Among my piles of E-mail I have seen messages from a few physicians and others in the health professions asking how (on earth) I manage to run this site -- and asking for hints on how to do it themselves.
My Web site is small compared to some of the behemoths, even the medical behemoths (such as Dr.Koop.com -- which, by the way, I have never visited). However, it's been open longer than many, also. Frankly, it started as:
Physicians who wants to set up a Web site for their practices have a few options.
There are a number of organizations that provide people -- both the general public and professionals of various sorts -- with free Web sites.
Some of these are "preconfigured", with templates into which you can plug information about yourself and your practice (or business). One example I'm aware of is a service offered by the American College of Obstetricians and Gynecologists to its members. A member OB/GYN can enter information about herself and her practice into a form on the ACOG Web site; this information is then plugged into one of several preformatted templates, and is then available on the ACOG server. ACOG also offers a search service for women looking for OB/GYNs that uses the information on these free pages to help match doctors with prospective patients.
Many of the large Web services, such as Yahoo and its recently acquired subsidiary, Geocities, now provide space on their servers where you can construct a Web site of your own for free. Although these services are free and allow you to put anything you want on the site, there are a few drawbacks. One major one is that ads will appear on your pages -- after all, these services depend on advertising revenue for their existence. Unfortunately, you often have no control over these ads. In that respect these sites really aren't free. Also, the URL will begin with the service's domain name, and may end up being long and cumbersome -- this may not be a drawback if all your hits are coming from other Web sites, but typing in long, involved URLs can turn some potential site visitors off (not to mention the space those URL's take on your business cards...)
Many, if not most, Internet service providers (ISPs) provide some server space with each account. This is provided as part of the monthly service fee.
Such facilities -- which you are already paying for if you use commercial ISPs -- can be very handy. You do, however, have to design the site yourself or get someone to do it for you; one takes time, and the other usually takes money. (I'll discuss content in more detail below.) Also, unless your ISP allows you to obtain your own domain name and attach it to the free space, your URL will begin with your ISP's domain name and will also be kind of lengthy.
Ease of use is a factor in choosing a Web hosting service, and more so if you use a commercial hosting service. "Ease", of course, is a relative term: many hosting services provide easy-to-use Web-based controls for you to run your site with. Others, like Msen, provide fairly full access to the server software itself, with only those restrictions needed to provide you and other customers with appropriate security. (The physical Msen server that my site is on actually hosts dozens of sites; I can easily find out what those sites are, but I cannot modify those other sites, and their owners cannot modify mine.)
This section is intended only for the rich amongst you... like surgical subspecialists. It costs a lot to run your own server. You must have a computer capable of storing all of the HTML and image files for your site, as well as the operating system (which may not necessarily be Windows-based -- and may need not to be Windows-based) and Web server software. It must be connected to the Internet through a permanent (24 hour/day, 7 day/week) line, and the line has to be high-speed (even cable may not be sufficient if you have a lot of visitors -- a moderate-traffic site pretty much requires at least a T1-fiber-optic line, and a high-traffic site may need a T3-line. These lines can cost thousands per month.) Unless you're running something like Dr. Koop.com, the expense probably isn't worth it. There are also maintenance considerations -- if your server crashes, your Web site is off the Web until the problem is fixed. ISPs can and do pay people to watch their systems 24 hours a day and fix problems immediately. Can you?
I mention this last because I feel this is the least-desirable option.
Shortly after I opened my practice, I started getting calls from companies that offered to set up a "Web site" for me for "only $29.95 a month" (some with $50.00 setup fees). These "sites" turned out to be similar to the template-based free sites I mentioned above -- but with much less versatility. They are essentially Web-based versions of the Yellow Pages, but with almost no flexibility in ad format and very little in content.
I will admit that I felt somewhat insulted by these companies. For one thing, the sales pitches were obviously scripted, and just as obviously not targeted at professionals, much less physicians -- in fact, they seemed to me to be targeted at people who knew nothing about the Web and how it works. For another, one minute with any of the major search engines would have told them that I already had a Web site running and that they were wasting their time and mine by trying to sell me something I was already doing (and better, if you, the reader, will allow me a little self-flattery). I would not recommend this option to anyone.
Most Internet business users have their own Internet domains.
A domain is, in computer/Internet terms, a collection of related computers that form part of a network. Each domain on the Internet -- whether it contains one computer or thousands -- has a name that identifies it and its member computer(s) to the rest of the Internet. The domains are grouped into "top-level domains", such as .com (for commercial users), .edu (educational institutions), and .gov (for government users). There are other top-level domains, including a long series of two-letter-name domains that denote foreign countries (for example, Canadian domain names all end with .ca, while names in England end with .uk (for United Kingdom) and Spanish domains end with .es (for Espana -- Spain, in Spanish) ).
To use a domain name, you must register it. Network Solutions, Inc. maintains the US Internet registry InterNIC. Their Web site gives full instructions on how to register a domain name, including fees (currently US$35/year) and how to make sure that someone else has not grabbed your intended name already. With the expansion of the Internet, finding a short, snappy name that someone else has not already taken can be a problem. (Domain names, by the way, are a valuable commodity -- there is a small but significant trade in names.) Your ISP can also help you register a domain name with InterNIC; this may be easier, since you have to have certain information from the ISP to register a name, and since the ISP must then take certain registration information to make your domain name visible on the Internet.
What to put on a Web site depends on your philosophy. Some Web sites are very glitzy in appearance. Some are staid-looking, but convey lots of useful information. Some are nothing more than ads for the business that owns the site.
As you may have noticed, my Web site is very simple from the graphic-design perspective -- but people come to drreddy.com mainly for information. In fact, my site's home page accounts for only about 2% of my hits, while the page on urinary tract infections gets 25-30%. Several Web designers have said that the best way to get repeat visitors to your site is to provide useful information (or other commodities that people want) and to keep that information fresh and useful.
