Use of the Internet has grown at a remarkable rate over the past few years for business transactions, entertainment, research, and general communication. One of the most common reasons people access and search the Internet is for medical information.

There are many aspects of the Internet and electronic communication with which all patients must be familiar. When properly used, the Internet can provide significant education for patients and, perhaps more in the future, will provide improved communication between patient and physician, physician-to-physician interaction, and other professional resources for physicians. Searching for medical information on the Internet, however, can be like searching for a needle in a haystack.

Perhaps the most important thing patients need to know when surfing the Internet for information is that there is no governing force or entity ensuring the quality or validity of any site. If one types in the words "spine" or "back pain" or "neck pain" into any search engine (e.g. AOL, Yahoo, MSN, Askewest, About.com), a wide variety of sites will be listed. Some may be advertisements for a particular product, group practice, hospital, pharmaceutical company, physical therapy center, or personal website of an individual.

The Internet surfer must develop a critical eye when viewing any site purporting to offer medical information. The following tips may be helpful.

Locating Legitimate Information
If you are searching for legitimate, valid information, take a look at the site's banner and check for a mission statement. A mission statement should briefly describe the goal of the site. If a single corporation or practice sponsors the site, it should be readily apparent. One should realize the potential for bias in any material presented.

Also, look to see if physicians are involved in providing the content of the site. Most sites that boast a "faculty" or "editorial board" of physicians will provide their names and backgrounds that can be checked. In the field of spine surgery, one would want to see names of board-certified neurosurgeons, orthopedic surgeons, physiatrists (rehabilitation medicine), physical therapists, anesthesiologists, registered nurses and nurse practitioners, psychologists and psychiatrists, and neurologists.

Look over the mission statement or informational pages to see if the content of the site is peer-reviewed. Peer-reviewed means that recognized practitioners or experts in the field have reviewed and judged the material to be valid and legitimate, and suitable for posting on the site. In order for information to be judged valid, it must have met certain scientific requirements and be recognized in the scientific literature (e.g. journals, textbooks, oral presentations at conferences).

SpineUniverse.com is one of the leading, award- winning educational spine sites with a diverse and talented editorial board. The site is rich in content including papers, videos, graphic artwork, and depictions of anatomy. There is an Ask The Experts function that allows patients to send their questions about spinal disorders to doctors, nurses, and other medical professionals.

Other reputable sites include SRS.com, AAOS.org, WebMD.com, iscoliosis.com, Neurosurgery.org, NASS.com, Spine.org, Medem.com, Spine-Health.com, and others. Currently, the most trust-worthy source of advice would come from your treating physician. Internet-savvy physicians should be able to point a patient in the right direction to find legitimate and useful spine-related sites.

Free Literature Search Engines
Patients can also make use of free literature search engines. Though some sites require payment of a registration fee, many are free to the public. These sites allow you to type in a "keyword" such as "disc herniation," "back pain," "lumbar spondylolisthesis," and search the professional peer-reviewed journals for pertinent scientific publications.

One should keep in mind, however, that these publications are for professionals and the text will be difficult to interpret by the layperson (patient). One may have to ask their physician for interpretation of articles that are found. Articles may be available in abbreviated (abstract) form, or they may be available in full length. Popular free sites include Medline (on Medscape.com), PubMed, National Institute of Health (NIH.gov), GratefulMed, and others.

Near Future: Patient-Physician Interaction
Soon the Internet will become useful for many of the patient-physician interactions that normally would take place in person, over the phone, via written mail, or via facsimile (FAX). It is likely that most referrals and requests for appointments will be made via electronic mail. Patients will request and receive an appointment date and time via email.

Instead of receiving preliminary informational material via snail mail or at the initial office visit, patients will likely receive all information about the office location, telephone and fax numbers, and email addresses, the physician's professional background, and services offered all via email.

Patients will be able to send in information about their past medical and surgical history ahead of time and have it already reviewed and available at the time of their visit. Referring physicians will be able to send pertinent information and test results electronically, allowing for instant communication rather than relying upon the limitations of FAX and paper mail. Electronic communication will likely expedite the communication of test results and treatment options to patients. Everyone has experienced waiting for a physician's office to call back with blood test or x-ray study results. Phone calls are often missed during everyone's busy daily schedule. Electronic communication offers both the physician and patient the capability to send questions and information when convenient.

Many physicians have been hesitant to use electronic communication because they fear that an unanswered message or inappropriate use of electronic communication (e.g. for an urgent matter) will result in litigation. Recent studies have shown, however, that both physicians and patients have been very satisfied with initial trials of electronic communication.

Security and Confidentiality
One of the main concerns about using the Internet and electronic communication (email) involves security and confidentiality. Computer hackers will always be able to break software security defenses, and considerable time and effort is being spent to develop more secure transmission of patient medical information. It is likely that patients and physicians will be confident and comfortable exchanging patient-specific data electronically in the future.

Professional Development
The Internet is becoming increasingly useful to physicians for professional information and development.

All scientific spine organizations (e.g. North American Spine Society, American Association Neurosurgeons/ Congress of Neurological Surgeons Joint Section on Disorders of the Spine, Scoliosis Research Society, American Association of Orthopedic Surgery, Congress of Neurological Surgeons, American Association of Neurological Surgeons, GICD) now have websites that allow spine specialists to identify upcoming meetings and continuing medical education opportunities, new scientific reports and discoveries, new Food and Drug Administration (FDA) rulings, changes in reimbursement and coding issues, and other socioeconomic and legal news.

Furthermore, almost all scientific journals are now available on-line to professional subscribers (and some to the general public). Some journals are now only Internet-based (no paper journal is ever printed).

Practice Management
Physicians now can benefit from various sites that offer information and advice about practice management. Rather than hire an expensive business consultant, many private or academic spine groups can obtain useful information about office management including medical record retrieval, office visit protocol, human resource management, billing, and collections. This will translate into a more efficient, productive visit for the patient when they seek the advice of a spine specialist.

Patient Education
Many physicians have used the Internet extensively to educate their patients after the initial examination. When a patient is told their diagnosis and treatment options, they can now be referred to several sites that allow them to read and educate themselves about their diagnosis and what to expect. This easily accessible source of information will better prepare the patient to ask further questions and to be in more control of their health. A better-informed patient is more confident and more capable in making decisions with their consulting physician.

Summary
In summary, the Internet and electronic communication provide a powerful and convenient source of information for patients and physicians. Patients surfing the Internet for information must be discerning and should seek advice from their physician. The most valid information comes from websites that are run by physicians, edited by physicians, and where the content is judged, critiqued, and published by physicians. Biased or incorrect information can be dangerous and invaluable to patients and physicians alike. Patients will need to learn to discern between science and advertisement, between fact and fiction.

Many fringe or quack treatments are advertised on the Internet. If they are not supported by published scientific information, then they are likely not yet part of standard practice. Recognized professional organizations and journals, and peer-reviewed and edited spine sites offer the most reliable and valid information. Most physicians are more than happy to offer their advice regarding information that their patients find on the Internet.

The best-educated patient is the patient most confident and able to manage their spinal condition.

This article is an excerpt from the book Save Your Aching Back and Neck: A Patient’s Guide, edited by Dr. Stewart Eidelson.