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Am Fam Physician. 1999;60(3):1042-1045

Web Doctor: Your Online Guide to Health Care and Wellness

By Richard M. Sharp and Vicki F. Sharp. Pp 557. Price $28.00. Quality Medical Publishers, 11970 Borman Dr., Ste. 222, St. Louis, MO 63146, 1998.

One complaint that users frequently have about the World Wide Web is that it can be difficult to find useful information and relevant Web sites. Just knowing that a site exists can be a big step forward. Web Doctor: Your Online Guide to Health Care and Wellness by Richard and Vicki Sharp provides doctors and their patients with a well-organized listing of almost 1,500 health-related Web sites.

The book is divided into 23 topics that include exercise, nutrition, aging, diseases and conditions, medicines, death and dying, and medical organizations. Each chapter contains an alphabetical, clearly arranged list of Web sites. The entry on each Web site contains the title, the address or uniform resource locator (URL), a short description and a picture of the site.

The authors selected Web sites for the book that met certain criteria. These include “appropriate, relevant, and timely health care information”; good site organization and connectivity; short download time; regular updating; and awards for authoritative and reliable information. Taking a unique and useful approach, the authors list the most informational page on the Web site, not necessarily the home page. Most of the sites selected tend to have information targeted at patients. While some sites for doctors are included, the book does not focus on sites intended solely for doctors. Web sites relating to family physicians are also included appropriately.

The book includes a short, helpful, introductory chapter with tips on using the Internet, and a Web glossary. The book also comes with a Mac and PC-compatible CD-ROM. By installing the CD-ROM, the user has access to every Web site in the book without typing the Web address. Although this addition is beneficial, a Web-based version would be simpler and more valuable.

The authors meant to include valuable and reliable Web sites. However, they do not enumerate other accepted characteristics of high-quality health information sites, namely sponsorship, authorship and disclosure.1 Sponsorship of the Web sites that are included is not always well explained. For example, Proctor and Gamble's sponsorship of the “Always a Woman” Web site is not mentioned in the site's description. Also, many Web pages from private individuals and companies (some not in health care) are included. While these sites may contain valuable information, not disclosing the authors and sponsors of these pages adds to the myth that every Web site is reliable. A chapter on evaluating the content and reliability of health care Web sites would have been a welcome addition.

Shortcomings aside, this well-organized listing of sites may help some doctors and patients looking for patient-oriented information on the Web. Like the Web itself, the book can be useful if surfers look at the medical information critically and keep the source of the information in mind.

Book Reviews

Health Care Ethics: Critical Issues for the 21st Century

Edited by John F. Monagle and David C. Thomasma. Pp. 614. Price, $65.00. Aspen Publishers, 200 Orchard Ridge Dr., Ste. 200, Gaithersburg, MD 20878, 1998.

Health Care Ethics: Critical Issues for the 21st Century is an unusually comprehensive anthology. Beginning with cloning and ending with intercultural reasoning, this volume treats a remarkably wide range of bioethical problems. Unlike other medical ethics textbooks, it does not concentrate on specific cases. Instead, it consists of 54 essays organized around six major topics: reproductive issues; adult medicine; critically ill and dying patients; justice and economics in health care; institutional issues; and methodology. Many of the contributors are physicians and philosophers, and leading figures in bioethics: Howard Brody, Timothy Quill, Margaret Battin, Edmund Pellegrino and others.

This anthology includes some topics that family physicians often confront but which are either absent from, or have only recently become a part of, standard bioethics discussions. For example, several essays discuss how people from other cultures view ethical decision-making differently from the majority culture in America. Western bioethics stresses the informed consent of an autonomous individual, but many other cultures, including some minority cultures in the United States, believe that families are obligated to shield patients from bad news. An essay by Margaret Battin specifically compares American, Dutch and German attitudes toward forms of assisted death and suggests that the danger of a slippery slope might actually be greater with the American practice of withdrawing life-sustaining treatment without great scrutiny than with the German practice of assisted suicide or with the Dutch practice of euthanasia.