There are several approaches to a physician's Web site.
This is the approach ACOG takes with its free sites for members (see above). The site consists of one or two "pages" (a "page" on the Web is a single computer file, with a single URL; these can be very short, very long, or in between). It tells the visitor who you are, where you practice, and business-related information such as office hours and insurance plans you accept. You can add simple bells and whistles; one useful one is a map showing prospective patients how to get to your office.
This will help prospective patients find out about you and your practice. However, unless you are also hooked up with physician referral services (from your hospital, local medical society, or third-party insurers), you may not be able to attract prospects directly with such a page. To do that, you almost certainly need to provide information that people will want to come (back) to your site to see.
Many Web sites consist mainly of links to other sites. These links are usually to related (usually by topic) sites. Many personal Web sites are built this way. Some of the link collections are quite useful, however.
One collection of links that many pediatricians hear about -- and one that I refer to on my own site -- is Internet Resources for Special Children. This is an indexed compedium of sites dealing with different diseases and disorders that affect children. It is the most comprehensive such site I have seen -- it covers a lot of ground, including many of the rare and low-profile diseases. Although it has relatively little original content of its own, the indexing service it provides is very useful. In fact, it's easier to look up rare diseases in IRSC than it is in the big search engines.
Of course, the more specialized a link collection is, the more people will come to visit it (within limits, of course). If you adopt this course, one option is to establish a niche by concentrating on diseases or conditions in which you have a special interest.
Writing your own Web pages takes the most work, but it can reap the greatest rewards in publicity.
As with link collections, it helps to have a focus for the information on your site. My approach -- begun in 1996, when the Web was relatively young and public access was not as widespread as it is now -- is to address questions that parents in my practice ask frequently. This has a couple of advantages for my practice: I can print out the Web pages and give them to parents to take home with them, and I can refer parents to the Web at night to amplify what I tell them on the phone.
Writing the material myself has advantages. Since I wrote the material, I know that what I'm giving my patients to read is exactly what I would tell them in person -- unlike handouts from "throwaway" journals or from books of such handouts, or (even worse) handouts produced by drug companies and others, some of are excellent but some of which are slanted, often in what I think is the wrong direction.
Also, since I wrote the material, I hold the copyrights, and I can do anything I want with my own writing. Some people have put together Web sites using material "borrowed" from others. Using copyrighted material without permission is as much a crime on the Web as in any other media. I have been plagiarized once so far, to my knowledge; that ended after I threatened the plagiarist with legal action. I will often give permission to others to use my material (with conditions, which always include proper credit to me as author) if they ask. I will take legal action against anyone who uses my copyrighted material without my permission. Most copyright holders will do the same.
There are many potential pluses in using the Internet to communicate with your patients.
As physicians are painfully aware, it is an unfortunate part of American life that anyone can sue anyone for anything, no matter how frivolous. Some malpractice actions are justified, but many are simply attempts to shake down health-care providers. I am not yet aware of any attempts to sue physicians for material they have posted on the Web, or for consequences of advice they have given people through the Internet. It won't be long, though, before someone tries. Institutions are at risk, as well, and some have simply refused to post even general medical information lest they be sued.
Every one of my information pages contains a disclaimer that states that all of the information I offer is intended as general information about medical problems, not advice on how to treat a specific patient. I also state what is obvious to every physician: I cannot give specific advice about a patient I have never seen, and therefore a reader who needs specific advice about a child must ask the child's regular doctor. A similar disclaimer appears on the feedback and E-mail pages. Although the information I give on the site reflects my own practice, and I occasionally describe treatment options (such as that for scabies), I do not give specific treatments. For the same reason, I do not give dosages for medicines -- even Tylenol. (It would be very easy to write software that takes a child's weight and returns a Tylenol dosage -- but I don't need the potential trouble that may come with such a post.) Some writers have suggested that medical Webmasters might consider setting up parallel pages: one set with general information on problems, and one with specifics that only your patients can access, using password protection to keep the general public away. This is a lot of added work -- it amounts to setting up two parallel Web sites -- but it does give you some added protection.
Despite all the disclaimers, much of my incoming E-mail is from people asking questions about specific medical problems -- their own, or their children's. I state on the feedback and E-mail pages that I may not even answer such questions; if I do (and I do, occasionally) answer, I start my answer with another, similar disclaimer. (Obviously, this rule does not apply to questions from my own patients -- see above.)
I do not yet know how many medical liability underwriters have addressed Internet-related liability issues. I know of one who has: Frontier Insurance Group has published short articles on potential Internet-related liability exposures in its newsletters to policyholders. My own underwriter's local claims examiner has looked at the site, as have attorneys recommended by them, with particular attention to the disclaimers I post.
Of course, the best defense against extortion is not to give anyone a usable weapon. Make sure that the information you give is accurate; have colleagues review your pages for problems before you post them. If you are advocating something outside the mainstream, say clearly that it is your opinion and that it is not shared by others in your field. (One example is the varicella-zoster vaccine. I am still not convinced that VZV is preferable to natural chickenpox, and I say so on my chickenpox page. However, I also state that this is my opinion and that it is not shared by many, if not most, pediatricians.)
This isn't just a matter of Web site security. If you keep any patient-related information on your office computers, you are obligated to keep that information as secure as your paper records. And most personal computers (the majority of office computers) are not designed to keep data secure.
I can't really begin to address data security here. If you plan to gather or distribute patient data via the Internet, though, you need to consider the security risks and take steps to keep hackers away from your patients' data. There are many computer security specialists around. Find a good one, and have him/her make sure your computers are resistant to unauthorized penetration.