“Adapt or perish, now as ever, is Nature’s inexorable imperative.”

— H.G. Wells

everal years ago, I listened to a colleague complain about a patient who brought in a copy of the results of an Internet search and wanted to know if the care about to be provided would follow the recommendations discovered in the search.

My colleague’s concerns reminded me of two other incidents. One occurred when I was a child in the doctor’s office, and my mother asked the doctor about an article in a popular lay publication. I remember the doctor’s frustration as he stated that he did not have time to read his medical journals, let alone magazines. The other incident occurred during a lecture that I attended in medical school. The physician speaking warned us that we would have to be prepared to deal with patients who would bring in an article from Reader’s Digest and want to know why we were not practicing according to its recommendations.

While these incidents were separated by a number of years, the issues raised by these three physicians remain with us. Many of our patients are going to do their own literature searches, and some of them are going to be very persistent in their attempts to get us to practice in accordance with their findings. Many would consider the statement of Wells as little more than a well-accepted cliché, but we may have to adapt as Mr. Wells and others have advised.

Just the FAQs
Edward R. Murrow once said, “Our major obligation is not to mistake slogans for solutions.” How can we move from Wells’ warning to a solution to the problem of helping patients to sift the wheat from the chaff on the Internet? The development of well-researched fact sheets by the Committee on Communications is one way to assist our patients in this process by putting good information out there for them to review. During the tenure of R. Lawrence Sullivan, M.D., as Chair of the Committee on Communications, he proposed the development of a series of fact sheets, or frequently asked questions (FAQs), that would be available to patients. These would be more concise than the already existing patient education brochures and would focus on common, specific patient questions. The committee proceeded with the project by designating one of its members to draft a sample set of FAQs on intubation.

The intubation fact sheet was discussed and revised by the committee. The committee also developed a list of topics that the members felt were of general interest to patients. Among the topics suggested by the committee were spinal anesthesia, epidural anesthesia, analgesic adjuvants used by pain management physicians and nothing-by-mouth guidelines. The members of the committee divided the topics among themselves and drafted fact sheets for further development by the committee as a whole. The committee members reviewed the fact sheets electronically, and each one was refined, taking the committee’s suggestions into account.

Communications Associate Roy A. Winkler and Public Relations Manager Donna E. Habich of the ASA Communications Department reviewed the FAQs to verify that they were in appropriate lay language and that they were in a standard corporate language and format established and used by ASA.

The FAQs will undergo final review and approval by the current Chair of the Committee on Communications, Michael H. Entrup, M.D. They will then be forwarded on to Keith J. Ruskin, M.D., Chair of the Web Site Editorial Board, for review and approval. Upon completion of this process, they will then be posted on the ASA Web site and made available to our patients.

Making Good Information Available
The upshot of this is that ASA will provide its patients with information that is based on clinicians’ perceptions of the questions our patients are asking. The information has been written by clinicians and peer-reviewed by clinicians. The information has been reviewed to make sure it is in a patient-friendly format and conforms to ASA standards of communication. This is an example of how ASA is trying to serve the needs of its members and its patients by acknowledging the reality of what our patients are doing and striving to make sure that there is good information available.

The volume of information that physicians need to consider is only going to increase, while the amount of time available for reviewing this information is at best going to remain constant. A number of our patients have always wanted to do personal literature searches to be more informed about health care; this desire by our patients is very likely to increase. The information available to them is only going to grow, and there is no mechanism in place to ensure the quality of this information.

Rather than feeling threatened by this phenomenon, ASA has chosen to view it as an opportunity to provide our patients with quality information about the questions that concern them. In doing this, ASA recognizes the wisdom of Anne Morrow Lindbergh who said, “Only in growth, reform and change, paradoxically enough, is true security to be found.”

Robert E. Kettler, M.D., is Associate Professor of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin.