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Strategies for Consumer Health Reference TrainingJo-Ann M. Benedetti MA and MLS aa Crandall Public Library , 251 Glen Street, Glens Falls, NY, 12801 E-mail:Published online: 21 Oct 2008.

To cite this article: Jo-Ann M. Benedetti MA and MLS (2002) Strategies for Consumer Health Reference Training, Health Careon the Internet, 6:4, 63-71, DOI: 10.1300/J138v06n04_06

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Strategies for Consumer HealthReference Training

Jo-Ann M. Benedetti

ABSTRACT. Public librarians are challenged to provide consumer healthreference services. Libraries cannot afford extensive health and medicalcollections; moreover, librarians fear giving the wrong answer or provid-ing medical “advice.” Most public libraries have access to the Internet,and this, along with adequate staff training, can provide the public librar-ian with the tools to handle all but the most difficult consumer healthquestions. This paper describes a model three-hour training session forpublic librarians covering the inherent difficulties in the consumer healthreference interview. Using a handful of reliable and easy-to-navigateWeb sites, the challenges in consumer health reference can be over-come. [Article copies available for a fee from The Haworth Document DeliveryService: 1-800-HAWORTH. E-mail address: <getinfo@haworthpressinc.com>Website: <http://www.HaworthPress.com> 2002 by The Haworth Press, Inc.All rights reserved.]

KEYWORDS. Consumer health, reference training, reference service,public libraries

INTRODUCTION

In today’s world of heightened media, consumers are bombardedwith medical information. Certainly they are exposed to the long-famil-iar prime-time “doctor” shows, as well as the many popular magazineand newspaper articles devoted to health issues. Television news pro-

Jo-Ann M. Benedetti, MA, MLS (benedetti@crandalllibrary.org) is Head of HealthInformation Services, Crandall Public Library, 251 Glen Street, Glens Falls, NY12801.

Health Care on the Internet, Vol. 6(4) 2002http://www.haworthpressinc.com/store/product.asp?sku=J138

2002 by The Haworth Press, Inc. All rights reserved. 63

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gramming’s “health topic of the day” has escalated. Entire cable televi-sion channels are devoted to health and medicine; entire magazinescover health and wellness. There has been a dramatic rise in the numberof pharmaceutical companies advertising direct-to-consumers (DTC).Now, with the growth in usage of the Internet, consumers are beingoverwhelmed with ads, facts, remedies, vitamins, dangers, warnings,stories, and cures. How is the consumer supposed to know whom to be-lieve? A former U.S. vice-president endorses pharmaceutical products;with DTC advertising, it is difficult for the layperson to detect bias inadvertising. Even Dr. Koop’s Web site blurs the line between informa-tion and marketing, making it difficult to differentiate fact from “spin.”Factor in the myriad sites designed by individuals with no review at all,and it is no wonder that consumers are more confused than ever.

Throughout the years, reference librarians have maintained theircredibility as information providers. Their services are available forfree, they are impartial, they are not selling anything, and they are veryusually very helpful. Consumers are subsequently going to their publiclibraries with questions, and librarians are being put in the position oftrying to wade through the “muck” to find nuggets of relevant informa-tion.

This is a huge challenge to public librarians. Many public librariansare uncomfortable providing health-related reference.1 Reference staffare often not familiar with the resources that would best answer thequestions. They are concerned that the language/vocabulary in medicaltexts in the collection might be too difficult to read/understand, and theyare also uncomfortable because they fear giving the wrong answer orproviding medical “advice.” Their collections may be outdated, and ifthey look for answers on the Internet, how can they be sure it’s the“right” information?

PRESCRIPTION FOR SUCCESS

It is clear that most public libraries are strained and have limited bud-gets. Most cannot afford extensive health collections. In spite of cut-backs in book and database budgets as well as library staff, even thesmallest of libraries can offer quality consumer health reference. It isclear that the Internet can provide the answer to many of the questions,if the librarians know where to look. So, armed with two assets, accessto the Internet and adequate staff training, most librarians can learn tohandle consumer health questions and gain confidence.

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CHALLENGES OF CONSUMER HEALTH REFERENCE

Students must first learn the challenges inherent in conducting ahealth-related reference interview and the special problems that con-sumers bring into the library. It is, in many ways, very difficult to han-dle inquiries from consumers because of their limited knowledge ofmedicine, their confusion over the diagnosis, and their fear of the un-known. These create a huge barrier for the librarian to get to the “truth,”that is, to get to what the patient wants to know.

