The effective use of the Web by physicians should fulfill a few criteria. First, the time spent should be proportional to the value obtained from the information sought. The material obtained should be able to add measurably to the care of patients, office efficiency, fund of information, or bottom line of the practice. Ideally, the time spent finding information should be an investment if the use of a site is ongoing.
One such type of reference Website is MD Consult (www.mdconsult.com), which provides reference textbooks, a MEDLINE journal search, drug information, a review of medical news of the week, clinical topic tours, practice guidelines, patient handouts, online CME programs, downloads for PDAs, and a drug information module. Some specialties, such as infectious disease, have a separate collection of materials, called editions, but currently there is not one for orthopaedic surgery. The edition relevant to orthopaedic surgeons is the Core Collection, which can be accessed easily for a 10-day free trial by submitting your name and e-mail address.
Although the offerings for primary care physicians and internists are somewhat broader, only two of the forty reference texts on this site are directly relevant to the orthopaedic surgeon: the tenth edition (2003) of Campbell's Operative Orthopaedics and the second edition (2003) of Delee and Drez's Orthopaedic Sports Medicine. It does give access to all of the text and most of the figures for viewing and printing. The MEDLINE search is similar to that found in many other sites. For fifty journals, full text is available free through this site, but only one, the American Journal of Sports Medicine, is an orthopaedic title. MD Consult has a catalogue of 3,500 rather straightforward patient information brochures that can be downloaded and customized. Twenty-five relate to musculoskeletal conditions; a few have diagrammatic illustrations, and several are also available in Spanish. There are two hundred grand rounds topics available online for CME credit in fifteen specialties; however, none is related to orthopaedic surgery. Similarly, there are approximately a thousand clinical practice guidelines but, again, none relating to orthopaedics.
What are the practical applications for the orthopaedic surgeon? There is immediate access from any computer with Internet access to MEDLINE for a quick topic search or to the text of Campbell's Operative Orthopaedics to rapidly review surgical techniques. With problems such as antithrombolic prophylaxis or septic arthritis, immediate access to texts such as Conn's Current Therapy or Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases allows a broader perspective than that in texts more commonly available to us. Information about various drugs, the spectrum of antimicrobial agents, and recommendations for appropriate antibiotic coverage are all rapidly accessible through this site.
Following are a few practical hints to maximize your use of MD Consult (or a site such as this). While viewing the reference text you have searched for, copy the material on the screen and paste it into a document in a standard program such as Microsoft Word (MS Word). Call the file Personal Medical Textbook (as an example). By cutting and pasting selected sections of the material, you can choose the groups of text you want so that the pasted matter represents your own “review” and personal interests. After you have it in the file, type a heading at the top of that section, for example, Biceps Ruptures. Highlight Biceps Ruptures. Then, in the Styles section of Word, assign that phrase the style Heading 1. When you do this with all of your downloads from the Web, you can, with only a few keystrokes, have Word make a hyperlinked personal Table of Contents for rapid access at a later date. Over time, you will have your own ongoing review text from multiple reference sources as well as the published literature.
You can view your Personal Medical Textbook on your PDA (Pocket PC or Palm). Any MS Word file can be converted into a format called Microsoft Reader. Microsoft Reader conversion programs, and the Microsoft Reader program for your PDA, are distributed free by Microsoft. When you load the conversion program onto your computer, there will be a single Microsoft Reader icon on your MS Word toolbar that will convert the file to PDA format so that you can transfer your Personal Medical Textbook to your PDA.
Microsoft Reader can be found at www.microsoft.com/reader/downloads/default.asp. The program to allow you to convert any MS Word file to PDA Microsoft Reader format can be found at www.microsoft.com/reader/downloads/rmr.asp. Detailed step-by-step instructions and models on all steps reviewed can be found at www.officemedical.com.
The cost of MD Consult for residents is $119.95 a year or $14.95 a month. For attendings, it is $219.00 a year or $24.95 a month. Considering the cost of just one of the textbooks available, this is quite a bargain and a tremendous educational and reference resource.
Ira H. Kirschenbaum MD