Finding Diabetes Info on the Internet – Part 1

Part 1 of 2 parts

When I came across this blog in my subscription to kevinmd.com, I thought great, something I can relate to and something that will expand and be good for another blog on the topic of diabetes education. However, after reading carefully, I will need to make at least one caveat to his analysis. His blog is about diseases and as such, he is correct across the broad spectrum of diseases in general, but this should not be about the diseases only. After correspondence with Edward Leigh, I would add that I am not only interested in the disease, in my case diabetes, but the nutrition in treating the disease, which should be an integral part of any treatment therapy or options for any disease.

The author, Edward Leigh, MA, is right to suggest paying attention to the website's “ending designation or domain name.” However, your homework is not done just because a website is of certain types. There can still be bad sites within these domain names and often you need to be careful. With that, I will list five of the most common ending domain names without comment. The list includes .gov, .edu, .org, .com, and .net. Yes, there are others, but very seldom will you find medical or nutritional information on them.

In general, each has its strengths and weaknesses; the order is ranking them from most reliable to least reliable. You may get tripped up by the weaknesses if you do not pay attention to what you are reading. An example: The USDA Dietary Guidelines.

Several government agencies are involved in the above image; however, the author of the Dietary Guidelines is not mentioned. This is the U.S. Department of Agriculture (USDA). Therefore, when reading under the USDA website, please be aware that not everything is done in the best interest of its citizens. USDA's sole purpose is to promote US agriculture and some of the foods are not always the most beneficial for us. It took the CDC and the National Center for Health Statistics to combine and show us the error of believing everything published by the USDA. I must thank the Healthy Nation Coalition website for pointing this out.

Even other government agencies make mistakes as well and they print retractions and issue corrections, but not the USDA. So in general this can be a fatal flaw in believing that websites ending in .gov are to be relied upon. More than any other domain name, these websites are normally the most reliable.

The .edu websites must be an educational institution to receive and use this domain name. Generally, patients can obtain excellent information from these websites, but again care must be taken and sometimes you will need to explore complicated sites to find good information, as they will openly and even not so openly be promoting medical services that many patients may not be looking for or needing. This may be because they have aligned themselves with a hospital system or have a medical education department wanting to expand.

Associations and non-profit organizations normally use this domain name - .org. While the majority of groups using this designation are reputable, any individual can get this domain name by filing as a non-profit, and this can create problems when they are unscrupulous people.

The next two, .com, and .net are website designations to be very cautious about. Yes, my site has this designation - .com. .com is generally for commercial use, but many medical websites use this domain name. There are many reputable websites with these endings, but I urge caution as there are many snake oil sales people using these domain names. Then there are also many outright fraudulent sites as well. This requires you to be extra vigilant and read with caution or a jaundiced eye.

Some medical information can be found on .net domains, but generally this is used when the name in .com in unavailable and for some other purposes like networks and internet service provider usage.

Are Doctors Using Meaningful Use with Patients?

This remains to be seen and raises some red flags for patients. Granted, we will find out in 2014 and probably not before then. Here are the rules to this point on the books, but I know from experience they are not being followed in most cases.

The rules state that physicians are to engage patients in their care is part of Meaningful Use Stage 2 which becomes law in 2014, and includes specific requirements that physicians must adhere to including:

#1. Provide patients with their health information (via a web portal) on 50% of occasions and have at least 5% of these patients actually download, view or transmit that data to a third party.

#2. Provide a summary of the care record for 50% of transitions of care during referral or transfer of patient care settings.

#3. Provide patient-specific education resources identified by Certified EHR technology to more than 10% of patients with an office visit.

#4. Engage in secure messaging to communicate with patients on relevant health information.

#5. Make available all imaging results through certified EHR technology.

#6. Provide clinical summaries to more than 50% of patients within one business day.

#7. Provide patients for more than 10 percent of all unique patients with office visits

seen by the EP during the EHR reporting period with patient-specific education resources.

This is very specific and there have already been attempts to water this down and make it less effective. It is not the existence of the regulations and their incentives that are in question, but whether physicians are adapting. Many are not willing to adapt and are saying that as long as patients remain passive, they can't change. Others are still concerned about billing time and especially those working for hospitals must abide by their employer's wishes. This is not favorable for patients when hospitals call the shots.

At the same time, many physicians are beginning to realize that engaging the patient in their health care decisions will make health care more efficient and cost effective, and improve patient outcomes. What many physicians are avoiding and say they will avoid is emails (#4 above). On this, I can agree, as most of us do not have secure email available to us. Almost all email services available to us are very insecure and open to copying and other uses, especially by the government.

Outside of the passive patients who do not want education, but just to see the doctor and get his advice, patients are changing and wanting education to help them manage what may be wrong, how to keep their health, and improve it. Yes, patients are becoming more proactive and many want to be more participatory in their care. What is discouraging is only about 40% sign up for access to patient portals for secure messaging with their healthcare providers. I have to wonder if the physicians are discouraging this or if more will, once 2014 is here. This shows that there is much to be done between now and 2014.

Since legislating these changes and offering financial incentives is not obtaining the desired results, will penalties become necessary? Hopefully, training of new physicians and retraining of established physicians in communication skills and interpersonal relationships will be a good start. Those into participatory medicine believe that the message needs to be convincing for physicians to practice medicine the right way.

There is also something to be said for training patients and making them desire to be participatory in their medical care. At the very least, they should become proactive in their care and then as they gain confidence may transition to participatory medicine. Currently, many patients are afraid of what doctors can do against proactive patients. Are these patients justified in their concern? Some need to be because of the attitude of their doctor and some just don't care as they have already reported their doctor for not providing meaningful use. Until 2014, there is a lot to learn by both sides.