Online medical information - what works?

For virtually any disease or medical condition, WebMD has a dedicated community message board run by a health professional. For over seven years, I have run the Ear Disorders Board. More recently, I agreed to share the General Medicine Board. And now, I have become a WebMD Blogger.

My association with WebMD has been one of my more enjoyable and rewarding jobs. As a primary care clinician, I answer numerous medical questions every day - during office visits, in the halls, and on the phone. My medical group recently made a commitment to become paperless, so those questions stream in daily on my desk computer. When I think about, answering postings on WebMD is really no different...or is it?

Actually there is a BIG difference. In my practice, I can pull up medical records and review them. Most questions come from patients that I know and have examined many times in the past. On WebMD, the health professionals are virtually blind as far as medical history is concerned - we do not know the medical history and very little, if anything, about the person who is posting.

We do not know in what part of the world they live - WebMD is a GLOBAL site. There can be significant cultural, educational, and international differences that health experts must take into consideration... that is IF the poster tells us they are in China or Mozambique.

We often do not know the AGE of the person posting, but we do get some clues, like "Dude...I gotta question!" Teenage patients have entirely different health issues than a geriatric patient.

And we often do not even know the SEX of the person posting. We can often get a clue from the sign-in name, but not always. Needless to say, women have different parts than guys, so when someone asks about abdominal pain, we are often at a loss.

Most importantly, we have absolutely NO way of examining anyone, so when someone asks about the red bump on their butt, I have no way of seeing it. Many board members offer to send digital photographs, but if you use your imagination for a moment on the wide range of questions we receive, you can see why this is not permitted.

You call your doctor at 8:00 AM and ask them to call you back. Rarely, will they call you back at 8:15AM. You may not hear back until lunch or after the clinical day is over. On WebMD, it is nearly impossible to offer a real-time response. Health experts may be in different time zones, may not be surfing the web at 3 AM, or sitting in front of their computers waiting for a posting. Although every health expert would like to offer profound advice to every question…instantly, it is unrealistic to expect it to happen. I always have this fear that I will read, "I just cut off my ear...it is really bleeding. What should I do?"

Third-party postings are quite common. Mostly, wives are posting about their non-compliant and stubborn husbands, girlfriends are concerned about their boyfriends, moms are concerned about their kids, and kids are concerned about their parents. Co-workers in Ohio ask questions about their next door neighbor's aunt who lives in Florida. It is hard to get the story straight from the person themselves, let alone second or third or tenth-handed.

We can't make diagnoses. We can't write you a prescription. We can't order diagnostic tests or treat you. And, not all people like or accept what we health experts have to say. So why do people post, and why do health expert do this? One of the greatest rewards on WebMD are postings from grateful people -- people that you have never met, yet have touched their lives in a positive way with kind words or thoughtful insight into their medical concerns. Postings from people who are no longer frightened or confused by what their doctors said or didn't say.

This is why we do it...

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