National Public Radio (NPR)

December 13, 2007 Thursday

SHOW: Talk of the Nation 2:00 PM EST

Do-It-Yourself Diagnosis on the Web



This is TALK OF THE NATION. I'm Neal Conan in Washington.

On a typical day, about eight million of us type back pain, migraine or some other medical condition into a search engine. More and more, the Web is our first stop for health-related information. Some people self-diagnose and try to treat their own problem, some scare themselves silly, a lot more research their complaints so they can go to their doctor with the right terminology and the right questions. Those same search engines can also uncover a lot of information about that doctor, everything from where they went to medical school to their home address. Whether you're a doctor, a patient or both, how do you use the Internet?

Later in the hour, "Ask Amy" of Amy Dickinson's - let me try that again - Amy Dickinson of "Ask Amy" joins us to talk about that moment when we all just want to get away.

But first, Google M.D. Do you use the Web to investigate your symptoms? How does it change the doctor-patient relationship? Our number is 800-989-8255. E- mail us, You can also join the conversation on our blog at

We begin with Dr. Scott Haig. He's an orthopedic surgeon and a contributor to Last month, he wrote about an over-informed patient for the Web site. He joins us from his office in Westchester County, New York. And it's nice to have you on TALK OF THE NATION today.

Dr. SCOTT HAIG (Orthopedic Surgeon; Professor, Columbia University): How are you, Neal?

CONAN: I'm well. Let me ask you about this woman you call Susan(ph). You also call her a brain sucker. What's a brain sucker?

Dr. HAIG: Well, if you're a doctor and you answer people's questions all day long, there are certain people that you get the impression are not just after the information and the questions. They want you to say it a couple of times they want you to tell them something that they themselves want to hear they may know already. That's a brain sucker, and it's like anything else. If you experience one, you absolutely know what it is.

CONAN: One of the symptoms of a brain sucker, you say, is when they call you up, you can hear them quietly typing into their search engine as you're speaking with them.

Dr. HAIG: Well, this lady that we wrote the article for, she actually called me. She got through to me through my office staff and while she was talking to me, I could hear her clicking in the background. And I had the feeling immediately that this lady was actually looking me up or looking at the computer about me while she was talking to me.

CONAN: And it turned out when she came in, she knew an awful lot about you.

Dr. HAIG: Yes, she certainly did.

CONAN: And you found this a little, you know, of course, people are going to look up the information about their doctor, but there's a point at which it becomes creepy.

Dr. HAIG: Well, it was all creepy with her because she knew where I lived. And, you know, it's not that hard to find out a lot of personal information about people if you're a good Googler(ph) and you know, the Web search, with a few clicks, you could find out a lot of things, and it's difficult for professionals oftentimes to keep distance from our patients. When they have this much more ability to get in there and not just find out about their sickness but about you, it's a problem.

They - people should be able to look and find out things about their doctors. You want to know, you know, if this guy has trained properly, if this - he has any standing in the community. But where the cutoff line is, you know, where he goes, where his kids go to school, that sort of thing, that's a problem.

CONAN: Or - but if he has got his medical degree from the University of Bora Bora(ph), that might be interesting.

Dr. HAIG: Yeah. Now, people should find that sort of thing out I think it's only helpful.

CONAN: There is also a moment at which you said you were ready to punt and she knew it. What were you talking about there?

Dr. HAIG: Well, this was a patient who had been to three other doctors just like me before coming to see me. She had a problem that was not easy to fix no matter how you do it. And I knew that she knew I was not going to go all the way with her, you know, we just didn't click and I wasn't going to put up with this kind of patient. And as it tuned out, the reason I wrote the article was the person I suggested she go see instead of me, who was somewhat may be more focused on her particular problem, she already had an appointment with the man...

(Soundbite of laughter)

Dr. HAIG: ...a couple of days after mine, so I didn't really feel like I lost anything to that patient.

CONAN: And let me ask you, you do also characterize patients in a number of different categories and you say nurses, people who know a lot of the information already, that they're your favorites.

