THE INTERNET is a rapidly developing technology that will have an increasing effect on our lives over the next few years. The potential for changing the way we work as doctors is only just becoming apparent but already there are a number of ways that it can be used in medicine. However, to the uninitiated it can be a minefield of unfamiliar technology and jargon. This chapter is meant to show what it could do for you and help you on your way if you are considering dipping your toes in the water.

What is the Internet?
The Internet (the “net”) is a world-wide network of computers to which an individual can connect to communicate with other individuals and computers anywhere in the world. Though it was originally conceived in the 1960s, it has only recently become a household name and a useful tool. There are a lot of myths surrounding the Internet and its content and a lot of talk about how it will affect our lives. No-one really knows for sure what impact the Internet will have on us and though it is not going to take over the world, we are all likely to be using it in some shape or form before long.

The cost of connecting
Any modern personal computer (PC) should be capable of connecting to the Internet but you will need a modem and a spare telephone socket. The modem is the piece of equipment that allows your computer to connect to the outside world via the telephone line. It comes either as a box that fits into the back of the computer or as a circuit board that plugs inside. You don’t need a separate telephone line though this is useful if you plan to use the Internet a lot as you can’t make telephone calls at the same time. To connect, you will need to buy a subscription from an Internet service provider. This is a company, for example Compuserve, through which you will be able to connect to the Internet. A typical subscription will be about £10 per month. Software to use e.mail and the World Wide Web is usually free. Once you are connected, you will also have to pay for the phone calls for the time you are connected (“on-line”) to the Internet but it should be at a local call rate. The following list shows the costs involved:

You may find the Internet somewhat addictive and the monthly costs can add up, even at local call rates. If you anticipate using the Internet for more than an hour or so per week, then go for a service provider that charges a fixed monthly rate no matter how much you use it. For further information on equipment, prices and details of suitable service providers consult an up-to-date computer magazine or a knowledgeable friend.

Uses for the Internet
To the average user, the Internet can be used for two main purposes: e.mail and the World Wide Web (the “web”).

E.mail is the electronic equivalent of the Royal Mail but is cheaper and much, much faster. It is used mostly for sending and receiving simple text messages but is increasingly being used for sending more complex forms of data such as pictures and full word-processor documents. It can be used to keep in contact with friends and colleagues, to request information from medical organisations or any other business or company that has an Internet site. Though some technically advanced practices may quote e.mail addresses in their job adverts, or send practice profiles by e.mail, it is not acceptable to apply for jobs or send CVs by e.mail, yet. It might make you look up to date if you quote an email address on your stationery.

The World Wide Web is what most people mean when they mention the Internet. It is the colourful graphic-intensive “front-end” of the Internet and is used by companies and organisations as a way of advertising themselves and for publishing information. As a doctor using the Internet the main problem is trying to filter through the huge amount of information available as much of it is unedited and uncensored. Here are some examples of the way the web is being used by the medical establishment:

Official Medical Sites
There is an increasing number of medical organisations that are using the Internet either to display information about their services or in more of a two-way process by allowing e.mail enquiries or the ordering of books and other publications. The Department of Health web site is one example though it is rather insipid. Far more advanced is the Royal College of General Practitioners’ offering, an example of what can be done, given a little imagination and a professional Internet design team. The site contains College press releases, details of courses and lectures, information on the MRCGP examination and even results of the most recent siting. There are several official American sites such as the American Medical Association and the Centers for Disease Control and Prevention that contain large amounts of useful information but clearly from an American point of view.

Medical Journals There is an increasing number of medical journals that have their own web sites but most are still reluctant to reproduce the whole text of their journals. The BMJ was one of the first sites to be set up and is probably the most sophisticated and progressive and is an example to other journals of how it should be done. Others include the Lancet and JAMA. There are a number of new medical “journals” that only exist on the Internet. Though they provide useful information and forums for discussion, their existence is precarious as they have virtually no advertising revenue and often survive only because of dedication on the part of the editorial teams involved.

Drug information
There are many good official pharmacological sites on the Internet, particularly in the United States. Drug companies are also waking up to this technology and are using it to advertise their products, in particular new drugs. Unfortunately it does mean that some patients will find this sort of information before you do. The Association of the British Pharmaceutical Industry has its own site with links to many other drug companies.

