Tips for making the most of electronic curbside consultsFrom the January 1998 ACP Observer, copyright © 1998 by the American College of Physicians.
By Chris Dwyer
While experts in medical computing debate which technologyor combination of forceswill ultimately lure more physicians to computerize, many practitioners have already discovered a use they say is changing the way they practice: the electronic curbside consult.
In addition to consulting colleagues in person or on the phone, a number of physicians are going to Internet-based discussion groups for advice from their colleagues. They say that going online can be easier than tracking someone down in person or on the phone, and that going online can also help locate the best source of information for a particular case.
"A patient I had about two years ago had an unusual severe pain syndrome complicated by several chronic medical conditions," recalled Patricia L. Hale, ACP Member, a general internist in private practice in upstate New York. "I had numerous specialists in my hospital see the patient without successful treatment."
Then Dr. Hale posted an inquiry about the case to the members-only area of ACP Online, the College's Web site. An internist who responded suggested a new approach, citing several journal references, which Dr. Hale reviewed with the local neurologist and other specialists on the case. "We agreed to implement the recommendations," Dr. Hale said, "and the patient had a dramatic recovery."
Although Dr. Hale's experience may not yet be commonplace, the growing number of discussion groups specifically for physicians is making electronic curbside consults more popular. Here are some guidelines to make the most of these online clinical discussion resources:
- Limit yourself to one or two high-quality groups. Several internists
who conduct regular clinical discussions online recommend ACP
Online's Clinical Practice newsgroup (http://www.acponline.org/auth-cgi/readnews.pl?g=clinic)
and a newsgroup run by Physicians' Online (http://www.pol.net). In each
case, users must have specific training and credentials to participate.
In the case of ACP, only board-certified doctors of internal medicine
may participate, while Physicians' Online allows physicians licensed
to practice in the United States in its discussion groups.
- Read the forum for a week before posting a question. According
to Jerome A. Osheroff, "It's important to keep an eye on
a forum and see what kinds of people are posting." He added
that "an online resource is as good or bad as the people
participating in it." By getting familiar with the discussion
styles, interests and concerns of those posting to a group, you
will be able to ask more effective questions and receive more
- Ask questions appropriate to the resource. ACP member Roger
D. Spitzer, MD, an infectious disease specialist, prefers to use
online discussion groups to ask and answer questions about recurring
clinical problems and the management of long-term conditions in
specific patients. "I usually restrict my questions to management
issues that are not answered in the medical literature or that
are controversial," he said.
Dr. Hale finds ACP Online useful for questions about less common illnesses or matters on which her local consultants have "run out of ideas." And several physicians report finding Internet-based forums useful settings in which to pose an ethical quandary to a group of peers.
Like other internists who discuss clinical questions online, Dr. Spitzer prefers an in-person or telephone consultation when discussing an acute clinical event or complicated patient, or when obtaining straightforward advice for a problem outside his specialty.
- Take advantage of the medium's unique strengths and weaknesses.
According to Dr. Hale, one of the key advantages of online consultations
is the fact that time and space do not limit who you can talk
"The farther away from a major medical center your practice is located," she pointed out, "the more powerful the Internet becomes. It allows you to regularly interact with other physicians in ways unlimited by distance." Dr. Hale noted that e-mail may be sent or received at any time, and respondents have the opportunity to gather their thoughts and relevant references into a more coherent package.
At the same time, Dr. Osheroff cautioned that online clinical discussion is "by nature not a formally peer-reviewed or evidence-based resource." He also said that credentials are more difficult to verify and financial interests harder to discern when you do not know a consultant personally. Internists who use these resources agree that they do not use online recommendations as their sole source of information, but rather as a springboard to exploring new options or raising issues with colleagues whom they do know well.
Chris Dwyer is Medical Informatics Program Associate in ACP's Education Division. He can be reached at firstname.lastname@example.org.
A different kind of online discussionThe following are examples of mailing lists, online discussion groups that send participants' messages directly to your e-mail in-box instead of requiring you to go on the Internet.
To join any of the groups, send a message to the address listed under the Subscription Address section (see list below). Type in the information listed in the Subscription Message section exactly as shown in the body of the e-mail you send. Once you join the group, you will receive instructions from the mailing list that tell you know how to "unsubscribe" from the discussion in case you receive too many messages or you find that the discussion is not what you expected.
- Case Discussion Mailing List (CLINICAL)
For information: email@example.com
This is a mailing list where physicians discuss diagnosis and treatment for difficult or unusual cases. It is sponsored by the Canadian Medical Association and is restricted to licensed physicians.
Contact: Dawna Lee Ramsay, firstname.lastname@example.org
- Chronic Fatigue Syndrome Clinical Concerns (CFS-DOC)
Subscription Address: LISTSERV@list.nih.gov
Subscription Message: SUB CFS-DOC
CFS-DOC is a private discussion group limited to doctors and devoted to clinical concerns regarding Chronic Fatigue Syndrome.
- Ophthalmology Mailing List (OPHTHAL)
Subscription Address: LISTSERV@UBVM.CC.BUFFALO.EDU
Subscription Message: SUB OPHTHAL Firstname Lastname
OPHTHAL is a moderated and edited list for ophthalmology. The list concentrates on the practice of clinical ophthalmology. Anonymous clinical case presentations, management decisions, treatment options and positions available are appropriate for posting.
Contact: Ray Magauran, email@example.com.
- Ophthalmology Mailing List (OPHTHAL)
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