Surgical Internet at a glance: healthcentral and drKoop

Abstract

Surgical patients today are different from those of earlier centuries, or even earlier decades. They demand, and deserve, a right to informed consent about operations. In addition to one-on-one counseling by a surgeon, a patient often looks to other sources for information about diagnoses and operations. A current turning point to procure this knowledge is the world-wide-web. However, not all medical information presented on a web page is true, applicable, or even useful. At present there is no quality assurance system to verify facts presented on medical web pages. In a recent review of representation of common vascular surgical problems on the world-wide-web, Soot and colleagues found that 96 out of 150 websites (66%) had virtually no useful patientoriented information. Of the vascular web pages that had information considered relevant to patient education, 33% had areas that were classified by the authors as misleading or unconventional. Until problems of verifying accuracy and integrity of the online content are solved, it is up to health care professionals to guide patients to reliable resources. One such way is to produce a “selected links” section for patients who seek additional medical facts online. This link would represent web pages that a physician has previously visited and “approved.” Such a program was established at the Family Practice Department of Medical College of Wisconsin where patients were given access to web pages that had been reviewed and sanctioned by their doctors. Ninetyfour percent of participants found this group of web pages useful and 77% said that they would modify an unhealthy behavior because of information read on online. Patients usually refer to search engines or corporate web pages as starting points in their information quest. Two commercial web pages featuring well-known doctors are highlighted here: television and radio celebrity Dr. Dean Edell’s Health Central at http://www.healthcentral.com and former US Surgeon General Dr. C. Everett Koop’s self-titled http://www.drkoop.com. While both web pages are informative, interactive, and fun, make no mistake— they are commercial ventures. Each is heavily laden with advertising banners that, when clicked upon, whisk the viewer away from patient information sections to a different site with a distinct agenda. Unfortunately, the future of medical web pages appears to be a cyberspace hybrid of patient information pamphlet and television commercial. Banners aside, these pages contain a reasonable amount of data aimed at health care consumers. Both are searchable by topics. Test searches that included the phrase “colon cancer” returned 205 “matches” on healthcentral.com and 33 on drkoop.com. Each match is a link to a published article contained within the respective web page. The articles read like newspaper columns and are generally up-to-date and factual. Other search topics included carotid endarterectomy (15 matches on healthcentral.com, 2 matches on drkoop.com), melanoma (94,33), hernia (35,37), cholecystectomy (9,5), and skin graft (29,5). In addition to a search and find technique, both web pages contain helpful interactive applications. At drkoop. com, an interactive “drug-checker” can determine whether a patient’s medication will interact with other medication, or interact with a certain food. To do this, a patient types in the medication and the web page responds with interactions. A sample on erythromycin and cisapride returned: “Severe! Erythromycin may inhibit the metabolism of cisapride. Plasma cisapride concentrations may be increased. This interaction may lead to a prolongation of the QT interval and the occurrence of serious ventricular arrhythmias such as torsades de pointes. Interactions between similar drugs have been fatal. Coadministration of erythromycin and cisapride is contraindicated.” This simple online tool would probably be a welcome addition to most any doctor’s office. At healthcentral.com, the “cool tools” section contains interactive calculators designed to determine personal health profiles. By answering a series of questions, the visitor is issued personal feedback about a variety of medical topics, including drugs and alcohol, eye and vision, nutrition, stress, and others. A more comprehensive assessment can be obtained via a ten-minute profile in the “Know Your Health” section that consists of answering a number of questions. The profile will even predict life expectancy and advise the visitor what areas need improvement. As medical web pages increase, it becomes less feasible for an organization or committee to monitor and approve the content, especially true with dynamic web pages that frequently change content. It is up to health care professionals to stay abreast of web pages within their specialty and help refer inuiring patients to appropriate sites. The large corporate web pages, which number in the hundreds, are a good place to start.