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Psychiatric Times. Vol. 16 No. 11
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The Internet as Practice Extender

by John Leipsic, M.D. | November 1, 1999
Dr. Leipsic is a child psychiatrist in private practice in Santa Rosa, Calif. In addition to writing on computer subjects, he is the author of Breeze the Boards, the Psychiatry Oral Board Review Series.

In the early 1960s, the Internet was born out of the idea of a "Galactic Network." By the late 1980s, technology had advanced to allow for computer-based exchange of scientific information between academic and research institutes. From these humble beginnings, the Internet has experienced explosive growth in the last five years, evolving into a powerful global information resource and new media format unto itself. Psychiatrists can now reap the full benefit of this fast-paced evolution to extend the reach of their medical practice.

At first, the only psychiatric resources on the Internet were searchable libraries and a few journal abstracts. Today, however, a new generation of medical Internet sites has emerged that delivers high-quality content directly to psychiatrists. These sites are easy to find and navigate, and they can be used to obtain practice updates, the most current journal summaries and even continuing medical education credits.

Consumers have already taken the lead over their physicians regarding medical information on the Internet. These computer-savvy individuals are using the Internet to enhance their understanding of diseases, medications and treatments. The Internet also provides patients with the opportunity to chat about their conditions or treatments and to access patient support groups online. Now it's time for their physicians to catch up.

Let's Go Surfing Now

To get on the Internet you will first need a personal computer with a modem. You can then "dial-up" an Internet Service Provider (ISP) and log onto a personal account. The cost of both computers and Internet access has come down considerably over the last year. The most popular companies like Gateway, Micron and Dell offer personal computers for under $1,000. Some offers even include one year of free Internet access with the computer purchase.

Computers usually come with either Microsoft's Internet Explorer or Netscape Navigator installed. These programs are "browsers" for "surfing" the Internet using the World Wide Web. Programs for sending and receiving e-mail and accessing user groups are also available. Nationally available ISPs provide access to all Internet services including the Web, e-mail and user groups.

Internet 101

The World Wide Web, also referred to as the Web, is the largest and most powerful space on the Internet. It is an international network of untold millions of computers woven together with a common language called HTML, or Hypertext Markup Language. Hypertext is a multimedia file format through which phrases or images link to other files for more information. Click on these highlighted "links" in your browser and away you go to other documents, images, audio files or even real-time video.

Web addresses (annotated www for World Wide Web), also known as URLs (Uniform Resource Locators), enable Internet users to access sites on the World Wide Web. E-mail, Usenet and Internet Relay Chat (IRC) are other powerful Internet resources beyond the Web. To keep things logical, e-mail addresses and URLs were set up to end with suffixes known as top level domains. These include .edu for educational institutions, .org for organizations, .gov for government addresses and .com for commercial enterprises among others. E-mail has been referred to as "telegraphy for the masses," enabling instant electronic messaging anywhere in the world. Usenet is a massive collection of bulletin boards organized into user groups based on interests. IRC allows for real-time talking or "chatting" on the Internet. This is often used by colleagues to share information or by patients for support.

Sending and receiving important information quickly and efficiently is one of the ways e-mail is used. For instance, you can compile a mailing list of patients and/or colleagues for practice updates or newsletters. Physicians are cautioned, however, that e-mail is not necessarily confidential or secure. (Although there are ways to increase the level of security for e-mail, it is beyond the scope of this article-Ed.) Mailing lists, called list-servers, are also used by groups to communicate and share information. For example, one well-established group discusses psychopharmacology issues. On this list, doctors from around the world write questions, comments, and share experiences with medications and patient management. There are also mailing lists for patient support and communication about their experience with medications and treatment. (For a searchable index of available lists, visit CataList www.lsoft.com/lists/lists/listref.html, the official catalog of Listserv and lists-Ed.)

A few forward-thinking psychiatrists have even created their own Web pages. A personal Web page helps generate new referrals and describes your practice to patients. It also provides a vehicle for continuing education for your patients. For example, you can post your own patient information handouts and provide recommended links for visitors. A Web site is also a good place to archive copies of electronic newsletters for patients to review. (Software is available to assist both the novice and expert alike in producing their own Web site. For more information on building a site, contact your ISP-Ed.)

For Your Information

Internet sites and services can be very useful in extending the range and depth of your practice. There are Web sites for professional and patient information, medications and mental illness information, detailed searches online, and for locating and registering for professional meetings. Continuing medical education credit is also offered online at a variety of sites.

A good place to start when searching online for medical information is the large Internet portal Yahoo! www.yahoo.com, which collects and categorizes Web sites. Yahoo! has a psychiatry section at dir.yahoo.com/Health/Medicine/Psychiatry> with sub-directories for information regarding children, conferences, forensics, hospitals, institutes, journals, organizations and psychopharmacology.

There are other huge Internet portals, including Excite www.excite.com and AltaVista www.altavista.com. Unfortunately, there is a drawback to their approach: the results of a search can be long lists of other Web sites, which can be daunting when you are searching for specific facts. However, there are sites specifically for psychiatrists, with only mental health resources, up-to-date news and diagnostic-specific information.

One of the best things about the Internet is that most of the resources are free for the asking. All you need is your own Web access. Psychiatry On-Line at www.priory.com/psych.htm is a good example of a site just for psychiatrists. This site features current articles and papers, a research roundup, and a plethora of links to other psychiatry resources worldwide. There are other subsections on this Web site for child and adolescent psychiatry and forensic psychiatry.

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