An Introduction to Cyberspace for Medical Professionals BY Sheldon Chang, MSPT Physical Therapist

Aside from the clinical benefits health care providers can receive on-line, they can also use the Internet to help them organize their professional interests better. Reimbursable and clinically useful implementations of telemedical applications may eventually grow in number and perhaps even reach a point of prominence in tomorrow's healthcare model. Perhaps, computers will go too far and become another cost cutting scheme that may potentially alienate providers and patients alike. Healthcare professions that choose to remain uninvolved in the march of Internet applications for patient care may find themselves supplanted in their appropriate areas of telemedical healthcare delivery by other groups that weren't as hesitant to embrace and direct change.

If for no other reason, healthcare needs to be aware and knowledgeable about medical uses for the Internet to ensure that telemedicine and telehealth applications become useful, remain useful, and does not become the much complained about monster that HMOs have become for many professions. The coming years will deliver great changes. At the very least, health professions need to become involved at least enough to create changes favorable to their respective interests in patient care and research.

On-line discussions through mailing lists or other group communication forums in the past have sometimes been shown to facilitate action through a grassroots type of mechanism. In 1994 (before the Internet was phenomena it is today), 47,000 marks of disapproval over the key escrow "Clipper chip" was delivered to the White House in the largest electronic petition in history. [44] In the United States, legislation can sometimes pass quietly before the affected groups can organize a response. Communications through the Internet provides another safeguard to catch important news that slips through the cracks of conventional media. Sometimes concerns raised over group forums are legitimate. Other times they're the first turn of the rumor mill.

Rumors are just another form of misinformation, the red alert cry of healthcare professionals over the Internet. Without doubt, increasing group interactions through a wide geographical area through the Internet may increasingly turn out some curious and incorrect rumors, but also provide the opportunity for the truth to be imposed before a myth is exploded into a legend. Legal issues are often a source of false alarms. When false alarms have been sounded on mailing lists over impending US legislation in the past, a visit to the "Thomas" Law Server of the US Government was enough to retrieve the actual contents of controversy. In a large interactive environment, misinformation has the fortunate tendency to invite its own dissolution.

Internet accounts have been compared to fax machines in that one person's account is only as useful as the number of people he has access to through that account. As more and more people got Internet accounts, the more useful one was. Likewise, many medical professionals may not feel the need to jump on the on-line bandwagon because many of their colleagues haven't yet, but the number of wired health care professions will greatly increase if for no other reason than because many health and medical degree programs have integrated usage of on-line resources as part of their program. Medical schools have put great resources and energy into integrating classroom and clinical material into teaching modules, interactive textbooks, on-line self exams, and other educational reference material. Soon, classes of Internet-literate medical professionals who have become accustomed to having the Net as a companion to their scholastic and clinical knowledge will be beginning practice.

A recent survey of Internet health information usage performed by the Find/SVP Emerging Technologies Research Group found that 36.7% of the general Internet user population fall into a group that shares the characteristic of being active and heavy consumers of health and medical information on-line. [13] Other characteristics that were dominant in the mentioned group were higher than average levels of computer literacy and assume more proactive roles in comparing conflicting information. In all, 80% of the surveyed users expressed some interest in accessing health and medical information on-line. [14]

It can be argued that laying out widespread medical information on-line will only further distance the healthcare community from their patients, but more than ever, healthcare providers are busy people who only have time to treat the diagnosis at hand rather than the whole patient. In an ideal world, healthcare clients would all enjoy a high quality of care, have all questions answered to satisfaction, and would have no desire to go on-line and play doctor. Needless to say, the world of healthcare is far from ideal. In a world where patients often leave medical clinics and hospitals feeling under-informed and confused, all risks considered, denying the importance and benefit of access to self-discovered medical information would not only be excessively conservative, but also negligent toward the well being of our patients.

Many patients, frustrated with the modern healthcare model turned on-line to take a more active role in their own healthcare and are becoming better informed consumers. In an on-line discussion hosted by the British Medical Journal about the merits of the electronic journal, a patient of a double bypass surgery interjected into the discussion that following his surgery, the only place where he was able to get the information he needed about his condition was on-line. [6] Though the media likes to highlight healthcare disasters via the Internet, the truth is probably that more often than not, patients benefit from having access to medical information on-line.

Promotions for scams and unsound treatments do exist on-line [30] and do pose a threat to a less critical public, but their existence is hardly limited to the Internet. At least on the Internet, there can be generous access to different views [42] about a therapeutic procedure regardless of its validity. Search engines often used to find esoteric information on-line don't bother to limit returned listings to only a pro side or a con side.

Still, this is not to say that the medical community should be passive about its beliefs about good medicine. One example of a conservative medical community attempting to debunk questionable therapies is the website "Quackwatch," which has regular updates to address what they see as popular fads and outright scams. Having a reliable watchdog for questionable information is definitely a good idea, but the reality is that there is far too much information and pseudo-information available on the Internet for anyone or any group to remain aware of. If clinicians knew of even a few good information resources on the Internet to start their patients off in the right direction, those under their care will be that much better off.

Clinicians who have been out of school long enough may be practicing out of their respective professions clinical standard practices. In addition to finding about clinical standards for their own respective fields, numerous practice guidelines are available on-line in specialty or adjunct treatment areas. One excellent resource for clinical practice guidelines is the Agency for Health Care Policy and Research's database which contains multi-disciplinary expert consensus statements in 19 and growing healthcare topic areas ranging from management of acute pain to smoking cessation, cardiac rehabilitation, low back pain, and sickle cell disease

Last, but not least of the reasons clinicians should learn to use the Internet, is to stay abreast of rapid developments. Resourceful patients can often get access to updated medical information through the Internet the same way their health care providers could and become more informed than the provider about new developments. Widespread print distribution of important information takes time [26] and the delay may promote hysteria through the rumor mill. A number of Internet information services such as the already mentioned Intellihealth and Reuters Health Information Services are available to help the medical world keep up with healthcare news as it happens. For some types of information, the Internet may become the only reliable source since much of our medical knowledge is sensitive to change from the results of new research and developments in very active sectors of research may outpace the ability of print media to follow. [61] Citing the need to provide the latest research on a timely and widespread basis, Virginia Tech University established a policy that requires all future graduate student theses and dissertations to be published on the Web. At least eleven other US universities have made similar moves. [61]