Medinfo.co.uk

Medinfo is a consumer health site. I reviewed the site previously in the first issue of Surgical Sieve. It is a delightful example of how individuals can create small, independent, and widely useful sites through the internet. The individual in question is Dr Charles Sears, a GP. In this interview, he discusses the impact of the web on patients' education.

Tell us a little bit about Medinfo.co.uk

Medinfo was set up by me, my son James (the technical expert) and my wife, Judith (who is trained as a physiotherapist) in 1997. It is intended to provide information on common medical complaints in accessible language, and in a technically easily accessible form. It started, on a non-profit-making basis, by Arboris Ltd., a company that we have set up to provide web services with an initial focus on medical clients.

I am a GP in Wiltshire, a trainer, active in the RCGP and in the areas of back pain and disability. I am on the editorial board of Guidelines in Practice.

When did you first become interested in the web's potential for medicine?

1997... We had already started work on a similar idea for use in doctors' waiting rooms, but realised that this had been superseded by the massive and rapid growth of the Internet. We confirmed the demand using a small scale questionnaire to patients attending my practice.

We have also become involved in developing Web sites for doctors, trainers groups, and others.

Interesting that you started with a questionnaire. Do you often do this with your patients?

Not often, but we do occasionally survey the patients to discover their views on current services and possible future developments. We use their responses and views to shape our future development.

I feel that it is important to try to match what we are providing in the way of a web site to our users' wants, as far as is possible. Thus we might be in a better position to adequately address their needs as well.

A better informed public is in a better position to optimise their use of health services, their health, and their input into shaping health services.

Back to your use of web sites for training - how can the web help with education for doctors?

The GMC and medical schools have recognised the information overload that current medical students face. This is true, in fact, at all levels of medicine. Some of the most important things that we can instill in young doctors relate to:

The lifelong desire to learn

Some of the basic clinical and consultation skills

Attitudes and the ability to see the patient as a whole

An increasing amount of factual information will have to be retrieved from information systems, as it is so rapidly out of date, and every special interest group requires us to be knowledgeable on their particular topic.

This is one reason for good information to be available, in an accessible form for medical/health students and doctors/healthcare professionals.

Interaction and contact with people around the country and the world enlivens the learning environment.

Learning or quick reference can be done at any time, and in nearly any environment, which has benefits over other methods.

The space taken by the learning resource is only as big as your browser.

Links by way of reference make the passage from one information source to another much more easy than books and journals.

A lot of doctors would like to get their surgeries on the internet. They worry about two things - having the technical savvy, and being overwhelmed with e-mail from their patients. What's been your experience with Arboris?

Some doctors have been using the Net for a long time, but the majority of us are just beginning. The one major problem we would highlight is that people tell everybody their e-mail address and then don't check their e-mail frequently enough.

Preferably this should be done more than once a day, but daily is a minimum.. this equates to using the post ("snail mail"). Many an urgent communication has been sent by e-mail only to be picked up by the recipient days, or weeks later.

We do need to have some basic tuition and understanding of the system. Attachments, in particular, cause a lot of problems. Firstly, as demonstrated by the recent "love bug" virus, people seem too keen to open attachments that they are not sure of. Secondly, far too many people send attachments which require specific software or operating systems to use them, without first checking that the recipient uses the same system. It is better to use plain text, or when necessary, attach standard format file such as HTML.

An understanding of and introduction to encryption, such as PGP [Pretty Good Privacy], would also be valuable to doctors starting out.

I would comment on the NHS Net address system which gives GP practices a number. Numbers are harder to remember and easier to muddle, which could send the e-mail to the wrong practice. It seems to us that this is not a wise system to use.

When we do start using e-mails more in practice, we will need to set aside some time each day to devote to these, much as many of us have for telephone communication, at present. Both our patients and we are on a learning curve at present, and the amount of e-mail use will rise, but the ease of response and the way that e-mail can be accessed at any time from anywhere may have benefits over other modes of communication.

We should consider encryption for sensitive information, but this is not vital for most of the letters we will receive or send to patients and colleagues.

Some doctors are skeptical of current medical information for patients on the web. What would you say to them?

There is much information in the world. A large amount of this is inaccurate

or misleading. Some may think the man in the street is fickle, but I suspect he knows that tabloid headlines sometimes have less substance to them than the editorial content of a broadsheet, or that more detail may be found from a reputable encyclopaedia or text book at the library, etc.

It may be expecting a lot, but I would hope that the Internet using public will become more sophisticated over time at cross-referencing and evaluating information that they find on the Web. Certainly, there may be ways of awarding stars to sites covering various fields of interest, but eventually all recordable knowledge will be on the Internet, and information that is not there will be "non knowledge". We have not excluded bad information in the written media in the Western world in recent years.

There is some very good technical and very specialised information on the web, and also some very poor and misleading information. Many areas are not adequately covered. Most of the information is not in an accessible form. Much of the information comes without guidance as to the weight that it deserves to be given, and much is written from a special interest group point of view (ie is one sided).

We need to be wary of the shortcomings, but should not be afraid of our patients being empowered by information. We will need to spend more time discussing the evidence for our actions or recommendations.

What advice would you give to patients in helping them identify a medical web site as being trustworthy?

Cross check information with other sources.

Return to a site which has produced helpful or reliable information before.

Look for, and perhaps follow up, references to reliable medical journals.

Be wary of a site that seems to be after selling you something.

American web sites have a head start. Do you think we can catch up and compete?

Yes. The American sites are quite often written at a level over the heads of the ordinary user, and we have very heavy positive feedback from our American users. Although one did comment on my English spelling!

People do recognise and appreciate quality.

Interview with Dr Charles Sears