Medical Forums
An Internet forum is a site where users can exchange ideas and information on a common theme. It is a difficult concept to get across without actually demonstrating it but it does represent a powerful new way of exchanging information. A popular medical forum is the Compuserve “Doctors Lounge”, a private forum for UK doctors, but unfortunately only for Compuserve members. ePulse is an extensive new site launched in 1998 with many discussion forums and noticeboards. GP-UK is another well-established and busy forum.

Medline
Medline is well-known as a vast electronic library of medical journals, both English and International, from 1966 to the present day. Its power lies in the huge amount of information available and the ability to search rapidly for information and being able to access it on the Internet is a very convenient way of looking up medical information. If you are a BMA member, then you can access it via their well-designed web site using your standard web software.

Usenet Newsgroups
Newsgroups are a peculiar part of the Internet that are often used by official and unofficial patient support groups for the exchange of information about a wide range of medical conditions. It is becoming an increasingly common way for patients finding out about new treatments for chronic diseases but, because much of the information is uncensored, the reliability of the information is often questionable.

Non-Medical Sites There are literally thousands of potentially useful non-medical sites. Most national newspapers have good web sites, especially the Times and the Telegraph. Companies, businesses and thousands upon thousands of user groups, hobbyists and individuals are also joining in and the list gets longer every day. You can look up travel information, read on-line magazines, order brochures or other product information, book holidays, look up travel and weather reports, all at your convenience without having to leave your house.

Buying via the Internet Until recently, the transfer of money over the Internet has not been considered secure enough for general use but it is now becoming more acceptable to use a credit card to order products or services from companies such as travel agents, book stores and computer equipment suppliers. The overall amount of trade passing across the Internet is currently quite small and the predicted boom has yet to happen but this area is expanding.

Creating Your Own Site
Many Internet service providers allow you to set up your own web site which can be accessed by anyone in the world. Many web sites are quite complex pieces of programming but to set up a simple site requires very little expertise and the software to do this is easily available, either from your service provider or via the Internet itself. Some surgeries have already created their own web sites as on-line versions of their practice leaflets.

The Future
It is clear that the Internet will continue to expand and increase its influence on our working and home lives. Rather than reaching for a textbook, we will search an on-line medical library and will be able to find the most esoteric of subjects. We will hold video consultations with distant hospital consultants, a technology that is already available though in a basic form. Hospitals and surgeries will use it to send patient information of all types, especially complex data such as ECGs and Xrays. We may even be able to earn PGEA points by remotely attending courses on- line. Our home lives will become more involved with the Internet. It will be used increasingly for buying and selling products and services: selecting and ordering weekly shopping and home- banking being two examples that are already being tested. It is beginning to be used for video- telephoning, technology that enables you to see and hear whoever you want to chat to.

The Present
It is easy to gaze into the crystal ball to predict the future of the Internet but the present reality is somewhat different. Looking from a pessimistic point of view, computers are still expensive, relatively unreliable pieces of equipment that require constant attention, a not inconsiderable amount of technical know-how to run efficiently and they suffer from an extraordinary rate of depreciation. The Internet can be slow, and is filled with a vast amount of useless information that makes searching through it difficult. However, the nature of computers and the Internet means the situation is developing and improving at a remarkable rate and whether you decide to take the plunge now or wait a little longer, you will benefit from this remarkable technology. But then, as you probably realise, I am slightly biased.

Useful World Wide Web sites
The following directory is designed to show you the type and variety of both medical and non- medical Internet sites already available and should assist you in developing your own directory of personal favourites. The amount of information on the Internet is vast and because there is no central directory in which to look, finding a particular topic can be difficult. The best way to search for information about a particular site is either to use a search engine (such as Yahoo) which will do the searching for you, or simply to browse from one site to another (this is the true meaning of “surfing”) using links that connect related sites. To visit any of the following sites you will need to type in the full address (an “URL”) into the appropriate part of your browser. The NASGP’s URL is http://www.nasgp.org.uk. Below is a list of useful sites that are all linked to the NASGP’s site. Go surfing…

Medical Journals:

British Medical Journal
That well-known blue-and-black journal manages the transfer to the Internet very successfully.

The Lancet
Joining the fray but has to do some catching up before it can match the BMJ.

JAMA
Well-designed, like many American medical sites.

New England Journal of Medicine
Somewhat dry but more easily accessible than the paper version in your local postgraduate library.

Medical Organisations

British Medical Association
As good as the BMJ, not surprisingly, and constantly improving.

Royal College of General Practitioners
A relatively new site but very well-designed with loads of information about the College’s activities. Who says they don’t know what the College spends your money on? Go and see! Useful too for looking up MRCGP exam results.

