The Electronic Pediatrican Returns

Medical Web sites for pediatricians:
The great, the good, and the rest!

By Andrew J. Schuman, MD

It is fair to say that many if not most pediatricians access the Internet regularly. It is no longer a matter of early adopters delving into the brave new world of the net; nowadays everyone–professionals, patients, and children–are dot com aware. We've all had the experience of being told by our patients’ parents that they learned of some new recommendations or new information by exploring the World Wide Web. So for many of us it is no longer a luxury to surf; it is virtually required reading just to keep in touch with the information that is being viewed by our patients and colleagues. I’d like to offer an overview of the best medical Web sites for physicians.

The best

We pediatricians are indeed fortunate that our professional organization, the American Academy of Pediatrics, is one of the most aggressive medical associations in terms of delivering useful professional and clinical information to its rapidly growing online audience. If you haven't visited www.aap.org recently, you'd be well advised to do so. Not only was the AAP one of the first sites to offer full online text of a professional medical journal (Pediatrics), but it also provides Web-only "electronic pages" that enable important peer-reviewed studies to appear online soon after they are reviewed favorably and edited. This considerably shortens the traditional publication delay that is associated with clinical studies. The AAP now also has a full-text version of Pediatrics in Review, and for a reasonable fee of $59 per year, its monthly online neonatology review series, called NeoReviews, is a terrific resource for information on newborn care. The AAP site also publishes full-text clinical guidelines, membership alerts, and a wide spectrum of recent and archived information for parent and pediatrician. In the members-only area there are regional and national discussion groups, and the visitors can search for e-mail addresses of member pediatricians.

For many years physicians have had the ability to perform Medline and Pubmed literature searches via the National Library of Medicine’s Web site (www.nlm.nih.gov). Such a literature search is easy to accomplish and produces printable lists of related articles based on your inputted search criteria with an accompanying abstract if available. However, if you want the full article you typically need to supply the search results to your hospital librarian, and days or weeks later the article will show up in your mailbox. This delay can be very annoying, especially when articles are needed to resolve clinical questions. A terrific help has been www.mdconsult.com, which features full-text online access to over 38 popular medical textbooks (several popular pediatric ones, including the Harriet Lane Handbook, the AAP’s Red Book, and Nelson’s Textbook of Pediatrics), as well as 48 popular medical journals. A subscription costs $199 per year, (or $19.95 per month, or $6.95 per day), and is well worth the investment.

Andy Spooner, a pediatrician who has been instrumental in promoting the use of the Internet to physicians, maintains a pediatric medicine site called PEDINFO, located at www.pedinfo.org. Be careful, though, because there is an unrelated site called www.pedinfo.com that appears to present similar content but is not the real thing. PEDINFO.org presents a comprehensive guide to the Internet for the medical professional, with links to dozens of professional organizations, pediatrician sites, disease-focused sites, and online textbooks and journals. Particularly useful is the "What's New" section, which displays new sites of interest to pediatricians and is updated frequently.

For the latest in general medical news, conference reports, and pediatric news, I like Medscape at www.medscape.com. It has a clean, uncluttered interface that is easy to navigate: One can quickly find what one is looking for. Medscape also features a comprehensive CME area, interactive cases, treatment updates, and much more.

The really good

Contemporary Pediatrics has long been the most popular professional journal for pediatricians. Articles are timely, well written, informative, and clinically relevant. A free subscription-only Web site, www.contpeds.com features a searchable archive of articles going back to 1995. This makes it really easy to locate the article you are looking for, and enables you to clear away some shelf space that now holds your old issues. Articles are embellished with pictures, charts, and flowcharts, just as in the print publication. The site also features about 20 of the most recent Parent Guides and daily medical news from Reuters. Like many medical sites, the Contemporary Pediatrics site has an online forum area. Notoriously, online medical forums are infrequently accessed by physicians, and the Contemporary Pediatrics forum area is no exception. For pediatricians who would like to have meaningful dialogue with other pediatric professionals, I suggest you enroll in PedTalk, an e-mail discussion list maintained and moderated by Chip Hart (see enrollment instructions at www.pcc.com/lists/pedtalk.html).

Another useful feature of the Contemporary Pediatrics site is full online access to a CME area developed in cooperation with the Johns Hopkins University School of Medicine. CME tests can be taken online to speed processing. The site would benefit from some online-only content, such as online monographs dedicated to specific issues in pediatrics, or an extensive Electronic Pediatrician area!

The Contemporary Pediatrics site is part of the PDR.net supersite (www.pdr.net) which, among other things, provides online access to Physicians’ Desk Reference and to articles from about 10 different journals published by Medical Economics, and offers free searching of Medline and other databases.

A distant cousin to the Contemporary Pediatrics site is QD Online, developed by Medical Economics for America Online users. QD Online provides very extensive news and information for all physicians as well as specialty-specific news and information. An added bonus of the QD Web site is that it provides free access to MD Consult full-text articles and search engines at no added cost. QD Online can be accessed outside of AOL by using the url www.qdonline.com, although access still requires input of your AOL user name and password. Besides clinically relevant news and information, there are well-thought-out management sections, with advice on improving the business end of your practice, and an interactive medical education area called CyberRounds.

The rest

Several years ago, motivated by a desire to be a Web medicine pioneer, I started my own medical site called Mednexus. Without financial backing, and with the naive impression that physicians would literally jump at the opportunity to view medical content online, I tried to develop the site's content and solicit advertisers. After a year or so, the site went belly up, despite some really good reviews and a respectable hit rate. Now www.mednexus.com points to a site I developed as a community resource for parents in my home state of New Hampshire. Having paid MY dues, I have enjoyed my return to objectivity and relish the idea of critiquing other people’s efforts. I base my evaluation of medical Web sites not on their appearance and use of layout or design, but rather on the usefulness of its content to me as a practicing physician. I have long endured the commercials and print advertisements for WebMD (www.webmd.com), but despite its appealing (but very complicated) interface, until recently there has been little content to hold my interest. I am encouraged by the appearance of an online version of Scientific American Medicine, some free online CME, and the promise of some clinically useful sections (prescription and lab test ordering sections). Likewise, Physicians' OnLine (www.pol.net) has migrated fully to the Internet (and has been acquired by www.mediconsult.com), but unlike several years ago when it was the only game in town, it has little to offer in terms of original material.

I'm sure I missed several sites that deserve mention and placement in the above categories, and would appreciate hearing from readers about their own opinions. Please feel free to contact me at ajs@mednexus.com.

DR. SCHUMAN is Adjunct Professor of Pediatrics at Dartmouth Medical School, Lebanon, NH, and practices pediatrics in Manchester, NH. He is a Contributing Editor for Contemporary Pediatrics.

Andrew Schuman. Medical Web sites for pediatricians: The great, the good, and the rest!.

Contemporary Pediatrics

2001;8.