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Dr. Nelson's Use of the Internet to Teach Patients

Patient RX
This "Rx for Patient Education" is modeled on my
"Information Therapy" form, which I initiated in 2000
- Dr. Nelson

Internet and computer-based technologies are transforming the health care industry. Major national trends include more patients sharing in medical decision-making, and doctors embracing computer-based technologies as strategic tools to improve care, save time and lower costs.

AAOS offers a range of free, Internet-based services to benefit member physicians including building and hosting Personal Physician / Group Practice Web sites (OrthoDoc) and a comprehensive patient education Web site, Your Orthopaedic Connection.

Practice Web Sites Enhance Orthopaedic Care

To help members get online quickly and easily, the AAOS offers help in developing personal physician and group practice Web sites through its OrthoDoc program. The sites are valuable tools orthopaedic surgeons can use to connect with Internet-savvy patients and market their practices to both the public and referring physicians. OrthoDoc Web sites are offered free as a benefit of membership to all active classes (AAOS Fellows, Residents, Candidate Members, Emeritus and International Affiliate Members).

Since March 2000, 1,620 AAOS doctors have built AAOS OrthoDoc Web sites. Since August 2000, these Web sites have been used more than 82,000 times by patients and the public. In aggregate, this is an average of almost 4,900 visits per month. Although some physicians may choose to pay a Web site designer to create their site, "For the great majority of AAOS physicians, OrthoDoc is the way to go," advises David L. Nelson, MD, of Greenbrae, California,. who routinely refers patients to his OrthoDoc Web site for information. "It is an incredibly valuable deal for members," Nelson says. "Importantly, you don’t have to write your own content about every medical condition that you treat."

Empowering Doctors, Patients

AAOS physicians who have OrthoDoc Web sites describe them as useful tools for helping patients who want more information about their medical conditions. The OrthoDoc program "empowers doctors to give better service to patients," Dr. Nelson says. Looking up health care information is one of the main reasons people use the Web. "Patients love to get a web site recommendation from their doctors because they want medical information from someone they know and trust," he notes.

Dr. Nelson says information on his OrthoDoc Web site is especially helpful for patients who do not remember everything the doctor says during their office visit. "My Web site provides information that can help patients to follow directions better, and results in fewer complications and unnecessary phone calls, Nelson explains.

"Anything that you have to say to different patients, over and over again should go on your Web site," Dr. Nelson advises. The minutes saved by referring patients to the Web site really add up—Dr. Nelson estimates his OrthoDoc site saves him at least 20 minutes each day. "You save several hours per week in decreased explanation time, while increasing the quality of information transferred. Patients routinely tell me that they love the Web site. They feel more in control, better informed and able to comply with physician requests."

Los Angeles-based orthopaedic surgeon Thomas Schmalzried, MD, agrees that his OrthoDoc Web site is a time-saver. "When my patients are hungry for more information than I can give them in the time allocated for the visit, I suggest that they visit my home page," Dr. Schmalzried says. "If they can’t find answers to their questions there, then they can contact me."

Lets Patients Share Decision-making

AAOS OrthoDoc Web sites provide ways to communicate more effectively and better partner with patients, says Stuart A. Hirsch, MD, of Bridgewater, NJ, who chairs the AAOS Council on Communications. OrthoDoc Web sites can link to easy-to-read Your Orthopaedic Connection articles about hundreds of orthopaedic topics—all created by orthopaedic surgeons with the help of professional writers. "AAOS information is both medically relevant and understandable," Dr. Hirsch says. "Patients can help share in decision-making using top quality orthopaedic educational materials."

An abundance of quality, peer-reviewed patient education materials is available on the OrthoDoc Web site of A. Herbert Alexander, MD, of Ketchum, Idaho. "I always remind my patients that while a lot of information on the Internet is incorrect, they should go to reputable Web sites that provide valid information—like mine," Dr. Alexander, who is chair of the AAOS Internet Communications Committee, says. He notes another benefit of the OrthoDoc program for doctors: you can provide patients with Academy educational brochure information without ordering and stocking paper copies of the materials.

Promoting OrthoDoc Web sites

Dr. Alexander promotes his OrthoDoc Web site address (URL) by giving it out to patients, and listing it on his e-mail address signature and office letterhead. Dr. Nelson also puts his web address into yellow pages ads. "Many patients see my ad and the URL, and they learn all about me and my practice.

"While having a Web site is the first step, getting patients to use it is the next step," he says. He encourages patients to read educational articles about their conditions by giving them a printed flyer with his Web site URL and a listing of all the articles on the site. He uses check boxes to "prescribe" appropriate articles.

Changing Patient-Physician Relationship

Accurate and unbiased health information can empower patients to make informed decisions about their own medical care. According to the Journal of the American Medical Association, "Access to medical information via the Internet has the potential to speed the transformation of the patient-physician relationship from that of the physician ministering advice and treatment to that of shared decision-making between patient and physician."

Studies show most American adults with Internet access actively seek health and medical information online. They turn to the Internet for three main reasons: it’s convenient and anonymous and information is abundantly available

The Internet has become a powerful tool for patients for learning more about a condition diagnosed by their doctor and the available treatments. It has also become a primary source for self-diagnosis, often serving as the first (or only) resource for deciding when or if to consult a doctor about their medical condition. In fact, many physicians report that patients regularly come into their offices armed with print outs from the Internet.

Although two-thirds of patients use search engines (i.e., Yahoo, Alta Vista, etc.) or other scattershot methods to locate health information on the Internet, they consider the source of information the most important factor in choosing what to trust. "Unbiased information associated with a credible brand" is what people searching the Internet want, according to the Boston Consulting Group (BCG) January 2001 report, "Patients, Physicians and the Internet."

People "trust data from university clinics and medical societies," BCG says, noting that research institutes and academic medical centers are "well-positioned" to provide information to patients and physicians and to keep up with rapid increases in medical knowledge.

Recommend YOC to Patients

Given this environment, orthopaedic surgeons can use the Internet to benefit both their practices and their patients. One valuable tool they can use to accomplish this is the AAOS patient education Web site, Your Orthopaedic Connection (http://orthoinfo.aaos.org). It is the most authoritative resource for orthopaedic information on the Internet and allows you to build on the established trust that patients have for information provided by a professional medical society. Your Orthopaedic Connection (YOC) is a free virtual library for enhancing patient education. With more than 350 articles available, the Web site provides instant, accurate and complete information about many common orthopaedic conditions and treatments. Articles are:

AAOS members can use Your Orthopaedic Connection in a variety of ways to educate and inform patients. Some suggestions: