The electronic realm has, at first click, made daily inconveniences convenient.

Like email and ecommerce. And emedicine.

	Richard Krause says consumers can best use eMedicine and other online services to gather data to ask intelligent questions of their doctors.
	Photo: Stephanie Hamberger

Type in the keywords "health" or "medicine" on any search engine, and the results turn up in the multi-millions. But given the informality and immediacy of the medium, users seem reluctant to give credence to much of the World Wide Web's medical content. Sites that provide medical guidance may serve the dual purpose of pushing a new product or therapy, confusing the truth with salesmanship.

So who—or what—can you trust?

More than 7,000 medical professionals are taking steps to build both health consumers' and practitioners' confidence in this burgeoning medium for dispensing medical information with the eMedicine Journal—an online library of continuously updated medical textbooks that caters primarily to medical professionals, but provides texts for consumers as well.

As part of that contingent, Richard Krause, residency program director for the Department of Emergency Medicine in the School of Medicine and Biomedical Sciences, has been a contributor to eMedicine since 1999. Recently named managing editor for the section devoted to emergency medicine, he says the lack of confidence in online medical publications is due, in part, to the perception that print publications are more credible.

"I don't know that when this (site) was started, people took it as seriously as they would have something in print," says Krause, clinical assistant professor of emergency medicine. "A lot of (what's on the Internet) is of questionable quality."

While that may be true, eMedicine provides textbook-quality articles on topics ranging from dermatology to sports medicine with one distinct advantage over the print variety—truly current information.

"They have come up with a way to keep textbooks, in effect, continuously up to date," Krause explains of the creators of eMedicine. Leafing through a bulky text and stopping at a chapter on bone marrow disorders, Krause points out that by the time the books are published, the information is at least two years old. For the current edition, published in 1998, the most recent article referenced in this particular chapter is from 1996. "That is clearly the problem," he says.

One of 21 managing editors at eMedicine, Krause has edited nearly 20 sections of the emergency medicine text, and as many for the site's consumer-oriented American Academy of Emergency Medicine Emergency Medical and Family Health Guide. He has authored two chapters-on anaphylaxis and renal failure-for the emergency medicine text, as well as co-authored with his residents several chapters for the family guide.

None of the authors—all of whom are physicians and culled from top medical schools, societies and institutions worldwide, according to the site—simply can post his or her work as is. Each article must pass muster with four editors before it is posted as new or updated, Krause explains. But even with such a rigorous peer-review process, he continues, sometimes updating an article takes only a matter of days versus the years it can take a publishing company to come out with a textbook edition.

More than 2,500 hospitals across the country have brought eMedicine into the workplace, says Scott Plantz, chairman and CEO of the journal, which has begun charging its institutional users a nominal subscriber's fee. And although money raised through fees helps offset operating costs, its main function is to fund site access at many of the roughly 10,000 hospitals in lesser-developed countries, where access—both in print and online—is constrained by cost.

Krause notes that the availability of such medical information should be treated as a "buyer beware" situation. Like all information, he points out, it shouldn't be taken as "gospel" or substituted for advice from one's health-care provider.

"You could definitely misuse any information if you misunderstood it," he says, adding that a reputable site will specify, as does eMedicine, when an individual can treat his or her own condition and when to see a doctor.

How, then, should online information be approached?

"In terms of the eMedicine textbooks, I would say to use those-and any other medical information-as a way of better understanding a condition that they have or a family member has, and using the information so they can ask intelligent questions," he says. "I think the way the average consumer should use it is to develop questions that they can talk to their doctor about in terms of their specific circumstances."

And coming to an appointment prepared can yield a much more fruitful interaction, Krause adds.

Other UB contributors to eMedicine include Jennifer L. Brown, Anthony L. Buscaglia and James L. Portzer, Department of Emergency Medicine; Thomas N. Helm and Thomas C. Lee, departments of Dermatology and Pathology; Jennifer R. Kam, Department of Dermatology; Sung W. Yoon, Department of General Surgery; Khalid Bashir, Department of Internal Medicine, Division of Nephrology; Paul James, Department of Family Medicine; James Springate, Department of Pediatrics; James F. Chmiel, Department Otolaryngology, and Kaushik A. Shastri, Department of Internal Medicine, Division of Hematology/Oncology.