Accessing the Internet for Patient Information About Orthopedics

To the Editor.—Patients want information about their medical condition from their physician, and it is not uncommon for patients to present at clinics with printed information obtained from the Internet.^{1 - 2} There are few reports about the accessibility of patient information on the Internet for those who want to improve their knowledge of their medical condition. We conducted a descriptive study to explore the accessibility and volume of orthopedic patient information on the Internet using nonmedical terms. Our aim was to categorize the information a patient would get when searching the Internet about his/her medical condition.

A questionnaire was administered to 100 consecutive orthopedic patients with knee (meniscal or anterior cruciate ligament) injuries attending outpatient clinics to determine what terms and keywords they would use to describe their medical condition. The 25 most frequently used terms were used to retrieve information from the Internet from 5 search engines (AltaVista, Excite, Lycos, Yahoo, and HotBot). The Web pages were then categorized according to intended audience and content.

Of the 100 patients surveyed (78 male, 22 female; mean ages, 32 years, SD, 9.61 years; 32 years, SD, 15.16 years, respectively) 79% had access to a computer either at home or at work; 56% used a computer regularly; and 40% searched the Internet either occasionally or regularly. Twenty-five of the most frequently occurring terms (eg, knee, ligament, cruciate) were used by the researcher (S.R.) to search the first 50 uniform resource locators from 5 search engines. Although only correctly spelled terms (n=20) were used in the search, 20% of the terms had been misspelled by patients (eg, cruchiat, cartilidge). Almost 5947 Web pages were accessed and categorized according to patient information, specialist information, commercial pages, sports news, unavailable, and other. Of the 5947 Web pages, 1219 (20%) contained patient information; 1130 (19%) professional information; 535 (9%) commercial information; 119 (2%) sports news; 488 (8%) were unavailable, and 2456 (41%) were classed as other (eg, non-English pages without English translation, bulletin boards, chat rooms). Of the patient information pages, only 395 contained knee-related information. Therefore, only 7% of the identified Web pages were considered of relevance for our patient sample. The choice of "lay" search terms did not significantly influence the search result. Only 1 page of 5947 was provided by a gateway service, ie, a service that facilitates access to previously reviewed Web pages.

The number of patients using the Internet to retrieve information on their condition is increasing; however, patients tend to use nonmedical terms to describe and search for information on their condition. In this study, patients who were assumed to have no special skills in information retrieval would have found only 7% of Web pages useful to their needs using their search terms. We suggest that access to reliable and valid Web sites should be provided for patients who express an interest in searching the Internet for medical information.