Dr. HAIG: Yeah. In that article, I said that nurses are my favorite patients because they tend to have respect for doctors and that's not a common thing in the lay population, at least in the northeast right now. Underlying the whole Googler problem with the fact that people just don't tend to treat each other with the proper amount of respect, doctor respect has been overdone in the past probably. But this day and age, a lot of us are feeling a real lack of respect. Nurses who rely on doctors for their orders and who work with doctors every day tend to give us more respect. They know the words, they know the anatomy, and I find them to be really great patients; I have a lot of nurses in my practice.

CONAN: We're talking with Dr. Scott Haig, who wrote an article for about a - well, incredibly well-informed patient. If you'd like to join the conversation about Google M.D., our number is 800-989-8255. E-mail us

And let's start with Katie(ph). Katie with us from Grand Rapids in Michigan.

KATIE (Caller): Hi. I had my first baby a couple of years ago and I did a lot of research on the Internet about everything from labor and delivery to pregnancy. And before I actually talked to my personal O.B. about this - my questions, I would call this friend of mine who's an OB/GYN, and he finally said, Kate, get off the computer. You are getting just enough information to think that you know what you are talking about when the fact is a lot of the stuff that you're reading isn't necessarily good medical information. And I wondered if there's a paranoia that seems to come along with all this information or is it something just particular to pregnancy?


Dr. HAIG: That's a great question, great comment, Kate. The problem is that when the lay public who hasn't trained - they don't have any real idea of what's common, what's not common, what happens, what doesn't happen - when you get exposed to all of the possibilities, you can make yourself crazy.

KATIE: Yeah.

Dr. HAIG: We see this oftentimes with prescribing drugs, you know - a very commonly prescribed anti-inflammatory drug. If people get that package insert and they read it, they can be paralyzed with fear when they're taking - what they're taking is an aspirin. And if, for instance, there were a package insert that came with something like aspirin, say, real regular aspirin, people wouldn't take it because the number of things that have to be listed because of various medical FDA rules, et cetera, are so many. So there is a kind of a person who actually has done a favor by pulling the plug out of the wall on the computer sometimes in medicine.

CONAN: Katie, how was the baby doing?

KATIE: Oh, wonderfully.

CONAN: Uh-huh. And do you still go online to look at skin knees(ph) and that sort of thing?

KATIE: I've tempered it a little bit. Now, when I look, I put it through a little bit of a filter considering the stories in that, you know, talking to somebody who has actual medical experience might be more useful to me.

CONAN: Okay, Katie. Thanks very much for the call.

KATIE: Thank you.

CONAN: Bye-bye. And Dr. Haig, I wanted to conclude by asking you what's been the response to that piece?

Dr. HAIG: Well, this particular article was fairly popular, it's still shooting around, you know. At the Web site, there's always a list of who's getting looked at, clicked and e-mailed the most and it was up there for quite a while. There are a few blogs that I've been watching that had been talking nicely - some not so nicely - about the whole idea of should patients have any kind of responsibility in the doctor-patient relationship. And I am writing another article, I'm sort of chairing a roundtable discussion of this for one of our journals called Orthopedic Review.

CONAN: I'll look for that in our mailbox.

Dr. HAIG: I'll try to give it to you.

CONAN: Thanks. Dr. Haig, thanks for your time today.

Dr. HAIG: My pleasure. Take care, Neal.

CONAN: Scott Haig, an orthopedic surgeon and contributor to He joined us from his office in Westchester County in New York.

Joining us now is Susannah Fox, associate director at the Pew Internet & American Life Project in Washington, D.C. She's been kind enough to join us here today in Studio 3. Nice to have you on the program today.

Ms. SUSANNAH FOX (Associate Director, Pew Internet & American Life Project): Thank you.

CONAN: And you conducted a Pew study on people that go online for medical searches. Is this more common today that patients go online before they go to the doctor's office?

Ms. FOX: Yes. We find that most people these days are preparing for doctor's appointment and recovering from the doctor's appointment by going online. Eighty percent of Internet users have looked for health information online.

