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Smart surfing: Finding the best medical Web sites

One expert offers tips on sorting the good from the bad

From the October ACP Hospitalist, copyright © 2007 by the American College of Physicians

By Jessica Berthold

Sidebars: Sites for patients Some specialized clinical guideline sites Continuing Medical Education sites

Most physicians who have practiced awhile have noticed an increasing number of patients coming to them with specific health questions or concerns. This is hardly surprising, given that 80% of U.S. Internet users have searched the Web for health topics, according to a 2006 survey by the Pew Internet & American Life Project.

But patients aren't the only ones doing the Web surfing. A 2006 article in Postgraduate Medical Journal found that 71% of health care professionals use the Internet regularly for medical or professional updating, and 63% recommend Web sites to patients. The issue for many physicians is not whether to use medical Web sites, but how to find the best ones.

"What you're looking for in a site is one that is easy to use, evidence-based, peer-reviewed…and preferably inexpensive or free," Anthony Otters, FACP, said earlier this year at an Internal Medicine 2007 session in San Diego on free and low-cost medical Web sites. "I generally try to lean toward sites that are either government sites, journal sites or medical association sites, because I feel those will have the most accurate information."

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Photo by Comstock Complete.

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Most free sites have some sort of registration process that requires people to divulge basic information, like a name and e-mail address. It's a good idea to set up a designated e-mail account through a free portal like Yahoo! or Hotmail to use for these registrations, so your regular e-mail doesn't get filled with spam, said Dr. Otters, associate medical director of AmeriChoice and formerly an academic hospitalist. Be careful not to opt in for unwanted services, like daily e-mail updates, when registering, he advised, as they are often automatically selected on the sign-up page.

Although medical journal abstracts are usually free, many sites only allow print subscribers to see the full text at no extra charge. Other journals have free trial subscriptions for a limited time. Some journals offer free access to their articles after a certain period of time—often a year, or six months as in the case of Annals of Internal Medicine.

Still more free access may be on the horizon, as the U.S. House of Representatives recently approved a measure that directs the National Institutes of Health to provide free online access to agency-funded research results within a year of their publication in a peer-reviewed journal. The Senate is expected to consider a similar bill.

Before spending money on subscription sites, internists should check with their employers. Hospital systems and medical schools often let staff and faculty access online resources that have been purchased by their libraries. These subscriptions usually include remote access from home.

A word of caution, noted Dr. Otters: Don't rely on medical information provided directly by Yahoo! or Google just use their search capabilities to lead you to proven, reliable sites, such as the National Institutes of Health. Wikipedia, a collaborative or "wiki" site edited by anyone who wants to volunteer information, should also be avoided, Dr. Otters said.

"A lot can be answered, and answered quickly, by using the Internet." —Anthony Otters, FACP

Medical wikis, which focus only on health topics and are maintained by members of the medical community, are fairly new and haven't been studied to determine whether the information they contain is comparable to other peer-reviewed, evidence-based resources, Dr. Otters said. AskDrWiki.com, the Cleveland Clinic's medical wiki, is probably the most well-known, he said.

"The concept is a reasonable one, but I don't think medical wikis have been tested to make sure they have accurate information, and I don't think the breadth of the information is quite as good as some of the other sites that are currently available," Dr. Otters said.

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Where to start

ACP has several helpful resources for members, Dr. Otters said. These include a summary of recommended vaccines for adults and a page of bioterrorism resources. PIER (Physicians' Information and Education Resource) is a good starting point for clinical decision support.

"A great thing about PIER is, when you are looking up a certain disease, it gives you a little box of newly cited references on the side of the page," Dr. Otters said.

However, sometimes PIER may not have all the information you need, Dr. Otters said. PIER has 460 modules, while Web site eMedicine has articles on more than 6,500 diseases and conditions. PIER has a higher standard of evidence, but eMedicine is a good second stop if you can't find what you need on PIER, Dr. Otters said.

