Find the Answers - Use the Internet Quickly and Effectively
Paul Kleeberg, M.D.
October 3^rd, 2003
Revised: September 27^th, 2003

The frames-based presentation version of this talk: http://fpen.org/aafp/find-frames.html
Printer-friendly version of the handout (this document): http://fpen.org/aafp/find.html

Outline

Objectives

Why do I use it?

Finding what you need

Search Engines

Metasearch Tools

Directories or Metaindicies

Subscription-based Services

Medline

Judging Quality

Keeping it Handy

In Summary

Objectives:

At the end of this talk, you should be able to:

• Understand the differences among Web search engines, Web directories and Medline search tools.
• Understand which situation is best served by which tool.
• Identify techniques for efficient Web searching.
• Know how to judge the quality of what you find.
• Know how to store links to your favorite sites on the web for rapid access from anywhere.

Why do I use it?

• Because it is fast
Faster than grabbing a text book and searching the index.
Faster than calling a colleague or waiting for one to get out of a room.
• Because there are excellent resources available to me from any computer connected to the Internet.
• Because it is current.

Finding what you need on the Web

There are five general classes of tools that you can use to search for information.  These are crawler-based search engines, meta-search tools, directories, subscription based services, and Medline search tools.  Each has its own strengths and weaknesses.

• Crawler-based search engines more or less randomly index the Internet allowing you to search a broad range of web sites.  They are not exhaustive.
• Metasearch tools send your search to several sites simultaneously and return the results together.
• Directories or metaindicies use a panel of editors to gather links to other web sites and group them according to content.  They may provide their own internal search engine that searches only the sites to which they have pointers.
• Subscription based services are designed to be one-stop-shopping resources of reliable information for health care providers.  These services will provide access to a variety of tools for a fee.
• Medline search engines allow searching of over 4600 biomedical journals.  Carefully indexed but generally less current than the Web.

Crawler-Based Search Engines

Crawler-Based search engines randomly index pages on the web.  They are not exhaustive and different engines will index different sites.

To use a search engine you must understand how your results are arranged.  Many search engines will arrange results according to the number of times your search terms appear in the document.  The more a term appears on a web page, the closer that page moves to the beginning of your results.  Some sites will give priority if your terms appear in the title.  With some, not all your terms have to appear in the document.  That rare medical term might not be present in your first few results.  Examples of some popular search engines are Google (http://www.google.com), AltaVista (http://www.altavista.com), and AllTheWeb (http://www.alltheweb.com).

Google has been the top choice for web searchers.  It indexes the largest collection of web pages of any crawler-based search engine and it was the first to use a unique method for ordering the results, ranking them according to the number of other sites that link to the target document - a type of peer review.

Google provides a search button you can place on your Mac or PC Web browser toolbar.  This allows you to initiate a search without having to first go to the search engine's web site.  This is a real time saver.

You will get better results if you keep these things in mind:

• Use terms that are specific to your topic and only those terms.  It is inefficient to use free text entry when only one or two terms will do.
• If you expect a word pair to occur together, define the terms as a phrase.  This will retrieve only the documents in which the terms appear in exactly that sequence.  With Google you can use double quotes such as "herald patch" and avoid getting links to newspapers.
• Specify the domain of the search results.  Using Google, type: fibromyalgia and site:.gov or "insulin pump" site:diabetes.org
• Get comfortable with one or two search engines and become familiar with some of the more advanced search techniques to help narrow your search.

Meta-search Tools

These tools are useful if you wish to canvas more of the Internet with your search.  Since none of the search engines exhaustively index the web, it is sometimes valuable to send your request to more than one search engine to find a relevant article.  These tools will send your search request to several search engines and collect all the results.  This can save you lots of time but your search will be less precise.  It will not allow you to tune your search using any of the added features that individual search sites may offer.

There are two tools you can use to perform this type of search:  A web site or an application that resides on your computer.

• Meta-search Sites are web sites where you enter your query.  Two examples of these sites are Metacrawler (www.metacrawler.com) and ixquick (www.ixquick.com)
• Meta-search Applications are applications that will reside on your computer.  They allow you to have greater control over the sites to which your request is sent and it may save you time if your Internet connection is slow.  One example of this type of tool is Copernic (www.copernic.com).  Another example for the Macintosh is Sherlock (www.apple.com/sherlock/).

Directories or Metaindicies

These sites can serve two purposes: they allow you to browse for information and allow you to search their collection.

• Browsing:   Resources are arranged according to topics so exploring is a lot like wandering through a section of the library.  You may find items of interest that you bookmark so you have direct access to them when you need them.  Examples might be patient information sites, a specialty society or a site listing CME opportunities arranged by topic, date and/or location.
• Focused Search:  Most of these sites allow you to limit your search to the contents of their sites or a particular directory within the site.  This can really help to hone your search.  Searches can sometimes point you to specific pages of on-line medical texts such as the Merck Manual (http://www.merck.com/pubs/mmanual/) or Abstracts of the Cochrane Collaboration (http://www.cochrane.org/) or the on-line Emergency Medicine Textbook (http://www.emedicine.com/emerg/).

My favorite metasite for patient information is Medlineplus (medlineplus.gov).  Other examples of a metasites are Yahoo! Medicine (http://dir.yahoo.com/Health/Medicine/), the Hardin Meta Directory (http://www.lib.uiowa.edu/hardin/md/) and HealthWeb (http://www.healthweb.org/).

Subscription-based Services:

These services are designed to be one-stop-shopping resources of reliable information for health care providers.  These services will provide access to a variety of tools for a fee.  Many providers find these services to be quite valuable but I rarely use them.  I find it easier to get my answers elsewhere but many busy physicians and academicians swear by them.  An example of one that is quite popular is MD Consult (http://www.mdconsult.com/) which is available for free for licensed physicians.  Access to the service can be obtained by regestering with Merck at http://www.merckmedicus.com.

