Open-source websites such as Wikipedia are popular resources for patients, physicians and medical students alike. But given that almost anyone can edit those websites’ pages, their quality is hugely variable. Given this variability, physicians have an ethical obligation to help patients avoid false or misleading health information by improving the quality of the information presented. A researcher suggests how.
The AMA Code of Medical Ethics provides related guidance on research and innovation, such as opinion 7.2.1, “Principles for Disseminating Research Results,” to help physicians fulfill their ethical responsibilities with respect to sharing research findings for the ultimate benefit of patients. Opinion 1.2.12, “Ethical Practice in Telemedicine,” also outlines physicians’ fundamental responsibilities with respect to online health content.
Following are highlights from an article in the November 2018 issue of AMA Journal of Ethics® (@JournalofEthics) by Donal P. O’Mathuna, PhD, associate professor at Ohio State University College of Nursing, to help physicians actively engage with open-source websites to ensure their content is evidence based and to prevent harm to users of that information.
A wiki’s weakness is also a strength
Wikipedia itself defines a “wiki” as “a website on which users collaboratively modify content and structure directly from the web browser.”
This open, egalitarian quality, along with free availability, makes Wikipedia a tremendously popular resource—last year, one web analytics firm ranked it the fifth most popular website in the world—but studies of accuracy have found statistically significant disagreement between it and peer-reviewed sources.
Of course, the author notes, this feature also provides an opportunity to improve the website’s content, and this, in fact, creates a responsibility among users to do so.
“Clinicians—especially those using the internet for informal professional education—have an ethical obligation to use their critical appraisal skills to help patients avoid false or misleading health information,” O’Mathuna wrote.
Approach it as you would approach medical care
High-quality health care involves several core commitments—to safety, to effectiveness, to patient-centeredness and to equity, among others, the author argued.
“Each of these commitments can be linked to ethical principles,” he wrote. “For example, patient-centeredness is based on respect for persons, and safety is based on nonmaleficence. Such commitments and ethical principles apply equally to clinical practice and internet health information.”
The author noted several ways to put these principles into practice when using open-source websites.
Provide clarity. Present health information in clear and readable ways to make it easy for nonphysicians to understand.
Eliminate false claims. To help patients make informed decisions about where to spend their limited resources, provide health information from only credible sources backed by high-quality evidence and references.
Cite your sources. When relevant, identify the type of study design and provide a link to a description of it so readers can inform themselves of the evidence’s strengths and limitations.
Be open and honest. Disclose any information—including conflicts of interest—that could affect readers’ understanding or use of the content.
The November 2018 issue of AMA Journal of Ethics is a theme issue exploring false beliefs and their implications. Other articles include:
- From the editor: “The Internet, Ethics and False Beliefs In Health Care”
- Medical education: “Should Crowdsourced, Unvetted Content on Wikipedia Be Used in Health Sciences Teaching and Learning?”
- Policy forum: “Why Health Professionals Should Speak Out Against False Beliefs on the Internet”
- History of medicine: “Ads and Labels From Early 20th-Century Health Fraud Promotions”
