With the explosion of medical and health information freely available on the Web, family physicians are feeling increasing pressure to find the most current literature and to direct their patients to reliable sources. Yet we all know that too much information can be overwhelming, especially for a busy physician, a patient facing a chronic condition or a family member dealing with a loved one's life-threatening disease. How can you track down information that is good for you, your patients and their family members? You might try directories (useful, Yellow-Pages-type searching tools) instead of search engines.
Categorizing your search
Of the search mechanisms available on the Web, two approaches are commonly used: search engines, which tend to work best for narrow searches, and directories, which tend to do better for broad searches.
Search engines, such as AltaVista, Excite, Lycos and WebCrawler, amass huge amounts of information in a huge variety of subject areas and therefore work best when searching for needle-in-the-haystack bits of information that are difficult to categorize.
A search for “blood glucose monitoring strips” in AltaVista, for example, retrieves an easily browsable list of about two dozen links. On the other hand, a search for “diabetes” retrieves an overwhelming list of more than 500,000 pages.
Directories, such as Yahoo!, are more useful when searching for information on topics that are broad enough to be categorized. Unlike search engines that work automatically, directories are created and maintained by individuals who pre-select Web sites and assign them to specific directory categories, which users can browse through, much like a paper directory.
To better understand directories, think of Web sites (other than search engines) as falling into one of three categories:
Primary sites have the information that may be the end point of a successful Web search.
Secondary sites, or directories, list primary sites categorized by subject.
Tertiary sites provide efficient access to the most useful secondary sites. (See "A directory of directories.")
A directory of directories
If you are looking for information on a broad clinical subject, one useful tool is the Hardin Meta Directory of Internet Health Sources (www.lib.uiowa.edu/hardin/md), a tertiary site the author and his colleagues developed and maintain as a tool for finding high-quality directories in a number of medical specialties. As implied by the name, Hardin Meta Directory is actually a “directory of directories.” It includes links to directories in 38 clinical subjects and medical specialties such as AIDS, cardiology, dermatology, family medicine, medical informatics, nutrition, occupational and environmental health and telemedicine.
Directories listed are checked for several characteristics, of which three are especially important: the number of other sites that have links to the directory, the number of links it contains and the percentage of the listed links that make good connections. The first characteristic amounts to a form of peer review, the second is a measure of comprehensiveness and the third is an indication of how well the site is maintained.
Hardin Meta Directory pages of interest
Consumers (www.lib.uiowa.edu/hardin/md/consumer.html). The high-quality directory sites listed here are managed by patients or their family members.
Electronic journals (www.lib.uiowa.edu/hardin/md/ej.html). This is a directory of general medical and health journals (including Family Practice Management) that post all or many full-text articles on the Internet and provide access at no charge.
Family medicine (www.lib.uiowa.edu/hardin/md/fam.html). As with other specialties, most of the directory sites listed here are developed by librarians or other health professionals, but there also are several excellent ones by physicians.
The prototypical Web directory is Yahoo!, which, in addition to covering health, addresses subjects such as business, computers, education, entertainment, government and sports. Using Yahoo! to find medical information is much like using the World Book Encyclopedia instead of the Merck Manual.
Several more comprehensive directories focused on medicine have been developed and are managed by librarians, medical informatics specialists and physicians. Because these individuals usually have a good nose for choosing sites with reliable information sources, the directories they've developed are especially valuable.
Also among directory developers are those gleaning health information for themselves and others. Patients, especially those with chronic diseases and conditions, are increasingly taking an active role in their care. These well-informed consumers often develop a wide communication network and a deep knowledge of electronic information sources.
A number of health directories exist, but there are two general types: the large, multisubject, umbrella-type and the single-subject-type, which has a more narrow focus.
Multisubject health directories
These directories have sections devoted to numerous areas of clinical medicine. Here are some examples:
About.com (www.about.com/health). This directory includes links to sites on a wide variety of subjects developed and maintained by independent subject specialists called guides who facilitate communication by hosting live chats, managing forum discussions and publishing newsletters.
HealthWeb (www.healthweb.org). Part of a collaborative effort of more than 20 participating member libraries, HealthWeb enables users to link to information on a number of clinical subjects, such as nutrition, preventive medicine and women's health.
Karolinska Institute (www.mic.ki.se/Diseases). Created by an information specialist at the Karolins-ka Institute in Sweden, it includes many of the best directory pages from outside the United States.
MEDLINEplus (www.nlm.nih.gov/medlineplus). Launched by the National Library of Medicine as part of its new emphasis on consumer health, this directory is especially useful for its hundreds of links to government and other official sites, such as the Juvenile Diabetes Foundation.
MedMark (www.medmark.org). A group effort by Korean physicians, this site includes some of the most comprehensive and well-maintained directory pages in clinical medicine, with links to medical organizations, national centers and institutes, university family medicine departments and consumer information.
MedWebPlus (www.medwebplus.com). Developed by a medical librarian and a medical informatics specialist, this directory includes links to information on diseases and conditions, clinical and biomedical specialties, medical and academic institutions and alternative medicine.
Single-subject health directories
These directories are managed by a variety of people, including physicians, nurses, allied health personnel, patients and librarians, and focus on a single subject or medical specialty. Here are some examples:
Family and Community Medicine (www.tulane.edu/som/departments/fammed/links.cfm). Managed by the professor and chair of family and community medicine at Tulane University Medical Center, New Orleans, this family-physician-created directory includes links in such subject areas as preventive medicine, patient education and evidence-based medicine.
On-line Diabetes Resources (www.mendosa.com/faq.htm). This excellent example of a patient-managed directory is maintained by a professional writer who has diabetes.
Pediatric Critical Care Medicine (http://www.PedsCCM.wustl.edu). A resource for critical care, this directory is edited by three pediatricians specializing in anesthesiology, critical care and emergency medicine.
Tufts University Nutrition Navigator (http://navigator.tufts.edu/). This navigator offers links to sites on general nutrition and special dietary needs, as well as topics specific to parents, women, children, health professionals and educators. Tufts University nutritionists review and rate all the sites for nutrition accuracy and usability.
Your final destination
While search engines certainly have an important role in retrieving information, using a directory can be extremely productive. Humans (instead of machines) have organized the directories and have done much of the winnowing of information, which reduces searching, lessens frustration and, most importantly, provides useful, reliable information to you and your patients.