Your patients and an estimated 90,000,000 other people in this country2 are among the growing number of users of the Internet for communication, business, purchases, and information. The changing doctor-patient relationships under managed care, as well as other time pressures, have increased the demand on both the patient and the physician for medical information. The Internet is increasingly used in our daily lives as a means of communication and commerce, and our patients see use of the Internet as a resource for information on health and wellness as a natural extension. The quality of this information, however, is extremely variable. Our patients would not drink water from a source they did not trust, and a source of medical information should be subjected to equal scrutiny.
Physicians have traditionally advised their patients about what to do and how to do it, and they have been respected for the guidance that they have provided. Patients are counting on the medical profession to maintain this role, and many are looking for the decision-making process in health care to revert to the hands of doctors and their patients. Physicians and medical groups as well as our educational institutions are currently harnessing the potential of digital medical information to assist in the personal encounter between physicians and the public. Eighty-five percent of physicians surveyed are currently using the Internet, an increase in online activity by doctors of 875 percent compared with that reported in 19974. While no web site can provide the comfort of a caring physician's touch or words, web sites can be used to allow a more informed and productive encounter.
Requests for more health-care information from the Internet stem from consumers' strong and growing desire to be more proactive in their health-related decision-making. They want access to a reliable and credible electronic medical database that will help them to participate in medical decision-making. Patients' use of the Internet should not be ignored, but rather it should be fostered and guided. A better informed patient, along with patient-centered care, allows more time for the development of the important doctor-patient relationship and has been shown to improve compliance and outcomes7.
Health-care information on the Internet is a resource of unprecedented size that provides a tremendous opportunity for us to partner with our patients. Most individual physicians do not have the time or skills to build or maintain a web site that will inform or attract patients on a sustained basis. Medical web sites are being created by academic centers and respected medical organizations for groups of physicians and their patients. For organizations such as the American Academy of Orthopaedic Surgeons (AAOS), the Internet is an opportunity to provide its fellows with valuable communication tools.
There are now many competing medically related sites, and it is no longer adequate simply to build a site and expect it to attract significant traffic. A web site can be more of a minefield than a field of dreams. The web sites that do not have a legitimate economic foundation or a well thought-out business plan will not succeed. E-commerce is not the future but the present, and it is projected to complement, not replace, traditional commerce. Search engines are not able to separate substance from snake oil. Dot.com fever has produced medically related web sites that can be a medium for unregulated medical information with scientific jargon and testimonials that are not easily distinguished from reputable data. The hazards of point-and-click medicine are matters of deep concern to many, but others seem less aware of these dangers.
An estimated 20,000 to 25,000 web sites are devoted to health care1, and approximately 70,000,000 consumers have searched these sites for medical information over the last year6. According to a recent survey, 40 percent of all searches on the Internet are for medically related information5. Seventy-five percent of your patients or their families are seeking online health-related information. Surveys have shown that these patients are seeking more and better-quality health information about disease treatment and prevention3. Consumers have favored sites that not only provide information in an easy-to-read format but also combine interactivity with quality and encourage rather than disrupt the patient-physician relationship. Physicians have traditionally been the providers of medical guidance to their patients, and they continue to be the most trusted source of health-care knowledge.
The new AAOS web site for patients and the public is dedicated both to its traditional educational role and to improving communication between orthopaedic surgeons and their patients. It is committed to providing validated orthopaedic information. The site is patient-centered, physician-driven, content-rich, and subject to the quality measures of traditional publications. With its site, the AAOS has sought to create a digital database of orthopaedic patient knowledge and to have that database serve as the interface between the public and current orthopaedic medicine and technology. Its content is designed to serve as an information resource accessible through the patient's physician and not as stand-alone medical advice. It aims to humanize the online patient experience and to power the deep need for the public to better inform itself about health-related matters. The technology is directed toward strengthening the bonds between physicians and patients and enhancing clinical-encounter skills. It has been developed to be sensitive to diversity and readability. The Internet mantra of content, connectivity, and commerce has been changed to add credibility as its priority, in order to be an ongoing resource for returning visitors.
On the AAOS web site, visitors may search for subjects by anatomy (such as hip, knee, or spine), activity (such as running, exercise, or ladder safety), sport (such as football, sledding, or baseball), or injury (such as ankle sprain, anterior cruciate ligament tear, or fracture). Topics such as fitness and wellness, injury prevention, surgical procedures, rehabilitation protocols, and health policy are available. More than 150 titles are currently online, and content development by a professional writing staff in collaboration with orthopaedic specialty societies is ongoing.
The AAOS web site is part of a unique partnership with the public, the Fellowship, its patients, and quality educational content. The site contains a collection of patient-education materials that have been reviewed for accuracy and timeliness. These materials, which have been formulated to create better communication between doctors and their patients, are ready to be viewed and downloaded by patients. The Fellows can direct their patients to their own web sites, created with links to the AAOS content. The AAOS web site helps to incorporate the Internet into physicians' practices to improve patient satisfaction and compliance, and it can be a source of patient self-referral. The linked web site can serve to humanize the online patient experience; to inform and educate patients; and to dynamize the interaction of physicians and their patients with fresh thinking, new approaches, and enhanced communication.
Your own web site is now available from the Academy, without charge, as a benefit of membership. Your customized web site can be personalized with your practice philosophy and focus, photograph, educational background, and affiliations. A web site can reach out to each community and can connect you and your patients to the AAOS content. To start building your site, all you need is your Academy membership number and access to the Academy site at http://www.aaos.org. You will provide your patients with access to quality orthopaedic information and resources and your practice with enhanced communication.
Stuart A. Hirsch, M.D.
Chairman, Council on Communications
American Academy of Orthopaedic Surgeons 6300 North River Road Rosemont, Illinois 60018-4262
1. Belsie, L.: Web medicine: a power shift for patients takes first cautious steps. Christian Science Monitor (electronic edition), May 18, 2000. http://www.csmonitor.com
. June 1, 2000.
2. Computer Industry Almanac: Over 150 million Internet users worldwide at year-end 1998. Computer Industry Almanac, 1999. http://www.c-i-a.com
3. Miller, L.: Online medical data burgeoning but quality is not always clear. USATODAY.com, Jan. 26, 1999. http://www.usatoday.com
/ life/cyber/tech/ctc780.htm. June 10, 2000.
4. Nicholson, L.: Research shows 42% growth in physician use of Internet in last 3 months. Healtheon Corporation, 1999. http://www.healtheon.com
5. Sherman, L.. The World Wide Web: what physicians should know when patients are surfing the Net. Wisconsin Med. J.
, 97: 31-32. 1998;
6. Taylor, H.: Explosive growth of cyberchondriacs continues. Harris Interactive, Harris Poll Library, Aug. 5, 1999. http://www.harrisinteractive.com
/harris_poll/index. June 10, 2000.
7. Zablocki, E.. A new resource: empowered patients. Qual. Lett. Healthcare Leaders
, 10: 2-10. 1998;