A friend of mine had a patient with a rare disease. Seeking help, he sent me an e-mail asking for assistance in finding an appropriate therapeutic treatment. Although many people use the Internet to search for various topics, it is not a routine practice here in Poland to use it to research treatments. Therefore, since an increased number of clinicians are now asking me to help them in such searches, I have become the resident expert on Internet searches relating to patient care.
An extension of the standard, mainstream uses of obtaining educational information, use of the Internet for clinical practice is a way to improve the quality of diagnoses and therapy across the entire diagnosis and treatment cycle. Internet-based knowledge for the practice of medicine is rich, offering a wealth of reliable data from clinical journals and standard medical newspapers, as well as from Web-based consultations, listservs and discussion boards.
Since embarking on research for difficult cases, and solving them with the assistance of searches and discussion, I have become convinced that such access can successfully improve patient management by finding best treatment methods as well as by discovering experts within specialized care centers. However, there remain some hurdles when attempting to incorporate such Internet searches into everyday practice.
Building your library
The selection of reliable information remains a challenge for the novice Internet researcher. Although there have been various attempts to accredit medical services, there are still too many Web pages created to keep up with any type of institutional verification process. The anarchic nature of the Internet itself results in a great deal of inaccurate, inappropriate, and often fraudulent information. In my opinion, as well as that of other experts, the best method is to become educated consumers. Learn how to select high quality medical sites and how to systematically locate high quality, reliable, sources of information.
I advise creating a list of such sources with a plan to review and re-evaluate them regularly. If monitoring such sites is performed collectively among a group of doctors representing different specialties, there may be incentives to divide the tasks. With simple tools, relevant news and medical updates could be published locally on a Web site with information tailored to all physicians participating in the collective work. This process leads to the aggregation of highly reliable and useful medical portals and educational sites and is currently being done in Edmonton, Alberta, Canada on a local intranet network.
A good starting list might include Medline, Psychoinfo, CINAHL, Healthstar, 38 full text journals (including JAMA, BMJ, NEJM) Harrison's Online Book, Cochrane, Micromedex, interactive ECG tutorials, full therapeutic guidelines and pharmaceutical resources. My personal list includes Proquest and Elsevier databases with full text medical journals, Medline, Docguide and MedScape.
E-mail as a tool
Clinicians using e-mail to exchange private or collective messages can also tap into the collective wisdom of one or many to ask about help with a specific problem. Those who belong to a Web-based discussion group can use the tool on a continuous basis. Listservs, blogs and online forums can be good places to find others interested in similar problems. In addition, physicians who watch patient exchanges can gain insight into their problems and preferences.
Where to start
In my own practice, for example, I used the Internet to research a case concerning pediatric autoimmune neuropsychiatric disorder associated with Group A Streptococcus. My colleague in a Polish child psychiatry research center asked me to help find a commercial reagent to test anti-DNAse B — important in confirming evidence of streptococcal infection but for which there was no known commercial manufacturer.
My search started broad, with the open search method using the Google search engine with text to search: “obsessive-compulsive” AND “Anti DNAse B”. Results showed 64 possible resources, of which I determined that the most relevant one seemed to be an article from a clinical journal. I sent one of the authors an e-mail requesting more information on the topic. Further correspondence from this expert revealed that it was his laboratory which had tested the blood samples for the clinical trial cited in the journal. Although no commercial test was available in Poland, I did find the method recommended by the World Health Organization and published in a brochure in 1996.
The research was not only timely, it was fast. I started researching near the end of May and had the answer at the beginning of July, with vacation time between.
Net knowledge for physicians
Access to clinical information via the Internet has great potential to improve medical practice if clinicians take care to scrutinize resources and sites. The Internet can be a major channel through which medical knowledge can influence medical practice. Mailing lists and discussion boards are full of patients and their families searching for support. This virtual world is a new place to help people — to support human values and heal bodies and souls. Incorporating Internet-based knowledge is one more tool that physicians can use to keep up-to-date with medical practices, reach individuals in need and diagnose mysterious cases.
Piotr Kasztelowicz is based in Poland at District Hospital in Chelmza, Department of Internal Diseases
Engines That Can
Search engines are as helpful in fi nding and organizing clinical information as in fi nding, say, a restaurant in Warsaw. I have divided search methods into open search (using standard search engines such as Google, Lycos or AltaVista) and specialized searches using dedicated medical services. There are pros and cons for both methods, but, as with all searches, verifi cation and discernment are necessary.