In 1999, I registered the domain name www.veins.co.uk. Why did I do this? At the time, I did not know anything about websites. However, a gynecologist I knew of had registered a gynecological domain name and was the talk of the town! I had found a domain names registry, and to my shock, my preferred choice—www.varicoseveins.co.uk—had already been registered. In a state of panic, I registered my www.veins.co.uk website, merely so I would not be behind the curve.

Once I owned the name, I did not really know what to do with it. Having registered it on a Saturday night, I phoned the company that I had registered it from on Monday morning to ask what I should do with it. The answer was quite simple: “Set up a website.” The lady on the information line then gave me a 10-minute tutorial on what hosting was and told me to buy Microsoft FrontPage to create my first website.

Armed with a domain name, hosting, and a program to write websites, I then had to decide what I was going to put on my brand new website. I did what most academically minded doctors would do—I wrote an explanation of how veins work, how they can go wrong, and how we deal with the problem. In the United Kingdom, my website became very well known between 1999 and 2004 and was often quoted as an excellent resource about veins. In fact, most patients coming to see me quoted from my website. It was clear that the marketing potential of such a website was huge.

As the years have passed, it is now rare to find a vein surgeon, clinic, or hospital without a website. Most have gone from being educational to promotional. Search engine optimization experts point out that patients do not wish to read through huge amounts of text but merely want a simple explanation of their problems, how you would fix them, and why they should come to you. Additional diagrams and videos help, but these have to be simple, and with the short attention span of the online browsing public, should preferably be very short and easily digestible. As such, the quality of information provided to patients, even by the professionals who perform the vein surgery, is usually very simple and in current parlance has been “dumbed down.” Although this may attract patients to the website and even increase referrals, it causes issues when patients turn out to have anything but the most standard of venous problems.

To complicate things further, add to this the huge explosion of websites that provide biased information at best or completely erroneous information at worst. Many of these are from commercial entities selling products that have huge budgets to make very impressive websites that look both professional and convincing. Who wouldn’t want to have some plant extract made into a tablet that could cure your varicose veins at home rather than undergo a potentially painful surgery? Now that the Internet is available everywhere—not only when you sit down at a computer but also every time you pick up your mobile phone—the problem has changed from how to provide information to patients to how to help patients distinguish information from misinformation.

IS AN EDUCATED PATIENT OUR BEST CUSTOMER?

There was a time when a patient would turn up to a doctor with a problem, totally trusting that the doctor would know the “right” treatment option. An explanation was not required. The patient merely wanted a set of instructions or a decision as to what treatment was required. This might have been a “golden time” of medicine as far as the doctor was concerned, but as we are all aware, this might not have been in the best interests of patients!

Over the last few decades, increased education of the public has resulted in increased questioning of, and decreased confidence in, the medical profession. Second opinions are often requested, and litigation continues to increase. Certainly in vein surgery, we are moving from patients seeking the help of vein specialists to consumers choosing which of the vein specialists they would like to see and which treatment option they would like to have.

So, is this a good or bad thing? At a very simple level, it is clearly a good thing. An educated patient who understands his or her condition and the options that we are able to offer is likely to be compliant and to understand the risks. However, this supposes that the “educated patient” has been given the correct information, has fully understood it, and has diagnosed himself or herself correctly.

OPPORTUNITIES IN THE AGE OF UNLIMITED INFORMATION

For doctors, clinics, and hospitals, the opportunity to be able to directly inform and interact with patients has been one of the major advances of the Internet. Particularly in fast-moving specialties such as endovenous surgery, directly informing patients about new techniques as they become available has been a huge advantage. In previous generations, doctors would have to convince less-expert colleagues and hope that with the passage of time, referral routes would bring patients to them. The ability to go directly to the end user has transformed medicine.

Of course, this is not restricted to doctors. This opportunity has also been seized upon by companies supplying products to the doctors. Device companies in particular—and more recently, pharmaceutical companies— can also inform and interact with patients directly. Such companies can promote their own products to the patient and then direct interested people to doctors and clinics that the company knows use their product. This is clearly a great opportunity for such companies.

Unfortunately, as we live in the age of virtually unlimited information, this opportunity also exists for companies producing products that most doctors would not recommend or sanction, as well as for pressure groups or anyone who wishes to comment on any disease process. As such, there is a huge opportunity for doctors to inform patients to increase their referral practices and for device companies and pharmaceutical companies to inform patients to increase their sales. However, there is also the opportunity for companies or individuals to provide misinformation—or, worse still, products or advice that have no science behind them or even any chance of working.

Finally, from the patients’ point of view, the Internet has given them an opportunity to find out about medical conditions and treatments. Before the Internet, patients would need to go to a doctor to get information or use print-based media that might be years out of date. The virtually unlimited information available through the Internet allows patients and interested people to find out virtually everything about their condition and all of the latest possible treatments provided; of course, they can wade through the almost unlimited amount of misinformation that is also found on the web.

CHALLENGES IN THE AGE OF UNLIMITED INFORMATION

From 1998 to the early 2000s, the opportunities of using the Internet seemed to be all that was important when talking about websites. Over the last decade, the challenges of the Internet have increasingly become more concerning than the opportunities. The challenges can probably best be outlined by considering those involved in the process of providing or receiving the information.

If we first look at the health care providers (ie, doctors, clinics, and hospitals), we can see some of the challenges that have become apparent. Any information that is provided in the name of a doctor, clinic, or hospital has to be accurate and honest. It also has to be kept up to date as new developments occur and new research results become available. Quite complex medical explanations have to be made into bite-sized bits of information that patients can understand regardless of their background. Health care providers have to strike a balance in providing accurate information in a simple enough form for patients to understand and in a way that does not scare the public. In addition, there must be a balance between promotion of a service and, conversely, the possible risks that can occur.

Even when health care providers have perfected their information, they then have the challenge of how to get people to read it. With the explosion of websites, Internet forums, social media, and electronic advertising avenues, there is massive competition for attention. The result of this is that the best Internet marketing strategy gets the largest audience—not necessarily the best information. Search engines, and Google in particular, are continually changing the algorithms used to rank sites. However, a simple search for “varicose veins” throws up the paid advertisements first, followed by the information portals, such as Wikipedia, or websites run by interested parties, such as insurance companies or hospital groups, governmental bodies, or charities. Most of these are written by medical content writers or enthusiasts; few are written and maintained by true experts who are up to date with current developments in the field.

Hard as it is for a specialist to get noticed, imagine how hard it is for a member of the public to decide who and what to trust. The same search for “varicose veins” not only shows information portals of variable accuracy and simplicity but also company websites and adverts for support stockings, medications, natural remedies, and lifestyle cures. It is little wonder that those who do make their way to our doors are often confused and, more often than not, a little distrustful.

CONCLUSION

In principle, an educated patient should be our best customer. However, when they are educated by content found on the Internet, many patients actually arrive confused and misinformed. This can result in considerable time and effort to help guide the patient to the correct understanding of his or her own condition and what treatment is needed. Goodness knows how many people end up being lost to proper medical care by being diverted away from seeking professional help due to poorly written, misleading, or incorrect content masquerading as educational medical information.

Mark Whiteley, MS, FRCS (Gen) is a consultant vascular surgeon and Founder of the Whiteley Clinic in Guildford, Surrey, United Kingdom. He has stated that his only financial interest relevant to his article is that he owns his clinic. Prof. Whiteley may be reached at mark@thewhiteleyclinic.co.uk.