"The information on eMedicine is reviewed by four doctors and a PharmD, so the product, while not at the high level of PIER, is usually pretty solid," Dr. Otters said.

There's little difference between the free site at eMedicine and the subscription "premier" site at www.imedicine.com, beyond the fact that the former has more ads and looks more cluttered, he added.

"A nice thing about eMedicine is they start with conservative therapy," Dr. Otters said.

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Sites for specific needs

For pharmaceutical information, PIER offers members access to the Gold Standard's Clinical Pharmacology resource. Meanwhile, Drugs.com uses information from Micromedex, Facts & Comparisons and Multum. The latter is free to use and doesn't require registration—though it does have a lot of advertisements, said Dr. Otters. Epocrates.com is also decent: It has a basic version and a subscription version, and includes a handy database of drug interactions, he said.

PIER is a good resource for information on screening and prevention, as is the U.S. Preventive Services Task Force's site, which rates recommendations based on scientific evidence.

ACP has links to the most recent practice guidelines that have been published in Annals of Internal Medicine, sorted by clinical field. The National Guideline Clearinghouse, compiled by the Agency for Healthcare Research and Quality, draws from a wide variety of sources—from the CDC to the European Federation of Neurological Societies—in its comprehensive site. In addition, specialized medical societies have individual guidelines published on their sites (see sidebar).

Free Medical Journals is a useful site that, as the name indicates, lists all of the medical journals that offer free access, sorted by specialty, titles or general importance. Through this site, physicians can also sign up to be notified by e-mail when a new free journal becomes available. Of course, PubMed Central also archives all scientific journals.

The Web also offers tools that can help physicians make quick calculations, Dr. Otters said. Charlie's Clinical Calculators, for example, lets users calculate a patient's heart disease risk, creatinine clearance, IV infusion rate or other medical formulas. It can even help convert volume, weight, length and temperature from the English to the metric system, and vice versa. "As doctors we come across five or six clinical questions per day, but we typically only pursue answers to about half of them," Dr. Otters said. "A lot can be answered, and answered quickly, by using the Internet."

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Sites for patients

Physicians should have at least a passing familiarity with the Web sites that patients use to research or discuss their health problems, said Anthony Otters, FACP, associate medical director of AmeriChoice. He likes to refer patients to the federal government site MedlinePlus because it's easy to navigate, has slide presentations and is available in Spanish.

"It's a place I'd start for basic information—like if a patient were getting a colonoscopy, but had no idea what that meant. Patients can go through the slides on the site at their own pace, and the slides are also given verbally," Dr. Otters said.

Here are some other sites your patients may be using:

• WebMD Health is an interactive site with information on more than 90 disease and lifestyle topics, and more than 140 message boards.

• Daily Strength has support groups for people with more than 500 medical conditions.

• EverydayHEALTH is a general medical news site, with health calculators, polls and discussion boards.

• The HealthCentral Network is a clearinghouse of community-focused Web sites sorted by specific conditions (e.g., MyDiabetesCentral.com, MyHeartCentral.com).

• OrganizedWisdom selects and organizes user-generated health content from the Web.

• Revolution Health is a comprehensive, interactive site with articles, discussion boards, disease information and more than 125 consumer-friendly health tools.

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Some specialized clinical guideline sites

• American College of Cardiology Clinical Statements/Guidelines

• American College of Gastroenterology Clinical Updates

• CDC MMWR Sexually Transmitted Diseases Treatment Guidelines, 2006

• National Cancer Institute Physician Data Query

• National Heart Lung and Blood Institute Clinical Practice Guidelines

• Pulmonary Rehabilitation: Joint American College of Chest Physicians/American Association of Cardiovascular and Pulmonary Rehabilitation Evidence-Based Clinical Practice Guidelines

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Continuing Medical Education sites

• American Cancer Society Online CME

• AHRQ Web M&M [Morbidity & Mortality Rounds on the Web]

• Annals of Internal Medicine CME

• CDC MMWR Continuing Medical Education

• freeCME.com

• Medscape CME

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ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated