TECHNOLOGYSurfing instructors: Teaching how to hang ten over medicine on the Internet.One doctor has set up a college course to teach consumers about how to evaluate medical Web sites.By Tyler Chin, amednews staff. Oct. 8, 2001. Whenever Kathryn Ball accesses medical information on the Internet, she critically assesses whether the information is reliable by going through a mental checklist she learned from a community college class taught by Darol Joseff, MD. "One of the things Darol talked about was how to evaluate the information once you get it," Ball said. "He said to look at the source of the information, who wrote the article, who paid for it to be written, and that was really helpful in terms of evaluating it. The class also helps when I go see my doctor because it helps me clear up what is real and what isn't real so when I go in and talk to him, I can be more specific and not waste his time and mine." The class Dr. Joseff, the Santa Barbara, Calif., nephrologist teaches is one of the few college courses in the country, perhaps the only one, that instructs consumers on how to find health information online and judge its reliability. Hospitals and patient advocacy groups occasionally hold workshops teaching patients how to find disease-specific information, but not how to evaluate it. Few, if any of those workshops, are taught by a physician, as is the case with the adult education course offered by Santa Barbara City College. Dr. Joseff teaches that course, called "Finding Health Information Via the Internet," with medical librarian Lucy Thomas and patient advocate Nancy Oster. The involvement of a physician gives the class more credibility and makes it more valuable to students, Oster said. She and her co-instructors knew each other before deciding to teach the course in 1997 at the request of Santa Barbara City College. The year before, the college had sponsored a Women and Wellness Day workshop addressing various topics, including a session led by Thomas and Oster on how to find medical information online. Impressed with the turnout for the session, the college asked Thomas and Oster to teach a course on that subject. They asked Dr. Joseff to join them as an instructor because they knew that he avidly used the Internet to search for medical information, Oster said. Dr. Joseff agreed to teach the course. Later, the three cooperated to write Making Informed Decisions: Where to Look and How to use What you Find, a book that was published in July 2000. "Our class is not designed to replace the doctor," Dr. Joseff said. "It's to help patients do better with the doctor [by offering them] basic recommendations on how they can interact with their physician more effectively. "We tell people, 'You don't necessarily want to believe everything you hear from experts, and that includes us.' "We tell them upfront that this is not an exhaustive class. This is a starting point, and we will give you some tools to go on without us," Thomas added. The three-hour course is held on a Saturday morning every three months. Spreading the wordSome in the Santa Barbara medical community said they would suggest the course as a resource for patients because they know Dr. Joseff personally or by reputation. They also think the course could be helpful to physicians and patients. One of them, Jeffrey F. Hankoff, MD, medical director of the Santa Barbara Select IPA, recommended the course to his patients before he stopped practicing two years ago. The course could help physicians improve their interaction with patients, he said. Still, he doesn't believe the course has had a big impact or that it would have a big impact anytime soon because few of the approximately 150,000 people in the Santa Barbara area have taken it. "You have to get a lot of people to go to the course, but I think it's a valuable thing, because it addresses an issue that nobody has effectively addressed yet, which is the [large amount of] medical misinformation that is on the Internet," Dr. Hankoff said. "People literally come in with stacks of stuff." The Santa Barbara County Medical Society is aware of the course, but doesn't recommend or endorse it because it is not familiar with its content, said Sondra K. Jacoby, the society's executive director. Then and nowThe course initially was designed to teach consumers about the Internet -- what a good research tool it was and how to use it to find information, said Thomas, director of the Reeves Medical Library at Cottage Hospital in Santa Barbara. But as people became familiar with the Internet and Web browsers, the focus shifted to evaluating medical information. Although Internet usage is pervasive today, the course's instructors believe the need for their course is greater now than it was before. "Snake oil has been around for a long time, and now there's ways to be more sophisticated about it," Dr. Joseff said. Also, the course remains relevant because consumers will continue to seek information online. Medicine has become more complex and "it's important for all of us to have the best information," he said. That includes physicians, he added. The course has a basic but loose structure. Thomas starts by introducing the instructors, giving a short overview of the Web and asking students specifically what health information they want to research. Oster then walks the class through some basic Internet searches that incorporate students' stated interests, giving them a realistic experience of what searching for information online is like. The instructors often find information fairly easily, but sometimes they struggle to find it or don't find it at all. Next, Dr. Joseff shows slides and tells students how to assess the information they find. After that, the instructors let students search for information on their own or have them follow a scripted scavenger hunt on the Internet. Students range in age from young adults to seniors. Most of them learned about it through the college's adult education class catalogue. Others learned about it from flyers posted at Cottage Hospital, patient advocacy groups and Dr. Joseff's offices. Until now, the class has been free. But starting with this month's class, students will pay the college $8 for course materials, which is primarily the use of its computer lab. Dr. Joseff's patients are aware he teaches the course, but few have taken it, he said. Teaching for funDr. Joseff and the other instructors teach the course because it's fun and because they want to help consumers. They certainly aren't doing it for the money. They get paid $30 each for the course and haven't seen any royalties yet from their book, for which they received a $5,000 advance from the publisher. Dr. Joseff also hasn't taken advantage of the class to troll for new patients. Several students have asked him to become their physician, but he hasn't taken them on because most of what he does is referral-based nephrology consultations, he said. "I usually try to understand from them if there is a problem they are having with their physician and possibly how to support or improve their relationship with their physician," Dr. Joseff said. If other physicians are interested in developing a similar course, they shouldn't have any trouble because they already have the necessary skills, he believes. "Your average physician is very, very good at sniffing out what makes sense or not, whether they articulate it in such a way or not," he said. "All of the training of a doctor is to determine what is right or wrong in that interface between art and the science of medicine. And the very best doctors will almost have an innate sense of that." As far as how to approach a college about its interest in offering such a class, the only advice Dr. Joseff had for physicians was to ask. "If colleges think a lot of people will be happy to take it, then they will be happy to offer it." ADDITIONAL INFORMATION:Let's go surfing nowIn connection with the adult education class, "Finding Health Information Via the Internet," at Santa Barbara City College, instructors Darol Joseff, MD, medical librarian Lucy Thomas, and patient advocate Nancy Oster created a Web site (http://www.silcom.com/~noster/wcindex.html) listing many health information sites available to consumers. The listings, updated every three months, are organized under several categories. The next update is scheduled for this month, in time for their next scheduled class. Drkoop.com Inc. (http://www.drkoop.com/)
Everybody's learning howDarol Joseff, MD, tells consumers to look for a number of signs and ask themselves several questions when evaluating health information they pull off the Internet. Those include:
Come on and safari with meThinking of developing and teaching your own course to consumers or patients? While a passion for or a strong interest in using the Internet is a prerequisite, here are some other tips:
Source: Darol Joseff, MD; Lucy Thomas; and Nancy Oster Copyright 2001 American Medical Association. All rights reserved.
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