site also offers online CME resources.
   
   
   
10. The Sierra Sacramento Valley Medical Society (www.ssvms.org): The official page of our Society offers information about the Society as well as interesting online brochures about the local history of medicine.
    
    

For patients, a few sites stand out as reliable sources of information for common diseases and other health concerns:

1. WebMD (www.webmd.com): This free site offers information to health professionals and lay persons alike and includes an online medical dictionary and encyclopedia, information specific to sufferers of particular diseases, zones dedicated to alternative medicine, and even preventative medicine topics including recommendations on diet and nutrition, healthy pregnancy and healthy seniors. This is a large, information-intensive site that practically everyone can benefit from.
   
   
2. Mayo Clinic Health Oasis (www.mayohealth.org): This layperson-targeted site offers general information on several broad health topics including "cancer" and "heart" and advertises a service where patients can email questions and receive responses from Mayo Clinic physicians.
   
   
3. DrKoop (www.drkoop.com): This site offers medical news headlines, links to various comprehensive pages on various health topics from disease to preventative medicine, as well as links to other sites where patients can, for example, purchase medications online. If you have the time to weed through the advertising here, generally sound medical information and advice can be discovered.
   
   
4. The Merck Manual Online (www.merck.com): Searchable, full text editions of The Merck Manual, the Merck Manual of Geriatrics, and The Merck Index are found here.
   
   
5. The American Heart Association (www.americanheart.org): This is a very good site dedicated to preventing, recognizing and learning about heart disease and stroke. It also offers information about CPR certification programs.
   
   
6. American Cancer Society (www.cancer.org): The definitive resource about cancer, this extremely useful site offers comprehensive information about various specific cancers from breast to bladder. It also includes a tutorial on breast self-examination, smoking cessation program information and information on cancer treatment options.
   
   

Ultimately, with the use of web sites such as those listed above, the Internet can be a powerful resource for medical education. From comprehensive, searchable journal articles online to basic preventative medicine lessons and techniques, physicians, students, and patients alike can benefit.

The obvious caveats surrounding quality control are serious, but can be circumvented through a proactive physician-level approach. The Internet is practically ubiquitous in American culture already, and thus we as health professionals must ensure that it is used as the accurate and powerful tool that it can be.

jbwiesner@ucdavis.edu