Consumers, unlike clinicians, do not use clinical terms, or they maybring in misspellings. Patients find medical vocabulary daunting andconfusing. It is relatively straightforward to answer a request when thepatient knows the name of the condition and how to spell it, but quiteanother when the patient wants information on “sick lick vomiting” (cy-clic vomiting), “cystic fibrosis of the breast” (fibrocystic breast disease)or “vascular urethral reflux” (vesicoureteral reflux). In such cases it isimperative to ask the patient to call his/her health care provider and get aspelling of the diagnosis or to confirm the diagnosis. It is not up to thelibrarian to try to guess what the patient means. In fact, it is essential thatlibrarians learn that they should get used to saying the phrase, “call yourdoctor.”

Another problem is the confusion generated by the patient’s own cir-cle of family or friends. These well-meaning people may have alreadytold the patient what the prognosis is, the “right” medicine he/sheshould take, and the recommended doctor the patient should see. So of-ten, these people give inaccurate information and increase the patient’sanxiety level. By the time a patient comes into the library, he/she mayhave already “heard” something that may or may not be true.

Librarians also need to consider that the patient has probably forgot-ten a great deal of what the doctor discussed with them. According toone study, “the ability to recall information presented by physicians inoutpatient clinics ranged from 50% at 5 minutes to 56% at 1-2 weeks.”2

There is another challenge to the librarian that makes the barrier evenmore intimidating. According to a Pew Internet Study,3 most consum-ers do not turn to the Internet for wellness information, but rather, 91%are looking for information about a disease or condition. This makessense, but it is also important to keep in mind that because consumersare looking for information about a particular disease or condition, theiranxiety may be heightened during the reference interview. Additionally,most information seekers are looking for information on behalf ofsomeone else–a child, a spouse, or other relatives/friends. Because of

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this, the person requesting the information often has never spoken to thehealth care provider, and is getting the diagnosis secondhand. If the li-brarian is aware that these challenges exist, there is a greater chance thatthe librarian can provide the service that the patient needs, even if it is toremind the patient that he/she needs more information from the healthcare provider.

It is also important to keep in mind the kind of questions to expect inthe public library setting. Typically, the questions can be divided intothe following categories: information about diseases/procedures, infor-mation about doctors and hospitals, information about pharmaceuticalsand herbals.

MEDLINEplus AND FRIENDS

A great deal of training time should be dedicated to MEDLINEplus<http://www.medlineplus.gov> from the National Library of Medi-cine. It is surprising to hear how many librarians either have not heardof this site, or those who have heard of it but never used it. As one li-brarian once confided, “I figured MEDLINE was difficult to use, soMEDLINEplus must be even more challenging.” Librarians should beinstructed to start here when looking for information about diseases andconditions, and told why this is the best place to go. The information atMEDLINEplus is reviewed, reliable, and updated continually, and, be-cause of the lack of advertising, the bias is minimal. It is not enough tohand out a URL and assume librarians will review the Web site on theirown; they will not. Because of this, students should be given real-worldexamples to search.

Many librarians will immediately go to the search box and try aBoolean search; however, since this database is designed for the publicto use, it is much easier to browse the “health topics.” This is a casewhere “less is more,” that is, instead of typing in a string such as “lupusAND treatment” (which results in 163 “hits”), it is better to click on“health topics,” then browse to find the disease “lupus.” The resultantMEDLINEplus topic gives the librarian ways to narrow the search forthe customer and then ask: “Would you like an overview of the dis-ease?” “Would you like to know how to cope?” “Are you interested inknowing how it is diagnosed?”

The search box is useful if one is not sure about the disease/conditionor what part of the body is involved. If, for example, a patron wants in-formation on “pacemakers” and can’t seem to find it when browsing, a

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general search of MEDLINEplus will bring up several links relating topacemakers. It is important, though, to examine the search results! Asearch of “pacemakers” results in three pages of links, some of whichmay or may not be useful. There are the MEDLINEplus tutorials, theMEDLINEplus Medical Encyclopedia, MEDLINEplus Topics (in thiscase, Arrhythmias, Heart Failure, and Fainting) and MEDLINEplusDrug Information (which includes drugs that should not be prescribedto patients with pacemakers). Librarians need to understand the dif-ference in the information provided in each of these sections ofMEDLINEplus by comparing and contrasting the information. Somepatrons would be quite happy with the information that the entries inMEDLINEplus’ medical encyclopedia provides (MEDLINEplus hasan agreement with A.D.A.M.’s medical encyclopedia, which coversthousands of diseases and conditions and medical illustrations). It istypically concise, well illustrated, and easy-to-understand.

