People increasingly search the Internet for information about common medical problems such as trapeziometacarpal (TMC) joint arthritis. However, this information can be biased, inaccurate, and misleading. Medical professionals should be aware of what patients may be reading about their condition, because concepts and beliefs can affect symptoms, limitations, and decision-making. Our study sought factors associated with the quality of design and content of health information websites about TMC arthritis. We found that online information on TMC arthrosis is difficult to read, often biased in favor of a particular treatment, and influenced by profit and Health On the Net code certification, a code of conduct for medical websites (1). Hand surgeons should prepare to gently correct misconceptions established or reinforced, in part, by material found on the Internet.
The fact that anyone can add information to the Internet allows almost the entirety of human knowledge and opinion to be archived and shared. Wikipedia takes this idea and attempts something very ambitious: an online encyclopedia edited by everyone with articles on everything while still remaining well-moderated and quality controlled. To evaluate the iterative process of a collaborative public database (a Wiki) as a reference for information on hand illnesses, we tested the null hypothesis that the number and type of edits are comparable for web pages covering different topics. The history of four hand surgery-related Wikipedia web pages (Trigger finger, Complex Regional Pain Syndrome, Ganglion cyst, and de Quervain Syndrome) were analyzed from inception to July 2011. Each edit was classified as one of six types: an addition is an edit that adds material; a deletion removes material; a modification is a combination of addition and deletion, or any rearrangement; a minor edit is a correction of spelling, grammar, or formatting errors; vandalism is any edit that is intended to harm the page; a vandalism fixed is an edit that addresses harm. The edits were also rated as possibly controversial or not (defined as edits that present information with a clear bias or do not list reliable sources).
The percentage of constructive edits (additions, deletions, and modifications) was significantly different for each page, and the percentage of edits related to vandalism was also significantly different (2). Vandalism was quickly identified and addressed. Twenty-six percent of all edits were classified as potentially controversial, and forty percent of those possibly controversial edits were deletions. The topic of a Wiki web page for information on hand illness influences the degree to which edits are constructive. A Wiki for hand illness could be a very useful resource for patients with hand illness, but it requires careful moderation, because only about half the edits are constructive.
Some Internet sites have programs that attempt to help patients find their diagnosis based on symptoms. Our study tested the null hypothesis that there are no factors associated with correspondence between an online diagnosis and the hand surgeon’s diagnosis in an outpatient hand and upper extremity surgeons’ office. It was found that only thirty-three percent of online diagnoses matched the final diagnosis of the hand surgeon (3). The correspondence between an online diagnosis and the hand surgeon’s diagnosis was associated with sex (women) and patients who studied their symptoms online prior to the visit but was not associated with psychological factors. The overall poor performance of the diagnosis guessing program relates to the high percentage of nonspecific conditions and conditions that are either uncommon or have many overlapping symptoms. It may be possible to increase the accuracy of a diagnosis guesser by taking into account the uniqueness of various symptom clusters and the probability of specific diseases.
References
- Ottenhoff JSE, Kortlever JTP, Teunis T, Ring D. Factors Associated With Quality of Online Information on Trapeziometacarpal Arthritis. J Hand Surg Am. 2018 Oct;43(10):889-896.e5. doi: 10.1016/j.jhsa.2018.08.004. PubMed PMID: 30286849
- Burgos C, Bot A, Ring D. Evaluating the effectiveness of a Wiki internet site for medical topics. J Hand Microsurgery. Published online 10 March 2012. DOI 10.1007/s12593-012-0064-0
- Hageman MG, Anderson J, Blok R, Bossen JK, Ring D. Internet self-diagnosis in hand surgery. Hand (N Y). 2015 Sep;10(3):565-9. doi: 10.1007/s11552-014-9707-x. PubMed PMID: 26330798; PubMed Central PMCID: PMC4551618.