A strength of this work is its treatment of the role of the family in the care of competent adult patients. In “The Family in Medical Decision Making,” Jeffrey Blustein offers a balanced discussion of the controversy between various kinds of challenges that stress the role of families in decision-making and those that emphasize patient-centered ethics and focus on the rights of the individual patient. Also refreshing for their balance and thoughtfulness are two essays on the emotionally charged issue of physician-assisted suicide, both of which include concrete clinical guidelines on how to respond to patient requests for aid in dying.

One feature of a good medical ethics anthology is exploration beyond the dramatic end-of-life questions that the media tends to highlight. In some respects, this anthology meets this test very well. It includes Carole Warshaw's discussion of the intellectual and structural changes needed to deal with domestic violence, George Agich's sensitive treatment of respect for the autonomy of the elderly in nursing homes, and extensive discussions of the institutional framework of health care.

On the other hand, several topics that are important to family physicians are not included in the anthology. The book does not contain essays devoted to the ethical issues of lying and truth-telling, and it has no discussion of an ethical duty to share medical information with older children and to allow them to participate in medical decisions—a stance recently encouraged by the American Academy of Pediatrics. The book also lacks a general discussion of confidentiality, a topic that is only covered in relation to disclosing genetic risks to family members or revealing information about a pregnant woman's behavior to the government.

Beyond the clinical level, many essays address the emerging ethical issues of health care institutions. Kate Christensen's essay on the ethical distinctions among different managed care organizations and Cory Franklin's discussion of ethical problems in outcomes research are important and helpful, as are several contributions on the subject of ethics committees and forms of ethics consultation.

Health Care Ethics does not begin with the usual primer on ethical concepts and theories. Instead, it uses seven essays in the final section on “methodology” to discuss the various aspects of bioethics as a field of study. By doing this, it recognizes that bioethics has become messier in the past few years. It also proves that it is no longer sufficient to trot out the oft-repeated “four concepts” (autonomy, beneficence, non-maleficence and justice) and the two major ethical theories (utilitarianism and Kantian or rights-based). But this departure makes Health Care Ethics less suitable for family physicians who wish a systematic introduction to bioethics.

Glenn Graber's essay, “Basic Theories in Medical Ethics” attempts to be inclusive but is likely to confuse those who are not already familiar with issues in ethical theory. Edmund Erde's “A Method of Ethical Decision Making” mixes an attempt to introduce ethics with often confusing references to more complex issues. Neither of these essays introduces basic concepts and theories as well as some of the less innovative, but more clearly organized, accounts in the standard texts.

Although not the ideal introductory textbook, Health Care Ethics is a diverse collection of essays that treats not only classical bioethics dilemmas but also some of the emerging issues that few other texts or anthologies address. It is a valuable resource, especially for the family physician who has some previous acquaintance with bioethics. The inclusion of an excellent index makes it eminently suitable as a reference work that can be called on as the need arises.

Also Received

Diseases of the Liver and Bile Ducts: Diagnosis and Treatment

Edited by George Y. Wu and Jonathan Israel. Pp. 450. Price, $125.00. Humana Press, 999 Riverview Dr., Ste. 208, Totowa, NJ 07512, 1998.

Mechanical Ventilation Manual

Edited by Suhail Raoof and Faroque A. Khan. Pp. 188. Price, $40.00. American College of Physicians, Books Program, Independence Mall West, Philadelphia, PA 19106-1572, 1998.

The Pain Management Handbook: A Concise Guide to Diagnosis and Treatment

Edited by M. Eric Gershwin and Maurice E. Hamilton. Pp. 390. Price, $69.50. Humana Press, 999 Riverview Dr., Ste. 208, Totowa, NJ 07512, 1998.

Success With Heart Failure

By Marc A. Silver. Pp. 250. Price, $19.95. Insight Books, 233 Spring St., New York, NY 10013, 1998.

Understanding Cancer

By C. Norman Coleman. Pp. 177. Johns Hopkins University Press, 2715 N. Charles St., Baltimore, MD 21218-4363, 1998.

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