Finding Drug Information

MEDLINEplus does have its limitations. It is this author’s opinionthat MEDLINEplus does not do a good job with drug information. Untilvery recently, the “Drug Information” link led one to a database createdfrom the USP DI Volume II Advice for Patients. This information isvery confusing to consumers. For example, searching for the drugLopressor brings up a 15-page monograph on beta blockers which iscomplicated and requires quite a bit of sophistication to use. A new fea-ture is a link to the American Society of Health-System Pharmacists’(ASHP) MedMaster database. This is certainly more readable, but as ofthis writing, it does not seem to have been fully integrated into theMEDLINEplus site. For example, using the same search as above,searching for the drug “lopressor” still brings up a 15-page monographfrom the USP DI, and no entry from the MedMaster database. To get tothe entry on lopressor from MedMaster, one must browse an alphabeti-cal list of drugs. Also, getting 106 search results from typing in the drugname “lopressor” is quite daunting to any searcher.

This author prefers Eckerd Drug’s site <http://www.eckerd.com>,which has an agreement with Gold Standard Multimedia and providesfree access to Clinical Pharmacology 2000. This database is much eas-ier for patients to understand and describes what the drug is used for,how to take the medicine, and potential side effects. Certainly in thiscase, Eckerd does what MEDLINEplus cannot.

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Another advantage of Eckerd’s Web site is access to a drug interac-tion report, again part of the Clinical Pharmacology 2000 database.Here one can enter over-the-counter or prescription drugs as well as se-lected herbals, and obtain a report of potential interactions. Althoughthe interface is a bit clumsy, it is nice way to use the Internet quickly todetermine potential interactions. To access each of these reports, clickon the “Drug Advisor” link from Eckerd’s home page. Of course, librar-ians are reminded that the local pharmacist is an excellent resource forpharmaceutical questions, and there should be no hesitation in referringpatients to this professional.

Finding Information About Physicians

Returning to MEDLINEplus as the “point of departure,” librariansshould then be introduced to the various doctor finders available throughMEDLINEplus. Librarians should be instructed to start with the AMAPhysician Select to search for a physician. Instruction should includewhat “board certification” means, along with how to interpret the list-ings in this database (AMA members are in bold and are listed firstwhen searching for a physician by specialty or region). Some users areconfused by this, and believe that only members of the American Medi-cal Association are “good” doctors. Since many physicians have a spe-cialty, it is more important for these physicians to belong to theirspecialty group, such as the American College of Obstetricians and Gy-necologists or the American Academy of Pediatrics. Membership in theAMA is not necessarily an indicator of competence.

Many states or their licensing authorities provide a link to a databaseof licensing information, which includes background and disciplinaryactions of physicians. New York State’s Department of Health, forexample, provides a database of “Disciplined Doctors” <http://www.health.state.ny.us/nysdoh/opmc/main.htm>. The Association of StateMedical Board Executive Directors created a database called Docfinder<http://www.docboard.org> that gives licensing information about doc-tors in 21 different states. A link to the latter is available throughMEDLINEplus.

MEDLINEplus has a link to “Current Health News” that studentsshould explore. This is helpful to those consumers who “heard some-thing on the news.” Although MEDLINEplus does not archive these ar-ticles, the site does keep about a month’s worth of news articles that canbe searched by date or by topic. This brief overview of MEDLINEpluswill give most students a basic start in consumer health reference.

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FAMILYDOCTOR.ORG

Another useful Web site that many do not know about is familydoctor.org <http://www.familydoctor.org> from the American Academy ofFamily Physicians. The AAFP has a wonderful collection of short pa-tient handouts on almost 500 diseases/conditions. This is great for thosewho want the briefest of descriptions. Surprisingly, many patients don’twant to read a lot, and want “just the facts,” and these handouts areideal. Also, these cover a broad spectrum of topics, from several com-mon family conditions such as nosebleeds, insect bites, and the advan-tages of exercise to the more sophisticated conditions such as epilepsy,heart failure, and HIV. Spanish content is also available for many of thetopics. To access these handouts, one can enter the disease/condition inthe search box or browse “health topics.”