An article in the July/August 2003 issue of Family Practice Management (http://www.aafp.org/fpm/20030700/49prac.html) described four sites with evidence-based clinical resources. These are:

• Clinical Evidence (http://www.clinicalevidence.com)
• InfoRetriever (http://www.infopoems.com)
• PDxMD (http://www.pdxmd.com)
• UpTpDate (http://www.uptodate.com)

Medline Search Engines:

Unlike Internet search engines, Medline search tools search over 4600 biomedical journals and will display your results in a chronological order with the most recently indexed article appearing first.  Although this method for arranging results may make it more challenging to find a relevant article, it allows you to scan the recent publications in your area of interest by running your search at regular intervals.  Most of the Medline search engines will allow you to narrow your search to particular journals, age groups and article type among other things.

My favorite free Medline search tool is PubMed (http://www.ncbi.nlm.nih.gov/PubMed/).  PubMed allows you to save your search strategies as “favorites” or “bookmarks” in your browser allowing you to check for recent articles with a single click of a mouse.  Instructions explaining how to do this are available on-line.  Another method is to use the “Cubby” feature.  I have not used it but I understand it is an easy method for saving and retrieving searches.

Here are two examples of saved searches as URLs:
Family Practice and Medical Informatics
Medicine and Internet

Once again though there are multiple tools that can be used to search Medline, it is best to become familiar with one of them so that you may refine your search techniques which will increase your efficiency.

Judging Quality

Just as one would evaluate a medical journal or any other article appearing in printed media, it is important to look at a number of things to assess the reliability of a document or a site.  Some questions to ask when evaluating a document are:

• Who runs the site?  Is it run by a well-known non-profit institution, a branch of the federal government, by a health system, a commercial organization or an individual?
• Who or what pays for the site?  Is it supported with public funds, donations or by commercial advertising?  Is it supported by sales to site visitors?  If it is sales driven, do sales appear to influence the content?
• Who is the author of the content?  When looking at health information, does the site identify the organizational source of the information?  Does it identify the author?
• How current is the content?  Are there dates on the document and is it current?
• Is it at an appropriate reading level?  This is important if you are giving the document to your patient.  Different patients have different abilities of comprehension.

None of these are make or break issues but are things to keep in mind when assessing the reliability of a document.

When choosing a web site to recommend to your patient there are a few additional details to keep in mind.  There are:

• Is the site well maintained?  Does the web site appear current?  Have you found any dead links on the site?  Is there a way to contact the Webmaster to report problems?
• How is the information selected?  Does the site have an editorial board?  Is the information reviewed before it is selected?
• What information does the site collect about you and why?  What types of questions were you required to answer before you could view their content?  Do they have a privacy policy?
• Is it easy to navigate?  How difficult is it to find the information you need?  Does the site download quickly?  Are the pages laden with unnecessary graphics that could make it slow on a dial-up telephone line?
• Is there a clear distinction between advertisements and content?  When you look at a page on the site is it clear when the content is coming from a non-biased source and when it is provided by an advertiser?

Finally, when evaluating web sites, a quick glance of the site’s domain may be informative.  Some common examples are:

.com or .net	Commercial site
.edu	Educational institution
.gov	Government site
.org	Non-profit organization

In addition the two-character top-level domains can indicate the country of origin.  Some examples are:

.us	United States
.uk	United Kingdom
.au	Australia
.jp	Japan

For more information about top-level domains see the Internet Assigned Numbers Authority at http://www.iana.org/.  You will find a listing of the top-level domains (TLD) for countries there as well.

Keeping it Handy

There are several things you can do to make the Internet more convenient to use.  Among them are:

• Organizing your favorites (or bookmarks):  This will help you find what you are looking for but these can be difficult to maintain if you move from computer to computer.
• Use your browser toolbar:  You can place favorite search tools or directories on you browser toolbar.  Techniques to do this and other tricks to streamline your browsing experience were described in the article “Supercharging Your Web Experience” in the September 2001 issue of Family Practice Management.
• Use a Personal Bookmarks Website:  Many of us need to use multiple computers at multiple locations.  Bringing our bookmarks (or favorites) from one site to another is impossible.  One solution is to use a website that allows you to build a page of personal bookmarks that are available to you from anywhere in the Internet.  My personal favorite is MyHq (http://www.myhq.com).  Creating, editing and rearranging them is quite simple and can be done from any computer at any time.  The page loads fast and is devoid of any advertising.  Definitely worth a look.

In Summary

The Internet provides us with access to incredibly rich, reliable and up-to-date medical information.  Finding it can be a challenge but once you are familiar with some basic search skills, information on the Internet can be accessed more rapidly that finding the same information in the books on your desk.

• Handouts from this lecture with active links: http://fpen.org/aafp/find.html
• Search Engine Watch http://www.SearchEngineWatch.com
• Supercharging Your Web Experience in the September 2001 issue of Family Practice Management. http://www.aafp.org/fpm/20010900/31supe.html
• Evaluating Health information a new topic area on MEDLINEplus: http://www.nlm.nih.gov/medlineplus/evaluatinghealthinformation.html
• Practical Evidence-Based Internet Resources in the July/August 2003 issue of Family Practice Management. http://www.aafp.org/fpm/20030700/49prac.html
• 10 Things To Know About Evaluating Medical Resources on the Web from the National Institute of Health’s National Center of Complementary and Alternative Medicine. http://www.nccam.nih.gov/health/webresources/

Paul Kleeberg, M.D.              O   o          paul@fpen.org
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