CASE: The Internet has (at least) two faces
Both Patient A and Patient B are 8 weeks pregnant with their first baby. At an office visit, you discuss influenza vaccination.
Patient A tells you: “I was undecided about the vaccine until I read all these horror stories about the H1N1 vaccine. A Web site, organichealthadviser.com, says vaccines and pregnancies don’t mix safely.1 It says that if the flu vaccine isn’t safe for a baby less than 6 months old, how can it be safe during pregnancy?1 I read story after story of women who got the vaccine and miscarried. Why would I want to be injected with a toxin?”
Patient B explains: “I was undecided about the vaccine until I read the information on the Centers for Disease Control and Prevention (CDC) Web site.2 I didn’t know that pregnant women are more likely to get really sick from the flu. The CDC says the vaccine is safe during pregnancy, will not harm my baby, and not only reduces my chance of getting sick from the flu, but will give my baby protection for 6 months after she is born.2 When and where can I get my shot?”
Sixty-nine percent of Americans (80% of those who have Internet access) turn to the Web for information about their health care, and 23% of people who have a major medical illness or other health condition report that the Internet plays a major role in helping them deal with their health issue.3,4 They might research symptoms, diagnosis, tests, and therapies before a visit to your office; many come armed with questions, sometimes bringing reams of pages downloaded from various sites. Among women receiving ObGyn care, almost 60% have accessed Web-based information before their visit.5 Others take to the Internet after their appointment to confirm or refute what they have heard in the office.
Regardless of what a patient researches or when she does it, the why is because she wants to be an active participant in her medical care. That is a good thing because participatory medicine (shared decision-making) leads to improved outcomes. However, the key to truly informed decision-making is content: A patient can be fully empowered to participate in her health care only if she has information that is accurate, understandable, and current.
Web-based health information: Entirely factual?
Not only do patients research health online, 60% of people believe what they read to be factual and at least as good as the information they receive from you in your office. In fact, there is evidence that only 6% believe the health information they gather online is lacking in quality.5,6
However, studies reveal that the accuracy of medical content on the Web varies greatly from site to site. For example, among women seeking information on the Internet about potential teratogenic agents, 40% found incorrect information, some of which was potentially harmful.7
In addition to the problem of potentially suspect content, more than 50% of patients don’t disclose with you the information that they find online.7 Ever encounter a patient you just couldn’t sway from a diagnosis she believed she had but you knew she didn’t? If your patient tells you where she got the information, you can walk her through the diagnosis and treatment step by step, pointing out where her information might not be accurate (or, sometimes, even medically plausible)—but it’s hard to undo what you don’t know about.
The ideal scenario. Discuss Web-based information as part of your visit, thereby acknowledging that the Internet is a valid place to investigate personal health care. You can also preemptively provide tools for tracking down the most accurate and understandable content. See, for example, the patient handout.
Let’s face it: Physicians have an advantage when it comes to weeding out the wisdom from the woo. To supplement our baseline knowledge, we can easily research facts on PubMed, check our medical societies for guidelines, or, simply, ask a colleague. Our patients don’t have these same resources, but with some guidance from you, their Internet health experience can be greatly enhanced.
Are your searches on the Internet turning up reliable health advice? Watch for these 10 red flags of bad information
- Sensationalized content Is the information on the site presented in an alarmist tone? Is it loaded with scary stories and extreme outcomes? Are the issues presented in terms of black and white, with no shades of gray? If the answer to any of these questions is “Yes,” the author may have an axe to grind or a hidden leaning. Suspect the accuracy of the information you obtain!
- No date This may seem like a minor problem, but the world of health care moves swiftly. Treatments and approaches that are reliable one day can be discredited in the blink of an eye. If the site does not date its content, or indicate when it was last updated, you have no way of knowing how current it is. Move on!
- No author credentials The author or authors of material on the Web site should clearly, and visibly, present their credentials—that is, their education and training, their title, and where they work. If they do not, it is impossible to judge their expertise—in fact, expertise may be lacking.
- Buzz words The use of quasi-scientific buzz words such as “toxins,” “heavy metals,” and “detoxification” should draw your attention. These words have no meaning, so they should lead to you question what else on the site might be fiction.
- Patient testimonials Three people may have improved with a particular drug, but what about those who haven’t? Using unverified personal experiences is a sign of advertising, not good medicine.
- For sale sign If you can’t easily tell the difference between the medical content and products for sale, move along. Even when products don’t appear prominently, chances are that the bottom line of the Web site is profit, not education.
- All benefits and no risks Sites that have a stake in a particular treatment—be it monetary, emotional, or some other involvement—usually provide a lot of information on benefits but not so much about risks. Every treatment has risks.
- No sources When physicians scrutinize an article or study, they make it a point to check the list of sources at the end, to ensure that it contains legitimate information, such as reports from a medical journal or government publication. A Web site that presents detailed medical information without providing links to the references or comparable detail about the sources of that information is highly suspect.
- Conflict of interest Most reputable health sites not only provide information from experts, they list any so-called potential conflicts of interest that those experts may have. For example, if a medication made by XYZ Pharmaceuticals is recommended by Dr. Smith, who is also a consultant to XYZ, you should know. Articles and presentations at scientific meetings require these disclosures for a reason: Financial ties can produce bias.
- The Web site or product is listed on QuackWatch This Web site is dedicated to exposing unproven and scientifically questionable medical claims (http://www.quackwatch.com).
Where can you turn for help?
- An excellent starting place is the National Medical Library Web site at http://www.mlanet.org/resources/userguide.html, which provides resources for obtaining reliable health information.
- The National Library of Medicine and National Institutes of Health also provide an outstanding 16-minute lesson on how you can evaluate online health information. Find it at http://www.nlm.nih.gov/medlineplus/webeval/webeval.html.
- healthfinder.gov is a Web “encyclopedia” offering entries on more than 1,600 health topics.
© Copyright 2011 Quadrant HealthCom, Inc. This “Guide” may be reproduced by clinicians without permission or fee for single-copy distribution to patients. All other uses require the written permission of the publisher.