One of the most useful features of this Web site site is the herbal data-base. This is provided through an online version of AltCareDex™, aproduct from Micromedex. It provides a synopsis of various herbals, vi-tamins, and other supplements and includes a bibliography at the end ofeach entry. The search interface allows using a search box or alphabeticbrowsing for the name of the herb/supplement. The interface does notallow for searching by disease or condition (for example, searching al-ternative remedies for arthritis), but it does provide a simple, succinctanswer to the many questions related to herbals. Most importantly, it isfairly easy to read and understand.

This site also has a link to “drug information,” but the database hereis the USP DI Volume II Advice for the Patient (just like MEDLINEplus),so I do not recommend this. However, the drug-interaction database isquite useful. Like its counterpart at Eckerd.com, the interface is quiteclumsy, but it is a handy reference tool to have on hand.

YOURSURGERY.COM

Many consumers come into the library wanting a detailed descriptionof surgical procedures. The best site for this is YourSurgery.com<http://www.yoursurgery.com>, a division of Animation EducationGroup. This site comprehensively explains several of the more com-monly performed surgical procedures such as cataract surgery, cardiaccatheterization, and hip replacement. The surgeries are categorized byarea of the body (such as head, chest, pelvis). The site explains the anat-omy of the site, the pathology of the disease, diagnostic tests, surgical

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procedures, postoperative care, potential complications, and follow up.Some of the procedures are described using animation, but even the“printer-friendly” version is superb.

CANCER.GOV

Another type of question that consumer health librarians face dealswith cancer. These are particularly frightening because the word “can-cer” connotes something devastating. Additionally, it seems that thereis news of some innovative cancer treatment almost daily, and to find“the latest” is intimidating. Although cancer information is covered insome of the sites previously discussed (MEDLINEplus, FamilyDoctor.org), no one does it better than the National Cancer Institute’s CancerInformation Page <http://www.cancer.gov/cancer_information/>. Thereare several nice features about this site, but particularly useful is accessto PDQ, the NCI’s comprehensive cancer information database. Thedatabase contains summary information about different cancers, treat-ment options, alternative therapies, and clinical trials, and each sum-mary is typically available in a version for the patient and for theprofessional. There are also useful links to support information. Thiscovers not only issues such as how to find a support group, but also triesto help those with concerns about finding a doctor, insurance, and hos-pice care. Most questions that a consumer has about his/her cancer canbe answered at this site.

ASSOCIATIONS

The last group of Web sites to consider includes those created by ad-vocacy groups and professional societies. Organizations such as theAmerican Cancer Society or the American Heart Association maintainexcellent Web sites with good patient information. Be sure the organi-zation is legitimate, though. The “Advanced Cancer Cure Society” maybe just a made up name of a money-making scheme operating out ofsomebody’s garage. To ensure the site is valid, one should use DIRLINEfrom the National Library of Medicine <http://dirline.nlm.nih.gov/>.DIRLINE is particularly useful because it includes not only associa-tions, but also research groups, government agencies, and educationalinstitutions. The site can be searched by MeSH headings, keywords, oracronyms. A search of the keyword aphasia, for example, brings up not

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only advocacy groups (such as the National Aphasia Association) butalso three research centers devoted to the condition. This is great for an-swering questions from users who want in-depth information, or infor-mation that the public library cannot provide from its print collection.

PUTTING IT TOGETHER

Certainly there are myriad Web sites devoted to health, and many arevery good. It is clear, however, that many public librarians need to learnabout a handful of reliable and easy-to-navigate Web sites to be able tohandle reference queries quickly and efficiently. These few sites can betaught to public librarians in a single hands-on session, and producegreat results with minimal time and financial investment.

Follow-up sessions could include classes on evaluating consumerhealth information on the Internet. When the above-named sites do nothave the answers, and one must rely on a “Google” search, it is impor-tant to teach librarians how to evaluate the results. A third class onPubMed searching for public librarians would round out a very nicetraining module. Public librarians can provide a tremendous service totheir patrons using these few tools.

Received: May 24, 2002Revised: May 30, 2002

Accepted: May 31, 2002

REFERENCES

1. Baker, L.M., and Spang, L. “The Provision of Consumer Health by MichiganPublic Librarians.” Public Libraries 37(July/August 1998): 250-5.

2. Tang, P.C., and Newcomb, C. “Informing Patients: A Guide for Providing Pa-tient Health Information.” Journal of the American Informatics Association 5(Novem-ber-December 1998): 563-70.

3. Fox, S. et al. “The Online Health Care Revolution: How the Web Helps Ameri-cans Take Better Care of Themselves.” The Pew Internet & American Life Project. No-vember 26, 2000. Available: <http://www.pewinternet.org>.

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