The Internet in Medicine Introduction – How I got involved Overview – Basic principles – Ideas of ways to use the internet • Patients and physicians – Group Discussion- share what you find useful with your colleagues
Jan 21, 2016
The Internet in Medicine
Introduction– How I got involved
Overview– Basic principles– Ideas of ways to use the internet
• Patients and physicians
– Group Discussion- share what you find useful with your colleagues
How I got involved…
Keeping up with the literatureConventional methodMove off campuswww.medjet.net
Keeping Up with the Medical Literature
ScienceDirect - My AlertsGoogle Med
“Google is a good Diagnostician”
BMJ 2006;333 (2 December) Using signs and symptoms as search terms on Google
finds the correct diagnosis 57.7% of the time (95% confidence interval 38.3% to 77.1%) say Tang and Ng.
The authors identified 26 case reports published in a single journal and selected three to five specific symptoms and signs from each to be used as Google search terms. They compared Google results with the original diagnoses. Google searching is less helpful in identifying complex diseases with non-specific symptoms than in diagnosing illnesses with unique symptoms.
Basic Principles
Core standards for the digital world should be similar to the world of print
Physician as Interpreter of medical information (patients have the same information we do)
Evaluating Medical Web Sites
“Assessing, controlling, and assuring the quality of medical information on the Internet: Caveat lector et viewer- let the reader and viewer beware.” – Article from JAMA 1997; 277:1244-5
Core standards for the digital world should be similar to the world of print
Evaluating Medical Web Sites
www.hon.ch
Ideas on Ways to use the Net
Pt usesPhysician usesThe interaction of the two
Patient Uses
Harris Interactive calculated that 111 million adults have looked for health information on the Internet last year.
Most Visited Health and Medical -Information Sites, March 2007, U.S.SiteMarketShare
MyWebMD10.61% WebMD9.84% Yahoo!Health3.68% MSN Health 2.5% Emedicine2.24% Med Help Intl2.00% Medscape1.76%
MayoClinic1.67% Kids Health1.62% RealAge1.43% Source: Hitwise
Patient Uses
Patients have basically the same information we do.
They often use the internet in the same ways we do.
Patient Uses
Disease specific informationOn-line prescription drugs
– Viagra, Narcotics
Patient Uses
Scorecards– www.thehealthcarescoop.com– www.healthgrades.com– www.carol.com
Patient Uses
Be aware of its use Be Proactive
– Recommend sites– www.mayoclinic.com
Become an Internet-Informed Physician– It is what patients want
The Internet in Medicine:Physician Uses
How do I best make use of the Internet?
The Internet in Medicine:Questions to Consider
Is your information need immediate or not?
What information do you want pushed to you?
What are you trying to accomplish?What information can you download to
your palm and carry with you?
Physician Uses
I need it now…– www.uptodate.com– www.infopoems.com
Physician Uses
I need it now…– http://hopkins-abxguide.org– http://www.eboncall.org– http://content.nejm.org/misc/videos
Physician Uses
I have more time…– www.guideline.gov– http://acpplus./EBMTools
Physician Uses
What am I trying to accomplish?– I would like to improve…– My clinical exam
• http://www.sgim.org/rationalclinicalexam
Physician Uses
What am I trying to accomplish?– I would like to monitor my improvement…
• BMJ Learning
Physician Uses
I want some information sent to me (in case I forget to go get it)…– acponline journal club plus
Physician Uses
I want to download some info and carry it with me (palm)…– http://www.nhlbi.nih.gov/health/prof
Physician Uses
Medline and Journal Sites– www.bmj.com
Physician supersites– www.medscape.com
CME Online– Cme locators– www.hon.ch
Physician Uses
Subspecialty sites
Physician Uses
Medical Content– http://pier.acponline.org– www.aafp.org– www.eMedicine.com– http://www.merckmedicus.com
Physician Uses
In the clinic– JNC 7
Storing your sites– http://www.blinkpro.com/tab/mysites
The Internet in Medicine
Think of what need you may have (e.g. my need to keep up with the literature) and then go see how this medium can help you.
Physician Uses
Any favorite sites out there people want to share?
Physician/Patient Uses
Interaction of the two…
Prostate Cancer Case
Questions: age, ethnic group, family history, height, vasectomy history (he had one), and dietary habits (<5 servings of tomato based foods a week and <5 servings of food with animal fat a day).
Risk is above averageCalled me
Web Based Risk Calculators
New Information resourceAdvantages:
– Tailored risk info based on personal factors
Disadvantages:– Accuracy?– Balanced?
Clarity about Risk
What risk is under consideration: dying of the disease or getting it?
Probability (a number)?Time period associated with this
probability?The site doesn’t tell Mr. Smith the chance
he will get or die of prostate ca in a defined time frame.
Quantitative Risk Estimate
Breast Ca Risk Assessment Tool– http://bcra.nci.nih.gov/brc/
Lung Ca Risk Assessment– www.mskcc.org/mskcc/html/12463.cfm
MI or death over the next 10 years– http://hin.nhlbi.nih.gov/atpiii/calculator.asp?
usertype=prof
Quantitative Risk Estimate
US govt Surveillance Epidemiology End Result Site– http://seer.cancer.gov/
Advantage: Broad array of cancers, time frameDisadvantages: Tailored only to age, sex, and
raceOver the next 10 years, a 55y.o. white man’s:
– Chance of getting prostate ca is 40 in 1000– Chance of dying of prostate ca is 2 in 1000
Context
How this risk c/w chance of dying of other cancers
Risk Charts: His chance of dying of:– Colon Cancer: 4 in 1000
– Heart Disease: 20 in 1000 (50 if smokes)
– Anything: 93 in 1000 (217 if smokes) in the same time frame.
– Journal of the National Cancer Institute, Vol. 94, No. 11, 799-804, June 5, 2002
Uncertainty
Strength of evidence behind the factors used in generating risk estimates:– Age consistently important for prostate ca– Height, diet, and vasectomies not consistently
important• Yet these were included in his initial risk calculator
Communicating Risk:the main work of doctors
Web based risk calculators demonstrate a paradigm shift in medicine.
Physicians are moving from primary medical information providers to information managers.
Physician Uses
Any favorite sites out there people want to share?
Case
52 y.o. man with multiple myeloma presented to our R4 team with fever last month when I was on wards.– Went over his med list– Day #3 he brought in a bottle of Astragalus
which he was taking “because his brother read about it on the internet and it has been curing people in China with cancer for years”
Case
www.puritan.com
Cancer Treatment Strategies at IEP
The Internet on Wards
alternative therapy disclosure
why pts use alternative medicine
Quantitative Risk Estimate
Breast Ca Risk Assessment Tool– http://bcra.nci.nih.gov/brc/
Lung Ca Risk Assessment– www.mskcc.org/mskcc/html/12463.cfm
MI or death over the next 10 years– http://hin.nhlbi.nih.gov/atpiii/calculator.asp?us
ertype=prof
Communicating Risk:the main work of doctors
Web based risk calculators demonstrate a paradigm shift in medicine brought about by the Internet.
Physicians are moving from primary medical information providers to information managers.