Department of Health
Rather dry but does contain useful government press releases but can you get your hands on them before your patients?

Communicable Disease Surveillance Centre
A good source of information on world-wide infectious diseases but still not as useful as the pull-out supplements in Pulse and G.P.

World Health Organisation The electronic voice of the WHO is well-established and contains a number of good links to other related sites.

U.S. National Library of Medicine
Not quite as comprehensive as you might hope but still a useful source of information.

U.S. Food and Drug Administration
Worth visiting for information on drugs not yet licensed in the UK.

U.S. Centers for Disease Control and Prevention
Contains more information than our CDSC but from an American point of view.

American Medical Association
The American equivalent of the BMA and home of JAMA and a number of other specialist medical journals.

General Practice-related Sites

National Association of Non-Principals
What can I say! Essential Information on the work that the NASGP is doing, with on-line discussion forums, contacts for all non-principal groups and a who’s who.

Doctors' Independent Network
A typical example of an Internet-only G.P. journal.

UK Primary Care
An independent on-line journal mainly used as a forum for discussing medical topics.
The Hacienda
A Yorkshire GP’s site with excellent links to other GP sites

GP-UK
A successful attempt at on-line medical forum run by the University of Newcastle. All areas of medicine are covered but with emphasis on healthcare computing, clinical problems, audit and education.

General Practice On-Line
An Internet-only G.P. journal, but suffers from infrequent updates.

Other Medical Sites

BMA Library Free MEDLINE Service
If you need just one reason for getting on-line then this is it. A very well-designed site that makes searching Medline almost easy. For BMA members only.

The Virtual Hospital
An attempt at creating an on-line medical library than only just works as the content is still rather patchy.

The Visible Human Project
Probably the most popular medical site for the general public. Contains detailed images from the project to map the entire healthy human body by CT scan, MRI and conventional photography. Grizzly but fascinating.

Medical Web Site Lists

Achoo On-line Healthcare Services
From the makers of Yahoo comes a dedicated directory of medical sites. Not surprisingly it is very good.

MedWeb: Medical Libraries
A good American-based medical directory but could do with updating a little more often.

UKMedW3 - The Gateway to Medicine on the Web
Comprehensive, well-managed and aimed at UK G.P.s. Published by GP-UK (see above).

Web Search Engines

Yahoo!
Probably the best and fastest search engine there is but suffers from poor filtering of information.

Alta Vista
Slower than Yahoo but often used in conjunction with it.

Lycos, Inc.
Similar to the above but often better at searching UK sites.

UK Plus
An excellent engine for hand-picking sites in the UK (and elsewhere) with an Advanced Search option which allows one to refine a search with an exact phrase match.

Non-medical Sites

The Times
The ubiquitous broad sheet embraces the Internet with enthusiasm.

Electronic Telegraph
A more sophisticated design than the Times, and an easier crossword.

CNN - World News
Current world news at your fingertips.

New Scientist: Planet Science
The consumer technology magazine on-line.

YELL, Yellow Pages UK
Apparently contains the contents of every single Yellow Pages directory but in practice is slow and difficult to search.

The Met. Office
Contains up-to-date weather information for the UK and satellite weather images.

The AA
Contains information on AA services but you can’t join or order products on-line. Its most useful facility is the traffic information section.

Vauxhall Traffic Information UK map
A Vauxhall-sponsored electronic version of Traffic Master, the traffic information service.

Waterstone's Bookstore
Order your medical or non-medical books only but you won’t be able surreptitiously to read the contents instead of buying them.

Amazon, the Biggest Bookstore on Earth
With mail order, from the US, cheaper than UK shops

Inland Revenue
No, you can’t badger the tax office from here, or send them your tax return by e.mail but there is still some useful information, but not a lot.

UK Government site index
Set up under the last Conservative Government this site contains vast amounts of information about most government departments and organisations, including all the press releases. Its worth a surf.

Tesco On line shopping
Available everywhere for selected items delivered by mail and, in some areas, for everything Tesco sells. You’ll never need to push a trolley or stand in the checkout queue again!. Reputed to be a great success in London and Leeds.

Edward Penman

Update from the NASGP Webmaster May 1999
With the speed that the Internet is developing it isn't surprising that some of the above links are out of date, and there are certainly many more other sites worth mentioning. Rather than rewriting this chapter I have decided to leave it as it is and to direct you to the NASGPs Internet Links web page which is much more up to date.