1. Teaching Patients How to Use the Internet Dr. Kenneth J. Stanley, MD

2. Dr. Stanley’s Story Imagine me, at a home improvement store. I know I need to repair my deck. And I know I am clueless. I go through the various woodworking books, deck magazines, and store assistants over the next 4 weekends. I even go to the internet a few times. And in the end, I have a perfect deck…..

3. Dr. Stanley’s Story Because I hired a professional contractor after rearranging the topography of Texas with my trusty table saw, 15 nails, and duct tape. Fortunately, the contractor bought the table saw, ”For you and the sake of humanity” as if the two were mutually exclusive.

4. Goals of this talk Give providers a guide to help patients effectively navigate the web. Give examples of websites that are patient friendly and informative. Help patients discern what information is relevant to their case. Help us think like patients.

5. Introduction Your patients are already using the internet for information regarding their health care Most of us view this as a nuisance We need to view the internet as a potential teaching tool But we need to think like a patient to do so

6. Who is looking on the internet Patients Family members Friends Patient advocates Marketing types

7. What are patients looking for Information on symptoms and diseases Acute illnesses (from colds to cancer) Wellness and prevention Diagnosis (What does this symptom mean?) Disease management Pharmacologic therapy “Natural” Medications Allopathic medications

8. Where are they looking? Google (or Yahoo!, ask.com, etc.) MSN Health (or Yahoo! Health) Webmd Periodicals (magazines, newspapers) Books (which have websites) Independent associations and foundations Bloggers

9. Where are they looking? Pharmaceutical company websites Ads (weight loss or, um, enhancement) Patient websites Doctor websites Alternative health websites Wherever Dr. Phil said Wherever their friend said to look

10. Why are they looking? They are sick or in pain They want to improve their health A second opinion (with no co-pay) A family member of friend asked them to look Curiosity The internet is more readily available than we are.

11. Here’s how to help Think like a patient: Assume some degree of ignorance of medical facts and how to prioritize information Remember that patients are in pain (physical and emotional) or on mind altering drugs Novices tend to grasp at the first reasonable looking straw, ignoring other alternatives People are swayed by popular opinion They have more incentive to find good information

12. What to look for: from the website Is the source of information unbiased? Government sites (CDC, NIH, Medicare) Associations (American Heart Association) Is the source biased, but has a vested interest in patients having good outcomes? Drug companies Insurance companies Hospitals

13. Screening information Is the information accurate? Is the source reliable? When was the information published? Do studies back up the information? Are the studies listed with the information? Does it sound to good to be true?

14. Screening information Is the information relevant to you? Does this apply to people of your age, gender, region? Do you have this symptom or something close to it? Can you understand the information?

15. Warning signs Anything that sounds too good to be true Any product that can cure 3 or more unrelated ailments Any product that claims “no side effects” or drug interactions Secret or ancient ingredients, usually found in a remote nation

16. Warning Signs Products that rid the body of non- specific “toxins” or “germs” The words “Don’t tell your doctor”. Lots of testimonials Anything where you lose weight without diet or exercise Anything to increase sexual potency without drugs

17. Common errors Self (mis) Diagnosis Forcing symptoms to match a diagnosis Not considering other diagnostic possibilities

18. Common Errors to Avoid Self (mis) treatment Using information meant for another type of patient Believing anything natural can be taken safely regardless of health status or other foods/drugs ingested

19. Common Errors to Avoid Mistaking an advertisement for unbiased information Watch for the words “Buy Now” Lots of testimonials High pressure sales pitches

20. The final piece of the puzzle- You Listen to the patients!!! Listen to them all of the time, if you don’t, they won’t listen to you Read the information they download from the internet Do not disparage the information they present to you, they will interpret it as a personal insult Complement patients when they bring useful information

21. Thank you for attending Please fill out your evaluation forms before you leave

22. References Quackwatch.com AAFP journal www.ask.com http://healthfinder.gov www.kidshealth.org

23. Contact me Kenneth J. Stanley, MD 10223 Broadway # P 335 Pearland, TX 77584 (713) 436-8501 kjstanley@hotmail.com