Search Engines: Second site - Doctor knows best - usually

THE DOCTOR-patient relationship is as uneasy as the wedding reception for a mixed marriage. Marching into the consulting room with a sheaf of printouts from medical websites, as patients increasingly do, makes doctors despair. "I groan inwardly and occasionally outwardly," says Laurence Buckman, a north London GP.

Doctors are unusual among professionals in being treated this way. As Dr Buckman points out, very few people use the Internet to influence the consultation with their lawyers or accountants. In general, what makes doctors different is that most people in this country pay their GPs through their taxes, whereas they normally pay premium fees to other professionals, and assume that the price tag is buying them quality.

The trouble, according to Dr Buckman, is that patients go to the wrong sites and pick up "anecdote, rumour and scaremongering" rather than reliable medical information. "People are either selling something or talking about their own suffering," he says. His concern about commercial influence is shared by Grant Kelly, a GP based in Chichester who represents the British Medical Association on information issues. Dr Kelly suggests that drug companies could infiltrate newsgroups to promote their products, rather as activists from political parties can pose as ordinary members of the public to get letters printed in the local paper.

The problem of website reliability has been discussed in the British Medical Journal, which, like the Lancet, is available on the Web. Some authors have suggested that medical authorities should institute the Internet equivalent of the British kitemark, to denote reliable sites. In assigning quality badges, the differences between countries in medical practice and drug availability would have to be taken into account. The latter was one of the issues that cropped up in a survey of sites offering advice about how to manage fever in children at home. None of the 41 sites was seriously misleading, but on the other hand, only four followed textbook guidelines closely.

It may be that the Web is inherently better suited to providing information on relatively uncommon illnesses. The world's leading medical database, MedLine, can be searched for journal abstracts free of charge. However, while patients keying in the name of a rare disease may receive a manageable selection of abstracts, searches related to common conditions may prove as useless as typing the word "computer" into a search engine. (The PubMed service does, however, offer a selection of pre-prepared MedLine searches for frequently requested topics.)

Specific treatments also give the Net a chance to perform at its best. When a member of my family was prescribed the anti-cancer drug tamoxifen, I was able to find a very useful and encouraging fact sheet about it within a few minutes. For routine inquiries, though, the Web may not be of any use. A few weeks ago, my wife and I took our three-year-old son to the doctor's with a temperature of nearly 40C/104F. The last time it reached that point, he had spent the night in hospital on a drip, so we were uneasy when the GP explained that although antibiotics could deal with the infection, the policy was to avoid prescribing them if possible. We pressed for a referral to hospital, where an antibiotic was given. Had we been overly pushy? What are the pros and cons of antibiotic prescription? This is a basic and important medical issue, but it doesn't readily reduce to practical keywords for Web searches. After about an hour and a half on- line I ended up none the wiser. But even if I had struck lucky, I'd never dream of sharing the results with the doctor. A little knowledge is sometimes best kept to oneself.

Visit www.poptel.org.uk/secondsite for links to pages mentioned or contact Marek Kohn on secondsite@poptel.net