CONAN: I was interested looking at the survey. Most of them seemed to go online to look for information on behalf of somebody else.

Ms. FOX: That's right. Half of searches are on behalf of someone else. And that's interesting because they are maybe caring for someone who isn't able to go online, maybe it's an elderly person, or it's someone who's frightened and doesn't want to see what's available about what's going on with them.

CONAN: Are you sure it's not just I was asking for a friend?

Ms. FOX: It could be. It also could be that it's important to remember that when someone who's diagnosed or someone who's sick, it's not just the one person, it's the whole community of people who care about them who want to find out about that condition, what's going on in their friend's life.

CONAN: And, interestingly, do people go on to look for specific information about a condition or to find - what kind of information people are looking for?

Ms. FOX: We ask about a whole range of topics. The most popular is a specific medical condition or a procedure. And that's when we know that it's probably in reaction to, you know, news from the medical professional. But we also ask about a broader range of topics, like alternative therapies, diet, fitness and nutrition, mental health information, other things that may or may not need a conversation with a doctor.

CONAN: And this information is also, you find, influential.

Ms. FOX: It is. People say that it has an impact on their decisions about how they care for themselves or care for someone else. It has an impact on their treatment decisions that they often make in consultation with a doctor.

CONAN: And the one caveat you seemed to come up with - there were a couple of them - people don't tend to look at when this information was added to the World Wide Web or necessarily the source of the information.

Ms. FOX: That's right. Three quarters of E-patients - that is Internet users who find health information online - three quarters do not check the source and date of the information. Those are the two of the most important quality indicators, and that's from the Medical Library Association. And most people are not looking probably because it's not available. The Department of Health and Human Services did a study and found that only about 4 percent of popular Web sites, popular health Web sites, actually disclose that information.

CONAN: Really?

Ms. FOX: Yeah.

CONAN: And there's also a lot of - you know, a lot of these Web sites are free.

Ms. FOX: Absolutely. They are free, and actually a lot of the general search engines create an algorithm that privileges the dot-gov information or the dot- edu information. And by that, I mean, approved by the federal government or approved by an educational institution.

CONAN: So it won't necessarily go to those. It will go to the dot-com information.

Ms. FOX: Well, basically, if you search just a general search on Google or Yahoo or MSN, it often comes up that there is a dot-gov source at the top, which is why a lot of people learn that this is okay.

CONAN: We're going to continue this conversation in just a minute. If you'd like to join us, give us a call, 800-989-8255. E-mail: How do you use the Internet in terms of your questions about health?

I'm Neal Conan. Stay with us. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington.

When you're sick, well, you usually call your mother then maybe you call the doctor. But the first stop for a lot of people these days is the Web, which has its advantages and its downside. That's our focus today. Do you use the Web to investigate your symptoms? How does it change the doctor-patient relationship? 800-989-8255. E-mail us, You can also send us comments on our blog at

In a moment we'll hear from a doctor who advises all of his patients to Google their health. But let's continue now with Susannah Fox, associate director at the Pew Internet & American Life Project. And Susannah, I wanted to ask you there are many millions of people in this country without health insurance. Are they using the Web in part because of that condition?

Ms. FOX: You know, that's something that we suspected but found in our surveys is not true. That we do not find that people without health insurance are any more or less likely to go online to gather health information. It actually is more broken down along age lines. People in their 30s and 40s, baby boomers, are very likely to be using the Internet to get a second opinion.

CONAN: And I was just going to ask you about the demographics. Thirties and 40s and baby boomers - who, obviously, a little bit older than that these days - these are better well-to-do people, presumably people with good computer access.

Ms. FOX: Yes. What we do find is that people with a college education, first of all, are likely to have Internet access and also people on that middle-age range are wired, both at home and at work. And we've now reached 50 percent of homes in the U.S. with broadband. And broadband really changes you as an Internet user. The Internet becomes the go-to source for all kinds of information including health.

