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The Internet and the Infectious Diseases Physician

  1. John C. Y. Shon1 and
  2. Victor L. Yu2
  1. 1Stanford Medical Informatics, Stanford University School of Medicine, California
  2. 2Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania
  1. Reprints or correspondence: Dr. Victor L. Yu, Infectious Disease Section, Veterans Affairs Medical Center, University Dr. C, Pittsburgh, PA 15240 (vly+{at}pitt.edu).

In the 21st century, no other technology has affected the consciousness of our society in such a rapid and dramatic fashion as the Internet. The first contact for many physicians has been the appearance of a patient asking a sophisticated medical question, armed with stacks of laser-printed pages retrieved from an Internet search. Although some information is state-of-the-art, much of it is anecdotal, biased, and unreliable. Medically oriented websites created by physicians are now entering the fray, and many provide state-of-the-art information with a multitude of images and hard scientific data. As numerous physicians learn to surf the web and acquire the ability to access it from home and office at all hours, the Internet has the potential to radically improve the retrieval of relevant and in-depth information necessary for clinical decision-making.

Since infectious diseases (ID) is a cognitive-directed rather than procedural-directed medical specialty, the Internet will have a particularly notable impact for ID physicians. However, several caveats are important. Difficulties and delays in obtaining relevant information are typical. Some of the difficulties will improve with evolving technology, increased bandwidth, and faster microprocessors. Search mechanisms are improving but have been outstripped by the sheer number of websites added to the Web on a daily basis. However, the biggest problem for the physician, which will not improve with technology, is quality.

Formal studies have documented that there are many problems with the quality of information on the Internet [1–3]. There are >15,000 medically oriented sites, and the greatest challenge facing clinicians now is to identify those sites that contain high-quality, clinically useful information. Unlike the print world, the quality of most sites on the Internet has not been established by reputation, because the medium is so new. In addition, the on-line versions of some medical journals may not necessarily have the same content or editorial process as their off-line counterparts. Finally, most clinicians do not have the time to investigate individual sites and would benefit from a reliable evaluation from a journal such as this.

In general, criteria that have been used to judge websites can be separated into 2 broad categories: those that address the usability of a site and those that address the quality of information on a site. Quality is the sine qua non of useful medical information, and criteria that address quality should be foremost in any rating system. The criteria suggested by Silberg et al. [4] were adopted by Shafer and Deresinski in their article on HIV websites that follows [5]. The criteria were authorship, attribution, disclosure, and currency. These basic publishing criteria exist in the print world, are fairly objective, and are easy to judge. They have also been incorporated in other rating systems, such as those of the Health Information Technology Institute [6] and the Health on the Net Foundation code of conduct [7]. These publishing standards may appear to be minimal, but 2 studies have shown that even these simple criteria are not fulfilled by the majority of medical web pages [8, 9].

Therefore, a guide for evaluating and highlighting websites would assist ID physicians, given the massive number of websites available (e.g., one search engine responding to the keywords “HIV” and “AIDS” found >96,000 websites). With the introduction of this new section, “Surfing the Web,” it is our objective to bring the newest information to the readers of Clinical Infectious Diseases. This section will feature ID topics dealing with specific websites, approaches to computerized diagnosis, advances in electronic automation of microbiology laboratories and pharmacies, epidemiological surveillance of emerging diseases, and a host of electronic innovations that will affect the ID clinician and researcher.

The authors of these invited articles have expertise on the ID topics being discussed and are also familiar with the Internet. Nevertheless, the readers must keep in mind that the opinions of these authors are neither infallible nor definitive, especially given the evolving nature of the Internet. However, we believe their perspective will prove valuable to the readership of this journal—after all, we have to start somewhere.

  • Received April 7, 2000.

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  1. Clin Infect Dis. (2000) 31 (2): 566-567. doi: 10.1086/313957
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