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January 13, 2007. Can we trust Dr. Google?. The importance of teaching student doctors how to evaluate medical websites. Geoffrey Talmon, M.D. University of Nebraska Medical Center. A scenario…. Learning issue: Describe the Schilling Test. The way it was…. The way it is now….

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January 13, 2007

Can we trust Dr. Google?

The importance of teaching student doctors how to evaluate medical websites

Geoffrey Talmon, M.D.

University of Nebraska Medical Center


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A scenario…

Learning issue: Describe the Schilling Test





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Another scenario…

“Doctor, I found this website that says that weasel saliva will cure my prostate cancer. What do you think?


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The Internet in medicine: statistics

  • WWW debuted in 1993

  • In 2005, 1 billion people worldwide

  • In 2004, 202,000,000 Americans used the Internet (72%)

    • 112% increase from 2000

    • 66% use the Web daily

      Pew Survey, 2007


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The Internet as a medical information source

  • Access to support/discussion groups, primary literature, society websites, etc.

  • Growth in health resources

    • In 2000: 100,000 medical websites

      BMJ 2000; 321:136

    • 2007 “medical websites” Google search: > 2,000,000,000 results

  • Online health ad spending: $662 M in 2010

  • 79% of Americans use the WWW to find health information, the majority utilizing search engines (Google=55%)

    Wall Street Journal 3/21/2006




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The Internet as a medical information source: caveats

  • Audience of websites varies

    • Patients/relatives to specialists

  • Complexity of information and language varies

  • Sponsorship (agenda) varies and disclosure not universal

    • Professional societies

    • Drug companies

    • Patient groups

    • Special interest groups


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The Internet as a medical information source: caveats

  • No systematic means to remove outdated content

  • Web search engines not discriminatory

  • No systematic peer review of content (the “wikipedia syndrome”)

    • 2000: ~50% of content was reviewed by experts

    • 4-89% of information was “inaccurate” or “misleading”

      • Worst in nutrition, best in cancer

      • Worst in “private sector”, best in societies’

        JAMA 2002; 287:2691-2700


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How health information on the web will impact student doctors

  • Primary medical resource

  • Evaluation of patients’ information


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The Internet as a primary m medical resource doctors

  • Little data to quantify or characterize medical student/resident Internet use

    • 88% of 18-29 year-olds use the internet regularly

    • >80% of college students own a computer

      Pew Survey, 2006

  • 94% of clinicians use the Internet with 81% using it at least several times per week

  • Personal experience: the WWW is ubiquitous

    • WebMD, eMedicine, UpToDate, pathologyoutlines.com, etc…

    • Access to online journals/texts

    • WWW searches


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The Internet as a primary medical resource doctors

  • Advantages:

    • Fast, convenient, inexpensive, easy to use

    • Wide variety of information from multiple sources accessible

  • Disadvantages:

    • Requires additional evaluation of content (“academic vigilance”)

    • Limit of research to material available online

    • Decrease in variety of sources used?

    • Digital plagarism


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Patients and the Internet doctors

  • 77% of consumers research health topics before and after seeing a physician

    • 54% discuss their findings

    • 64% get information from sites intended for professionals

    • 43% use WWW to seek second opinions

    • Online health information is trusted by public second only to that from clinicians

    • Average user looks for health related information 3x/wk

      HON survey, 2004-5


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Patients and the Internet doctors

Health Affairs, Nov/Dec 2000



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  • What should educators do? doctors

    • Understand that the Internet has and will continue to impact health care

    • Recognize the degree of current Internet use by students/residents

    • Foster conscientious use through teaching student doctors how to evaluate websites


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Preparing student doctors for the Internet Age doctors

  • Abundant experience with teaching the evaluation of primary/review literature

  • Web-based materials engender additional issues

  • Student doctors should be just as conversant in these as study design and selection of statistical methods

  • Medical research curricula should include these points

  • Learners and educators should encourage the empiric evaluation of all web-based materials


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Evaluating medical websites doctors

  • Additional criteria for evaluating websites:

    • 1. Audience

      • Intended audience should be clearly identified

    • 2. Accuracy

      • Cite the source(s) of published information

    • 3. Sponsorship/financial disclosure

      • Identify host organizations and funding sources

    • 4. Transparency

      • Identities/qualifications of authors, editor(s)/reviewers, and webmaster with accurate contact information

    • 5. Currency

      • Date created and/or last updated


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Resources doctors

  • Published guidelines for evaluating sites

    • Johns Hopkins University

    • Net.TUTOR

    • “The Good, the Bad, and the Ugly…”

  • Published guidelines for evaluating health-related websites

    • AMA Guidelines for medical and health information sites on the Internet (2000)


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Resources doctors


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Resources doctors

  • Health on the Net Foundation (www.hon.ch)

    • Non-governmental foundation in EU with published code of conduct for web publishing of health information (HONcode)

    • Accredits health websites

      • Downloadable toolbar

        • checks accreditation status of sites

        • Searches accredited sites


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Resources doctors


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Resources doctors


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Resources doctors

  • WRAPIN (www.wrapin.org)

    • Project of HON

    • Searches only “approved” websites

    • Searchable by keywords


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Resources doctors


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Resources doctors

Arch Path Lab Med 2005;129: 742-6


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Summary doctors

  • The Internet has and will continue to be an important method of obtaining medical information for patients and clinicians

  • The Web is currently being heavily used by the public and student doctors

  • Medical education needs to recognize the importance of the evaluation of health-related websites and the information they contain

  • Published guidelines and useful web-based tools are currently in existence to aid educators


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Questions? doctors


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