CONAN: There are, of course, a lot of other sources of information about health. Do people use those as well?

Ms. FOX: Yes. There are surveys that are done by the National Cancer Institute that actually asks people about all the different media offline and online sources. And it is still a mixture of media.

CONAN: Susannah Fox, thanks very much for being with us today.

Ms. FOX: Thank you.

CONAN: Susannah Fox is the associate director at the Pew Internet & American Life Project here in Washington, D.C., and was kind enough to join us today here in Studio 3A.

Also with us is Ted Eytan. He's the medical director of Health Informatics and Web Services for Group Health Cooperative, a nonprofit health care system. And he's with us here in Studio 3A. Thanks very much for coming in.

Dr. TED EYTAN (Medical Director, Health Informatics and Web Services, Group Health Cooperative): Good afternoon.

CONAN: And how do you think this use of the Web that we've just heard about changes the doctor-patient relationship?

Dr. EYTAN: Well, I think the thing that we have to do to react is to innervate around it and accept that this is what our patients do. So Group Health Cooperative supports about 580,000 members in Washington State. And what we do is we find out where our patients are and how we can support them. The reality is they're going to do this. We focus-group tested them and even though we have a comprehensive Web site and allowed them to e-mail us and check their medical records online, a lot of times what they do at the information we give them online securely is go to Google and check it out.

CONAN: Mm-hmm.

Dr. EYTAN: And if they're going to do that, then let's support them in doing it because, really, information is therapeutic. And the more information people have that's accurate, the better. And really what people want is information from their doctor that's trusted in addition to the online sources. And I think sometimes the medical profession shies away from being online with them which causes this other problem.

CONAN: Well, we'll talk about that reluctant to the profession just a minute. But it seems to me what you're saying is that Google M.D. is the second opinion.

Dr. EYTAN: Well, if that's where people feel comfortable getting information, they're welcome to do it and they can check it out with us, and we're here to help them. I mean, the issue about respect is the person paying the bills is the patient. And so the respect belongs to the patient. And they will respect us if we respect them.

CONAN: Is this - in general, you're saying, well, we have to live with it. Would you consider this a positive step?

Dr. EYTAN: Generally, yes. I think it's causing us to react to innervate, to provide care the way patients want it. I mean, no patient has ever said I prefer to get care only from you in person. You know, people want to get care at all times of the day, all times of the week. And now, we can offer it that way. And because of this, we know can access (unintelligible) physicians through e-mail, 24-by-7 toll-free Nurseline. That's what people want.

CONAN: But some people go on the Web and diagnose themselves, and well, sometimes they get it wrong. Have you gotten calls from people who say, doctor, I think I've got the yaws?

Dr. EYTAN: Sure. I mean, I have patients that come in and say, well, I looked at (unintelligible) at Healthwise Knowledgebase. I looked at that, and here's what I think I have. And I use that as a starting point. I say, great, I'm so happy that you're empowered around your health. Let's see if that's really what you have.

CONAN: Okay. Let's see if we can get some more listeners involved in the conversation. And let's go to Kara(ph), Kara with us from Bend, Oregon.

KARA (Caller): Hi...


KARA: ...and how are you?

CONAN: I'm well. Thanks.

KARA: Good. I don't know if this counts as public speaking, but it makes me nervous. So I'm just trying to make my point the best I can.

CONAN: Go ahead, please. It's not so hard.

KARA: Okay, thanks. I work as a massage therapist in Bend. I work with chiropractors, acupuncturist, and out of doctors offices. And whereas, I have a great respect for doctors, I don't always have a lot of faith in them being able to diagnose musculoskeletal issues. I've got some good examples. You know, I've seen a woman who was complaining with chronic headaches. The first thing her doctor did for her was give her Botox injections in the back of her skull. I've seen people who have gone to their doctors with back problems who's been given prescriptions or even had their nerve cauterized before they've ever seen a chiropractor done massage, done acupuncture or any kind of alternative treatment.

