1. Don't get buried
You can find what you need--if you stay focused
Setting limits. At the very least, make search terms restrictive. Suppose you want to find out whether losing weight can help lower your high blood pressure. A Google search on "hypertension" spits out more than 3 million results. Adding "weight" and restricting the search to the previous year cuts them down by about three quarters. And tacking on "benefits" shrinks that number significantly. It's still in six digits, but the search is so much better targeted that several high-quality resources appear near the top.
A better option is to go directly to particular websites. Those intended for consumers can be useful--the good ones, such as the National Institutes of Health's cancer.gov and MedlinePlus (medlineplus.gov) and for-profit WebMD ( mywebmd.com ), offer the basics for most conditions. But you need to cast a skeptical eye on any consumer site. If a site has an "about us" tab or link, click on it to see who the sponsors are, and ask yourself whether they might have an agenda other than full and accurate information. Many consumer sites are less than current--check for recent studies from major medical journals. And many don't list their sources of information, which creates uncertainty.
"The greatest sin of consumer sites," says Donald Vickery, "is that they take the attitude, 'I'm just an old-fashioned doctor, and I'm not going to allow you to know what the risks are.' " Maryann Napoli, associate director of the Center for Medical Consumers, a New York-based advocacy group, believes that consumer sites are watered down. "They sin by omission," she says.
Consider "watchful waiting." This is an option, involving close monitoring rather than treatment, that is advocated by urologists for some older men whose prostate cancer is localized and slow-growing. The option doesn't exist at NetWellness ( netwellness.org ), a consumer site sponsored by three Ohio universities. MedlinePlus has a thoughtful discussion of watchful waiting, but it's not easy to find.
Napoli and Vickery advise going to professional sites instead. At eMedicine.com, a website written by and aimed at physicians, a search brings up a thorough, lucid discussion of watchful waiting that includes a summary of studies of men who chose that option.
Slogging through the technical language in professional sites can be rough, Napoli readily concedes, but "you can get the gist" --enough to ask a doctor knowledgeable questions. You can always refer to an online medical dictionary like the one at www.medicinenet.com . Vickery's secret: Don't look for individual studies; "look for review articles and summaries." One of the best compilations of reviews and summaries can be found at the Cochrane Collaboration (www.cochrane.org), a cooperative of medical experts. Full reports are available only to subscribers, but anyone can access the abstracts, which include the reviewers' conclusions and source material. OHRI has begun to convert Cochrane reports into "decision aids" --condition-specific versions of its generic decision guide. They're on OHRI's website.
Once you've figured out which questions to ask a doctor, of course you need to find a good doctor to ask. To track down first-rate medical centers and doctors for serious illnesses, the annual U.S. News "America's Best Hospitals" rankings are a start ( www.usnews.com ).
Try to find volume data. Up to a point, the more often hospitals and doctors perform a given procedure, the lower the risk to the patient--and many providers, unfortunately, don't do enough. In New York State during 2002, almost 20 percent of hospitals that inserted heart stents did six or fewer of them, and more than 40 percent of physicians who inserted a stent did it one time. "Hospitals are not doing a very good job with their credentialing process," says Arthur Levin, director of the Center for Medical Consumers. A few other states, such as California, Maryland, and Pennsylvania, make similar data available on the Web. Otherwise, you'll have to ask. And if a hospital or doctor won't tell you? Say thanks, and look elsewhere.
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