Introduction

There is a lot of health information available on the internet, but the unwary surfer may find him or herself less well informed or at least more confused than when she started! As with all areas of on-line publishing, there is a lot of opinion sold as fact, and you need to be aware of this when reading anything. There is a particular difficulty in the area of healthcare, as things are rarely black & white.

Balance of risks

When making any medical decision, doctors decide whether or not the risk of treatment is balanced by the good which will come from the same. No-one inherently knows where the particular balance lies for any situation - every one is individual. What we do have to guide us is published evidence that says 'in the majority of cases this is so'. This published evidence comes from clinical trials or studies which, when properly conducted, can guide those in similar clinical scenarios.

These studies are published in medical journals who 'peer review' all that is accepted for publication. This means that they have been scrutinised by experts in the field who agree that the trial was well conducted and the results are likely to be valid (hence they may be used to guide other doctors).

Take for example a lady who is irregularly contracting at 32 weeks gestation. We know from well-organised trials that if she delivers early, her baby has a much better chance of surviving if mom is given a course of steroid injections prior to delivering. The clinical studies have been done, comparing survival in babies whose mothers were not given steroids to survival in babies whose mothers were. Of course we can't always tell which moms contracting early are likely to go on to deliver, so many might receive the treatment unnecessarily.

Evidence-based medicine

The above example is one which is well proven. Many decisions we make are not so evidence-based. Experience certainly counts for a lot too, because hard evidence from clinical trials is not always there. We doctors need to continually ask ourselves, however, if what we are doing is based on evidence or if we are just doing it because 'it's always been done that way'.

Evidence-based medicine is a buzzword in the medical speciality at the moment, but not without good reason. Justification of clinical decision-making is important. There are many interventions or investigations that are carried out without good evidence of benefit (e.g. antenatal cardiotocography or CTG, progesterone for recurrent miscarriage). Similarly there are many which have been shown to be useful which are not always used (eg. external version reduces caesarean section rate in breech presentation).

So finally, when assessing medical advice on the internet, consider the following:

• Only your doctor knows your full case history, has done the exam, has the test results in front of him. No-one can give patient-specific advice.
• Ask the background of whoever is giving the advice. How often do they see this? Is what they're saying backed up with clinical trial evidence?
• Arm yourself with the information and use it to get the most from your own doctor. It cannot be a replacement for her opinion.
• Don't be afraid to ask questions of your GP or specialist - the only dumb question is the one you don't ask! If you tend to forget your questions, then take a list. Most doctors would rather you did this and went away with all your worries addressed. Even if this seems not to be the case, they have a duty to do so.

This material is intended for informational purposes only and is not a substitute for the medical advice of your doctor or any other health care professional. Always consult with your physician if you are in any way concerned about your health.