I also have a good relationship right now with a man who specializes - his practice is in arthritis. And he says he's office is constantly filled up by people that have been sent to him from the regular M.D. telling them, which I believe, is already detrimental to their, you know, mental well-being that they most likely have arthritis. And he said they come to him with just, again, simple, you know, muscle issues that massage or a chiropractor could help.

I think that it is a really good thing when it comes to - especially when it comes to somebody that could head into surgery or alternative care for them to have the Internet at their fingertips. I mean, that way they're able to look and see, well, my doctor is saying this but other people are saying all these other things, and that might not be information that they're otherwise able to find. And in some cases, it might actually save somebody from rushing into surgery that is unnecessary.

CONAN: Kara, you might want to consider public speaking. You're not so bad.

(Soundbite of laughter)

KARA: Thank you.

CONAN: Ted, what do you think of what Kara had said?

Dr. EYTAN: I think it's a great point. You know, I'm a family physician and they say the best family physicians know what they don't know. And it's clear that there are things that patients bring to us that we don't know the answer to. And I ask patients how do you feel about the fact that if I don't know something, I may look it up in front of you. And in fact, they say that makes me more comfortable, more confident in you. And our health care system covers alternative care, a trainer at medical school that taught us about it. And so it's silly for us not to bring all those extra opinions in.

There's data that shows the average physician interrupts a patient 23 seconds after they start telling their story, and a patient that's allowed to tell the story can do it in six more seconds. So why don't we just give them the six more seconds and then bring in all the extra information.

CONAN: Yeah. Thanks very much for the call, Kara. But I wanted to ask you, Ted, is a lot of this affected by the fact that doctor's appointments these days tend to be so short. If you've got 15 minutes, you might want to come in as opposed to, you know, starting from zero saying, well, here's what I think is going on.

Dr. EYTAN: Well, in fact what we have done now that we have e-mail access to all of our 900 physicians in our care system is realizing health care is not about the visit. So the purpose of health care is to allow patients to achieve their life goals. It's not to get health care. And so the visit for us becomes a starting point. Our visits are 20 minutes long. So number one: We need to listen longer than 23 seconds. And number two: We continue the relationship outside of the visit. And so often for me, I continue the conversation via secure e-mail three and four days after. As whatever it is unfolds, they can come back if they need to, but often they don't need to. But - and that extra three to four e-mails makes a huge difference.

CONAN: Another caller. This is Kelly(ph), Kelly with us from Norman, Oklahoma. Kelly, are you there? And I think Kelly has hung up on us or maybe being in Norman, Oklahoma, the ice tree brought down its power line there or phone line.

Let's go to Rob(ph), Rob with us from - where are you, Rob?

ROB (Caller): I'm in Poquoson(ph) City, VA.

CONAN: Okay. Go ahead.

ROB: Hey, yeah, I'm a pharmacist and I think the Web can be good and bad. I get a ton of people coming into me every day saying, you know, I saw this on the Web, is this right for me? First of all, you know, like they say a fool - they say, someone who's his attorney is a fool for a client or whatever how it goes. I'm sorry, I'm a little nervous.

CONAN: Mm-hmm.

ROB: But I think the same thing could be the Web. I mean, you know, it's great that you can look up stuff but you still should relate that information to your health care giver because that could interact with the medicine you're on or it may not be even appropriate for you. So how people interpret that information is very important.

CONAN: So get out of the cocoon, talk to people is what you're saying?

ROB: Exactly. And, you know, I mean, 24/7 health care is great. But, you know, you - people have to realize there are limitations to what you can get in health care. You have to be your own patient advocate and you have to really, you know, educate yourself, yes, but also your doctor is there. This guy has experience. He is the one that went to school. And yet, no doctor is perfect, but no one else is either. You need to talk back and forth between your health care provider.

CONAN: Interesting. Ted?

Dr. EYTAN: You know, I think that the doctor has school experience but the patient has life experience. And so the thing that this is doing, which is really wonderful and I'm not unique - I'm one of 900 physicians in Washington, 13,000 permanent physicians nationwide - who - our role is changing in a good way. So we're becoming coaches and teachers and we're taking a new information people have and we're helping them judge what the quality of information is.

