To state that the Internet has changed the practice of medicine is to make a gross understatement. Expectedly, the sites that doctors and patients will surf are likely to be different. Thus, when Lounge asked me for a list of websites that lay people could use to access reliable health and medicine information, I pointed out that I never looked up the Web as a layman! What I did do, however, was look up sites for information that I needed in my practice.
Ready reckoner: Online services such as Isabel help doctors pinpoint correct diagnoses with exhaustive cross-referenced databases of symptoms.
Top of the list, of course, has to be the bibliographic database, Medline or Pubmed. The British Medical Journal (BMJ) wrote some years ago that America’s greatest contributions to man were jazz and Medline. Medline contains article titles or pertinent information on relevant medical literature since the 1950s: There are 18 million such citations. These are from 5,200 medical journals that reach a certain standard, as judged by the US National Library of Medicine. Pubmed is the motherlode: Pubmedcentral and other sites are useful sub-sites (incidentally, Medline is free to the world, courtesy the Bill Clinton administration. The now defunct hardcopy version of Medline, Index medicus, has a somewhat older history—it first appeared in 1879!).
This is one of the most popularly used websites by doctors and consists of reliable review articles on most diseases rather than cutting-edge research and is, hence, of immense practical use. Experts write the chapters and I find it an excellent quick 5-minute consult when I need information promptly on a subject.
Yes, I know that this looks like… I am desperately trying to curry favour with the editor of Lounge…but the fact is, I am also a medical journal editor and freelancer and need to get unusual, important and sometimes quirky information. This website and, of course, the newspaper, which I read daily, have reported that pharma companies in India have not documented any side effects of drugs in the past three years, that lifestyle products are available for diabetes and that a vaccine against malaria is about to be tried in a clinical trial—all news that I have not read elsewhere.
The truth can now be told! I, and many physicians, routinely use Google for baffling cases. If you have a patient with symptoms you cannot explain (or morphological features in a biopsy slide, in my case: I am a pathologist and peer at tissues under a microscope to make diagnoses), Google can sometimes save lives. Google also often throws up a Wikipedia link that provides further information.
First, a conflict of interest statement. This has been developed by a friend and I am a non-remunerated editorial adviser to it. Isabel is a diagnosis decision support system. It is of practical use only to physicians and its use is restricted by the fact that it is a paid service. A subscriber only has to enter the symptoms, signs and other data into its search engine to get a list of possible diagnoses. This helps reduce error and acts as a safety net for the doctor and the patient. The difference between Isabel and Google is that the latter also throws up noise while the former only picks up possible diagnoses—and is linked to e-textbooks which provide further knowledge. Incidentally, whether you are a layman or a guru, it’s worth reading how and why Isabel was created and named so!
Dr Sanjay A. Pai is consultant pathologist and head, pathology and laboratory medicine at Columbia Asia Referral Hospital in Malleswaram, Bangalore. He is an editor with the Indian Journal of Medical Ethics (www.ijme.in) and The National Medical Journal of India (www.nmji.in).
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