Psyber Psychiatry, Commentary
Are irreputable health sites hurting your patients?
‘NO BASH’ recalls 6 questions to ask when surfing.
Web sites that offer questionable information about psychiatric illnesses and treatments can sway patients toward unproven, often worthless “remedies.” These sites may present themselves as patient resources but instead are promoting political or antipsychiatry agendas or selling unregulated, untested therapies.
Don’t let unscrupulous sites fool your patients. This article offers tools to help patients find evidence-based mental health information from objective, reputable sites.
Why counsel patients on web use?
Bad information can be harmful. I have lost many patients to follow-up because they discovered an unsubstantiated treatment complication or off-the-wall “remedy” on an antipsychiatry or antimedication site.
Years ago, I treated another mental health clinician. After she viewed an antimedication site, she was convinced that her bipolar disorder had “run its course” and stopped treatment, even though she had suffered a severe manic episode 1 year earlier. Another doctor treated her as if her bipolar disorder had been “cured.”
I resolved never to let patients troll the Internet for medical information without rudimentary guidance.
Most patients do not know how to analyze medical information. In medical school we learned—by implementing dictums of evidence-based medicine—where to find clinical information and how to assess its quality and objectivity. Most patients have not received such training.
Patients need our support. Most patients seeing a psychiatrist for the first time are anxious and fearful of what they might find out about themselves or their lives. Exploring their inner worlds is routine to us, but unsettling and disorienting to them. Unfiltered, uncensored Web sites prey upon new patients by offering a ready source of comfort.
Guiding new patients during this vulnerable time can cement the doctor-patient relationship and prevent faulty information from jeopardizing recovery. Patients who do not receive emotional support could turn to a Church of Scientology site—such as psychiatrysucks.com—or one of many other antipsychiatry sites to fill the void.
Encourage patients to describe their anxieties and trepidations toward their illnesses and medications. Help them explore questions about trust and hope, and anticipate and solicit questions resulting from their Internet exploration.
Setting web search guidelines
When new patients ask where to find information on their disorder or treatment, suggest the National Institutes of Health’s Web site, which offers a wealth of current information written in plain English, and links to databases, such as Medline and ongoing clinical trials.
Then give patients basic guidelines for broader Internet exploration. Warn them against sites that post personal attacks, exude a zealous tone, or present extreme positions or statements. Sites infused with fervor—positive or negative—should always warrant suspicion.
For more subtle concerns about quality of information, encourage patients to ask the following six questions—easily recalled with the acronym NO BASH (Table)—when visiting a mental health site:
NO BASH: 6 questions to ask when perusing a health site
1. Is the site Networked?
2. Is the information Objective?
3. Is the content Balanced?
4. Does the site’s author make Accusations?
5. Is the site Selling something?
6. Is the site ‘Hyperholy’?
- IS THE SITE NETWORKED?
- IS THE INFORMATION OBJECTIVE?
- IS THE CONTENT BALANCED?
- DOES THE SITE’S AUTHOR MAKE ACCUSATIONS?
- IS THE SITE SELLING SOMETHING?
- IS THE SITE ‘HYPERHOLY’?
Also consider the site’s domain designation:
- sites with the .edu domain—operated by educational institutions—are most reliable
- .com designates a commercial site that is generally geared to selling goods or services and might or might not support psychiatric treatment
- .net and .org sites tend to be noncommercial, although some might be antipsychiatry.
Also steer patients to health care sites that display the HON Code seal of the Health On the Net Foundation (HON). HON, a nonprofit international organization that promotes development of useful, reliable online medical and health information, certifies health sites that meet its rigorous ethical standards (see Related resources).
- Health Care on the Net Foundation code of conduct (HON code) for medical and health Web sites. www.hon.ch/HONcode/Conduct.html.
Dr. Montgomery reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.