And sometimes, they bring us things we didn't know. And so I don't what to have a prescribed way a patient is supposed to behave with me because what am I missing. And there's - the health care history is littered with things that we have done that have not been helpful to patients.

CONAN: But do you - and I wonder if this applies to you as well, Rob, come into - you know, run into people who said, well, I need 250 milligram tablets of this particular drug that I would take four times a day.

ROB: And I would say, well, why do you need to take that? What are your signs and symptoms?

Dr. EYTAN: Exactly.

ROB: Is that really appropriate for you?

Dr. EYTAN: Exactly. Well, start with why. And if you listen for a while, they'll say because I'm worried because of X. And that's the thing that you can focus on.

ROB: Yes.

CONAN: Yeah. Rob, thanks very much for the call. And...

ROB: Okay, no problem.

CONAN: ...fear plays a large part. People are frightened a lot of the time of the implications of what they are feeling.

Dr. EYTAN: I agree. I mean, as I say, you know, if you walk into any waiting room in any medical center, 10 percent of people are scared to death because they have no idea what they have. And let's not forget that. And so half of what we do is making people feel reassured that they have access to the right information, that it's comfortable for them and it's what they need. And when they leave without that reassurance, it's just going to cost more and more of their time.

CONAN: Let's go now to Paula(ph). Paula with us from Worcester, Massachusetts.

PAULA (Caller): Yes. You know, I was calling in reference to the access to the Internet playing a role for physicians providing good care also because, for example, I'm a Parkinson's specialist and I provide deep brain stimulator surgery and Botox and clinical trials and that kind of thing.

But I actually Internet-access with our satellite facilities to coordinate, you know, in rehabilitation services, psychological support services, in nursing oversight and home education for self-injection protocols, that kind of thing, and find that it's hugely valuable, especially when you're in kind of a funneled system where you're the only specialist around and you have a giant catchment around you. You don't want to be, kind of, providing substandard care of the community and then say, well, you know, if there's a problem, we'll just send them to the university hospital and then they're not our responsibility anymore.

I try to work through the satellite hospitals and community where (unintelligible) specialists, especially the other neurologist, by the doing the Internet services sending them, for example, you know, Academy of Neurology algorithms for treatment and protocols for titration of medications and communication access for lab results and database, for example, on how patients' activities of daily living are in reference to their current treatment guidelines.

Because a lot of times, even as a specialist, when I have many more minutes to spend with each individual patient than somebody out in the community, it's hard to get all the information you need. And even worse if somebody is sent from a facility with, say, an aide who had never worked with them before and has no clue what's going on.

CONAN: So it sounds - if I'm hearing you correctly, it sounds like you recommend specific Web sites or places they should go for further information.

PAULA: Right. And we've created our own, too. In fact, you know, one of our new Web sites - and I'm going to be rolling out - aside from providing a database that patients can log into to help us with monitoring new treatment protocols is, you know, for new patients coming in that before they come into their visit, they can answer a whole series of questions on an Internet, you know, safeguarded, hit-guarded(ph) Web site that allows them to do a history and kind of review all their medication records and stuff like that so that we don't have to spend that time in face-to-face office visits addressing those issues, which can be done ahead of time.

CONAN: Ted Eytan, will the same principles apply for a family doctor like this?

Dr. EYTAN: Group Health has been doing that for a year. We have an online electronic Health Risk Appraisal. Kaiser Permanente has launched My health manager. We want to embrace all this technology. We want patients to be with us wherever they want to be rather than we are. It's a better way to do health care. I think to the caller, it's envisioning the health system where that specialty expertise is accessible wherever the patients need it. It's much better.

PAULA: Exactly. And we're also doing telemedicine for stroke intervention which is a similar model where you have the specialist at the university hospital, you have the video monitoring in the emergency rooms and the community hospitals all over the country that are contracting with us. And we're providing those, you know, one-on-one services via the Internet, including MRN imaging, Acute CT, transport, you know, instructions, et cetera.

