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Medical experts just a keystroke away

Is there a doctor in the mous?

by Deborah Rieselman

The word "surgery" hung in the air. Christine could virtually see the letters floating out of her doctor's mouth, like a warped cartoon missing the punch line. Although the man in the lab coat continued to talk, Christine began drifting into a Charlie Brown world, one where the authority figure speaks without syllables or consonants.

She may have nodded her head, but she heard nothing. Not really. Not until the doctor asked, for the third time, if she had any questions. Then she quietly shook her head. The doctor mistakenly assumed she understood. In reality, she didn't know where to begin.

Within a few hours the questions started. One after another. Coming so fast she couldn't remember if they were new ones or repeat customers.

Fortunately, someone explained that she had a wise friend closer than she knew. Just a keystroke away, more than 200 medical experts, including some of the country's best, were available to answer questions any time of day or night, thanks to the University of Cincinnati.

NetWellness is a nationally acclaimed interactive Web site of consumer health information. Begun as a University of Cincinnati experiment in '94, it attracts more than a million "hits" a month, has answered more than 17,000 questions from individuals this year alone and has grown into a comprehensive collaboration with the state's three Carnegie Doctoral/ Research I Institutions, Case Western Reserve University and Ohio State University.

More than a dozen professional and consumer organizations have bestowed accolades on the digital endeavor: Forbes declared it one of the six best health Web sites, and U.S. News & World Report named it one of the top 10 Web sites hosted by a college of medicine. "NetWellness," the Cincinnati Post wrote, "ranks with the Mayo Clinic and Johns Hopkins sites as being among the premier health information sites. And one of the most ambitious."

Last year, the site logged in 10 million hits. What kept people coming back? Some praised its "comforting" information. Others commented on the way it "gave us hope," "gave me the courage to seek treatment" and "put my mind to rest."

"Your answer was a relief and a blessing," one person wrote. "This service is fantastic." Former Ohio Gov. George Voinovich summed it up best when he said, "NetWellness is going to save people's lives."

With that in mind, the state of Ohio funds most of the site's $900,000 budget. The price is a bargain when one realizes that physicians who routinely bill at $250 an hour provide pro bono services, points out Steve Marine, director of outreach for the Medical Center's Academic Information Technology and Libraries (AIT&L), which oversees the site. When the worth of those consultations is calculated, the site's value more than doubles its budget, he estimates.


While patients come to NetWellness to better understand their own health, students show up to conduct research on everything from drug interactions to kidney functions to health concerns of minority groups. The main attraction is knowing "the information comes from world-class experts," says Marine. "It gives people confidence.

"Conducting medical research on the Internet is so commonplace that docs see patients with 50 pages printed off the Web. On other sites, it's difficult to identify the source. If the pages say 'NetWellness,' the docs don't worry."

In fact, patients who do NetWellness homework first discuss their conditions more intelligently, says Roger Guard, AIT&L director and assistant senior vice president. One health-care provider replied online that NetWellness research led an arthritic patient toward "improved communication and compliance, a better attitude and an enhanced quality of life."

Many things stand in the way of obtaining the same medical information straight from the doctor's mouth. The shock of hearing words like "malignant" keeps patients from thinking straight. Admitting one's ignorance can be embarrassing. Furthermore, patients often feel rushed and need time to think of questions.

Once they have formulated questions, they simply log on and "Ask an Expert," a service in which 200 of Ohio's top medical researchers and physicians answer anonymous questions within a few days. Doctors post answers online "in lay language," Guard says. Marine knows of no other medical site that promises to answer every legitimate question.

"It's one of a kind," says Guard, "because it's inter-institutional, interdisciplinary and operating in virtual space. We've got nurses from UC working with doctors from Case Western Reserve working with physical therapists from Ohio State. That kind of collaboration normally doesn't happen even within one institution."

NetWellness was one of the country's first consumer health Web sites. It began in 1994 before the World Wide Web existed in Cincinnati, and the site's first portal was Tri-State Online, Cincinnati's Free-Net.

"Before we got cheap Internet access, Cincinnatians got service through Tri-State Online," Guard says. "We had meetings to get the community involved. Tri-State Online general manager Steve Shoemaker attended one of the first ones, and he wouldn't go away," Guard says with a chuckle. "For at least four years, he was here every Friday."

The project team of UC staff and community volunteers created site features that were "really cool and leading edge," says Shoemaker, Eng '80. "People were copying them. As a team, we advanced the state of disseminating expert health information on the Internet."

"Our philosophy was to throw it on the wall and see if it would stick," Guard adds. "People had such fun that if you talk about the good old days, they actually get a tear in their eye.

"Shoe," as Guard calls him, "was high on skills. He confronted us when he thought we were being academic. That often made people mad, which was great because he got us thinking."

Considering how much cyberspace has changed since those Free-Net days, NetWellness has evolved through several life cycles, Shoemaker says, and many have benefitted from the process. "Not only has it helped people across the country obtain valuable information," he says, "it has also introduced hundreds of doctors to another conduit to understand what the public wants. I remember doctors saying, 'We keep getting the same questions over and over again.' Well ... that's the point."

Then, as now, the site has always discouraged self-diagnosis by referring users to health-care providers. Simply put, informative education is the site's singular goal.

It succeeds well, judging from the volume of positive feedback received from online users. Of course, one child's response probably sums up the service best. "This is better than a boring old text," he wrote.

Simply put, indeed.