The 11 Best Sites to Get a Second Opinion, Online
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Once you have an initial conversation about a health issue with your doctor, you can and should use the Web to get the background and perspective that you’ll bring to the next discussion. Here’s where to go — and where not to.
Related: When to Say No to Your Doctor
The Mayo Clinic
This health info site is an excellent place to begin educating yourself online. It presents easily digested information broken down by category. A lot of major medical centers have consumer sites, but they typically mix useful basics with pleadings for their procedures.
How to Navigate:
Go to the “Patient Care & Health Info” drop-down menu to find easily digested information broken down by category: symptoms; diseases & conditions; tests and procedures; drugs & supplements. True, a lot of medical centers have these kinds of consumer sites but they often dilute the useful basics with special pleading for their latest diagnostic and treatment widgets.
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HealthTap
For the price of $1 app, or nothing if you visit the website, you get a live link with real-live doctors, a network of some 50,000 strong, to answer your medical questions.
How to Navigate:
On the site’s homepage, type in your medical question in the search box and call up answers that network docs have already given to similar questions asked by members.
Become a member yourself by clicking on the aqua-marine “Sign Up” box at the top right of the homepage, the usual create-a-password-and-log-in drill. That way, you can get a doc to answer your personal but anonymous query whether anyone has ever asked it before or not.
We inquired about a recent 140 systolic blood pressure reading and a young family medicine doc answered that persistent high BP required “further evaluation and treatment” and added that we should lay off the caffeine, “esp energy drinks.” Fair enough.
But if you want an honest-to-god virtual consult, go over test results, etc., then you’ve got to upgrade to “Concierge” service ($44 a shot) or “Prime” ($99 for unlimited consults), and you’ll get plenty of encouragement from the site to do just that. At last count, according to the site, 17,132 people have reported that a Healthtap consult, Basic, Concierge or Prime, has saved their life.
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The U.S. Health Agencies
Perhaps surprisingly, the government runs a network of linked first-rate sites (including those for the Centers for Disease Control and National Institutes of Health) that cover common diseases and treatments, with information that’s seemingly unbiased and frequently updated. “With the exception of the roll-out of ObamaCare,” Welch says, “the government runs some damn good websites.
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How to Navigate
Go to the Centers for Disease Control and Prevention site, cdc.gov, and type in the disease or condition you want to learn about in the search box, top right corner of the homepage.
Or click on “Diseases and Conditions” slightly lower down on the left hand side to see the range of what’s covered.
It’s the same deal with the National Institutes of Health at nih.gov. Type in the problem in the search box or, slightly lower down on the left, click on “Health Information” to survey the landscape.
In both cases, your search will turn up lists of relevant government health websites, great for casting a wide net, not so great for a targeted search with the clock ticking.
If you’re looking for sensible, middle-of-the-road health advice, of the “do this, don’t do that” variety, check out the U.S. Department of Health and Human Services’ healthfinder.gov site.
[cdc.gov; nih.gov, healthfinder.gov]
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TheNNT
Dr. David Newman pulled together a small group of mostly young, reform-minded New York City emergency medicine docs to create and run this site. It currently reviews over a hundred therapies and wraps them up in the statistical bow of Number Needed to Treat, while providing handy links to the research from which the NNTs are generated, often Cochrane Collaboration meta-analyses.
How to Navigate:
The site is a breeze to navigate: click on the “Reviews” drop-down menu, top-left on the home page, and open either “Therapy Reviews” or “Diagnosis Reviews.”
Once you’re in, you can go to the large blue box at the top-left of the page, and organize the reviews alphabetically, or by body system or medical specialty.
Each therapy review gets a colored banner on the top of the page indicating whether the therapy in question is of more benefit than harm (green); of unclear benefit (yellow); or of no benefit (red). You won’t find the fourth option on a stop light, black, of demonstrated harm (see PSA screening and coronary stenting for stable heart disease). If NNT numbers could shout, these would.
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Choosing Wisely
Created by the American Board of Internal Medicine Foundation, a non-profit quality-control watchdog, the Choosing Wisely site is a master list of common medical tests and procedures that you probably don’t want any part of. The ABIMF has queried to date 62 medical specialty “societies” collectively representing over a million American health-care providers. Each group contributed “lists of five things that physicians and patients should question.” (The American Academy of Family Physicians took the exercise to heart and contributed 15 to avoid.) The lists don’t align, naturally, but cumulatively they provide a great object lesson in the range and depth of bad ideas that are routinely put in practice.