CONAN: Well, Paula, thanks very much for the call.

PAULA: Thank you.

CONAN: We're talking today about Google M.D. You're listening to TALK OF THE NATION from NPR News.

Let me just re-identify our guest, Dr. Ted Eytan, and he is medical director of Health Informatics - that's a new word for me - and Web Services for Group Health Cooperative, a nonprofit health care system. And he is with us here in Studio 3A.

Let's see if we can get another caller on the line. And this is Fernanda(ph). Fernanda with us from San Francisco.

Hello? Hello, Fernanda?

FERNANDA (Caller): Hello.

CONAN: Hi. You're on the air. Hello? I didn't know there was an ice storm in San Francisco, too. Let's see if we can go now to another caller. And this is Rose(ph). And Rose is in San Carlos, California.

ROSE (Caller): Hi.


ROSE: I'm on my cell phone so I hope the connection is okay.

CONAN: I hope so.

ROSE: I was a social worker in health care for many years and I just had a couple of ideas. Knowing that patients are often going to be coming to the doctor's office using the Internet which I think everyone's agreeing is a blessing and a curse. I think it would really behoove - and this is kind of piggyback from the previous caller - doctors' offices to have some sheets prepared that they can give patients that refer them to really credible Web sites, you know? Because you type in something and, you know, you get 40,000 hits and, you know, a patient doesn't even know where to go and what's credible. They kind of get lost in this maze of information. They don't quite fully know how to interpret. I think...

CONAN: Yeah. The new study we were talking about earlier showed a lot of people who are both confused and overwhelmed, not a majority but a lot of people, nevertheless.

ROSE: Absolutely. And I think that when you go into the doctor's office, doctors knowing that many patients are going to be using the Internet should have - you know, granted it would be hard or easier for specialist than generalist, but to have sheets saying, now, here are like the six named Web sites to go to. That would be one idea that I think should be - some of the doctors just kind of get on board with.

And the other thing is that, you know, the patient information that sort of form you fill out when you're a new patient when you go to the doctor that it might be helpful to include some questions on there about, you know, how do you get your health information other than from your doctor. And that could be really important point of discussion between the patient and the doctor. If a patient says, you know, oh, from my friends, oh, I got in the Internet a lot or, you know, whatever. That that could be addressed and you could really help focus that patient kind of away from maybe, you know, quote, unquote, "services and information" that might not be really reliable and help really focus them in a good way on how to get information other than from the doctor.

CONAN: Okay.

ROSE: So those were just my comments.

CONAN: Rose, thanks very much.

ROSE: You're welcome.

CONAN: One of the - I just wanted to ask you about that. Is - as you refer people to other Web sites, to some degree, you're lending credibility. Would you rather send them to something that you're much more confident in? I mean, there's all kinds of Web sites out there.

Dr. EYTAN: Sure. Well, two things. I think you're now seeing this second half part of the conversation, there is this wave of innovative practitioners who are embracing this technology and thinking about how they can help patients, which is great. Number two, we do both. So we do have after-visit summaries that are printed that refer patients to our health encyclopedia, Healthwise Knowledgebase. And I ask them to look at that but also e-mail us with any questions.

So we don't say what - where you should go, where you shouldn't go. But we say where do you want to get information. The thing I'd also add is that I've said since I've been practicing using our new system that do access the Internet. It's like the sixth vital sign.

CONAN: Hmm. Okay. The sixth vital sign, that's interesting. Ted Eytan, thanks very much for being with us.

Dr. Eytan is medical director of Health Informatics and Web Services for Group Health Cooperative, nonprofit health care system based in Seattle. He was joining us here in Studio 3A.

Coming up, our every other Thursday visit with "Ask Amy's" Amy Dickinson. We'll get her take on the back from the dead kayaker who turned up in London, and those moments when all of us just might want to run away and disappear.

Stay with us. It's the TALK OF THE NATION from NPR News.