Abstract
The web is a maze; and the amount of accessible information is truly amazing. Hence negotiating the web, even with the assistance of a search engine such as Google, can be puzzling. For example, when searching for the Australian and New Zealand Journal of Psychiatry (ANZJP) home page, typing in all but the last word (Psychiatry) generates a single Journal-related web address on the first page of results, but only just. In most instances the Journal homepage is trumped by half a dozen or more other websites. In contrast, typing in the acronym ANZJP produces a long list of entries that almost all relate to the Journal. Naturally, typing in the full name of the Journal produces results of similar specificity to that achieved with entering ANZJP. But if your typing skills are like mine, then the additional attention to detail that is required can take considerably longer.
Fortunately, this is not a concern for Royal Australian and New Zealand College of Psychiatrist (RANZCP) members who can easily view the Journal via the College website, but the issue of accessing accurate psychiatric information on the web is pertinent to clinical practice as patients increasingly surf the net in search of alternate enlightenment.
In fact, seldom a month goes by without being confronted by a ‘well-informed’ patient, armed with the latest ‘information’ from the net. “Why don't I have bipolar disorder? This online questionnaire says that I'm probably bipolar.”
Such heightened awareness can be quite problematic, especially if it results in misinformed choices that compound the complexity of managing psychiatric problems. So how can this be dealt with, both individually and collectively?
In practice, and when teaching, I often resort to analogies to describe the process of psychiatric decision-making. For example, I begin by explaining that aspects of making a diagnosis and determining a management strategy are similar to completing a crossword puzzle. Some of the clues (e.g. symptoms and signs) are straightforward, as are the solutions (e.g. modify lifestyle, ensure treatment adherence), whereas others (such as identifying the most efficacious, or best tolerated medication) may be more cryptic. I then outline the predicament that often arises when tackling a crossword puzzle, in which a word that fits the clue, and is thought to be correct because it can be accommodated within the allotted space, is inserted, but as other surrounding clues are solved it soon becomes apparent that it was not the correct word, and that another solution needs to be found. I then link this to dealing with psychiatric problems for which an optimal solution often requires several attempts, with successive revision of initial treatment paradigms as new information becomes available. Part of the reason for this is that every psychiatric ‘puzzle’ is unique, and that it can range from being relatively straightforward to impossibly difficult.
Further, I emphasise that the sources and quality of web-based mental health information varies considerably. Recognised websites such as beyondblue ( www.beyondblue.org.au ) that are updated regularly, are reasonably accurate and helpful but many websites are outdated and inaccurate and some even provide information and advice that is subject to personal and political views. It is important therefore that an experienced clinician is involved in the management of psychiatric problems so as to be able to vet any information accessed from the web.
The key perhaps is to engage patients and inform them of what we think are useful sites. To achieve this we have to equip ourselves with knowledge, and to this end in future issues of the ANZJP the Editorial and International Advisory Board of the Journal will aim to advise on disorder-specific websites that are deemed to be suitable.