How to Navigate the Site:
On the home page of choosingwisely.org, enter a test or a therapy in the search box, on the right side of the page below the colored banners at the top, to see how often it shows up on the different lists.
You can also click on the teal “Lists” banner to bring up the full menu of medical society lists on the left side of the page. On the right side is a list of common vexing medical questions answered with an eye to discouraging overtreatment (“Patient-Friendly Resources”). ABIMF’s partner in the latter feature is Consumer Reports which, along with the venerable Public Citizen, co-founded by Ralph Nader in 1971, serve as consumer watchdogs in the health care arena. (For a modest $15 a year, you can access Public Citizen’s ”Worst Pills, Best Pills” data-base at worstpills.org and receive its regular on-line news bulletins.)
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UpToDate.com
UpToDate.com analyzes treatment options with an independent-minded zeal. Founded by Harvard nephrologist Bud Rose, the site analyzes more than 10,000 tests and treatments and has become a go-to resource for those who don’t have time to wade through mountains of published research. And as the name suggests, the material is updated every few months, a huge plus considering how long outdated advice can survive on seemingly authoritative health sites. Hundreds of reviews are available for free on the site (type “patient information” into the search box). To get access to the whole site and the longer, more technical discussions aimed at doctors, you’ll have to subscribe, but you can do so for a moderate fee when you need to go deeper.
[UpToDate.com]
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The Cochrane Collaboration
This international consortium of doctors and biostatisticians (some volunteer, some staff) has combed through, to date, more than 5,000 tests and treatments to tease out evidence of benefit, or lack thereof. The site’s stock-in-trade is the meta-analysis, combining and re-analyzing data from past studies. Many of its meta-analyses, widely admired in the medical world for their rigor, have challenged received medical wisdom. Summaries of the reviews are available free of charge on the website.
How to Navigate:
You can peruse medical news on the opening page, then go to the top of the page, on the left-hand side, and click on “Cochrane Reviews.”
On the next page, top left, under “Cochrane Reviews,” click on “Browse free summaries.” You can enter a particular search term in the search box or, underneath the box, click on “Browse health topics” for a full menu of Cochrane reviews and podcasts. The reviews include over 300 “PEARLS” (“Practical Evidence About Real Life Situations”) that have been selected out for their real world usefulness.
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Johns Hopkins
Most of the information-searching services here are only available to the Hopkins-affiliated but the main page presents a one-stop-shopping menu of links to both government and non-government health sites that’s handy for all-comers.
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U.S. Preventative Services Task Force
This independent panel of primary-care care and preventative care experts produces annual reports for Congress on things we probably should and shouldn’t be doing in the name of health care.
How to Navigate:
On the upper left-hand side of the home page, click on “Recommendations.” On that page, you can type in a health problem in the search box, or to the left of the box, click on “Browse All Published Recommendations,” which allows you to surf, to date, 95 USPSTF reports on everything from aspirin for heart disease prevention to taking vitamins to reduce the risk of heart disease and cancer.
You can narrow your search, for instance, by clicking on “Adult” and “Male” in the “Filter” column on the right hand side of the page.
The list is a giant report card with each health intervention graded out from A (“Strongly Recommended”) to D (“Not Recommended”) to I (“Insufficient Evidence”), with links to the supporting research. (Taking aspirin for heart health rates an “A” although the report is currently being updated; vitamins for heart and cancer prevention rates an “I.”)
[uspreventiveservicestaskforce.org]
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One to Skip: The American Heart Association
Our experts advise bringing skepticism to anything you read on websites produced by medical societies or their allies, disease advocacy groups such as the AHA. Be sure to cross-check against other sources of information. As Newman writes in Hippocrates’ Shadow, “The overarching mission of these societies is to provide lobbying and advocacy for their constituents who pay annual dues.” The advice you get from the disease foundations is usually colored by the pharmaceutical and medical-device companies that provide much of their funding.
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One to Skip: WebMD
When it comes to shameless, even artfully camouflaged shilling, nothing beats one of the nation’s most-visited health sites, the for-profit, advertising-supported WebMD, which likes to impart information via health quizzes. The nadir was a 2010 quiz, sponsored by Eli Lilly, the makers of Cymbalta, in which 100 percent of the people who took it discovered they “may be at risk for major depression.” In truth, the site has improved of late with fewer questionable quizzes and more mildly interesting features on sex and beauty.
By Joseph Hooper
