This article appeared in the "Scotsman" newspaper in the "Interactive"
(Tech) supplement on 11th February 1998. See on line at
http://www.scotsman.com

A test of web-site manner

The net is helping to update doctors but it needs to be accredited, says
Alan Crawford 

"SINCE the Internet began it has been an information source without
equal. Unfortunately, much of it was unreliable or seemed to focus on
porn, computers or second-hand books. So how would you feel if the
surgeon who was treating you for a fractured femur was getting his
information from the Internet? A number of educational web sites and
mailing lists dedicated to accident and emergency treatment, known
technically as "orthopaedic and trauma surgery", have sprung up and the
common factor to them all is Edinburgh. Staff at the Capital's Royal
Infirmary have published more papers on orthopaedic trauma than any
university, so it is perhaps not surprising that a consultant at the
specialist unit should co-ordinate the sites. 

Mr Chris Oliver, a consultant in trauma and orthopaedic surgery as well
as an honorary senior lecturer at Edinburgh University, set up the web
site for the university's Department of Orthopaedics. He was also active
on medical newsgroups and has been subsequently invited to edit medical
web sites from New York to Sydney. But Oliver has realised that, unlike
other web sites, medical sites can allow no room for error or
misinterpretation. Issues of reliability are paramount when dealing with
people's health - something for which the web is not renowned. "I am
desperately worried about quality," says Oliver. "Doctors need to be
updated. The information changes so fast and we can't go on courses all
the time. One way of delivering information is the Internet, but it
needs to be accredited. "We are now even getting to the stage of having
an ISO 9000 standard. Nobody has done it yet, but I think that will
happen." Through his research into artificial intelligence and ways of
facilitating learning, Oliver has published several papers on surgery
and the Internet. In a paper entitled Surgical Care on the Internet,
published in the journal Surgery last November, Oliver wrote: "Quality
is a major concern and much doubt has been expressed about the content
of some pages. Since the Internet is an open environment, anyone can
post information that appears to be professional and authoritative." "On
the whole this is not happening. The effort involved in making a web
page is a deterrent to the malicious and most professionals post
information out of a desire to communicate." However, he adds: "That is
not to say that pages that seem to attract patients to contact a
particular doctor or institute do not exist." 

Speaking last week, Oliver said that the distinction between advertising
and medical opinion was not always clear. "If you look on some of the
American sites," he said, "there are pages that advertise surgeons'
services and institutions. That's not happening here." However, an
organisation exists in the United Kingdom which is responsible for
assessing and vetting medical sites. Organising Medical Network
Information (OMNI), funded by the Joint Information Systems Committee,
co-ordinating body for the academic network, is the UK's gateway to
Internet resources in medicine, biomedicine, allied health and health
management. OMNI provides comprehensive coverage of resources on topics
from AIDS, alternative medicine, medical ethics, to veterinary medicine
- including Oliver's web sites. Crucially, OMNI continually updates its
collection through a process of selection and evaluation of the myriad
sites posted on the web. According to Oliver, the benefits are not only
felt by the medical fraternity. He says: "Five to ten years ago it was
unusual to see reports of surgical scientific studies in a regular
newspaper, magazine or on television. Today the opposite is true. It is
not uncommon now for patients to present themselves in clinic with reams
of information obtained from the Internet. "Before I came to Edinburgh I
worked in Oxford and it happened half a dozen times. It has happened
twice here. It's difficult for patients to weigh up the information.
Equally, you can't possibly have read the amount of information that
they have. It's not uncommon for them to know more about their
particular condition than the consultant. "That means the consultation
gets very much longer, since it's not always clear what question they
have from that material. Or they may refer to treatments you have not
heard of. "Our role as surgeons is changing: we are now advocates and
not dictators." 

Doctors might be excused for being wary about this development. Yet it
is one more example of the empowering aspect of the Internet. Yet there
are more constructive routes to medical knowledge through the web.
Medline offers public access to all medical journals worldwide. "It's
not uncommon for people to go on to Medline," says Oliver. "If you want
to know about your fractured femur, or you want to know how good your
surgeon is, you can look up whether the chap has published any papers on
the subject. Patients can look up any scientific paper which has been
peer reviewed and get access to good quality information. "There are
various free sites and with some search engines you can type in
sentences. You could type, 'Is wearing a crash helmet on a motorbike
useful?', and it will give you a list of relevant papers. That's where I
would go if I was a patient." Oliver himself set up an Internet
discussion group, Orthopod, where orthopaedic and trauma cases from
anywhere in the world can offer their suggested treatments. Orthopod
<http://www.mailbase.ac.uk/lists/orthopod/> has over 420 members and is
now the largest mailing list in the world for orthopaedics and trauma.
"We had a broken tibia and we posted it on the web site," says Oliver.
"Within half an hour, we had 20 responses on the most suitable
treatment.

 "We've had 1,100 visits to the departmental site in three months. I
have been truly amazed - it's just gone mad."

_________________________________
Mr. Christopher W. Oliver MD FRCS (Orth)
Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh
EH3 9YW  SCOTLAND       [log in to unmask]
+(44) 0131-536 3720 Secretary  +(44) 0131-536-3810 Fax





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