Sunday, August 17, 2003

Online physician has all the answers

UC professor is there to help patients understand ailments, medications

By Jim Knippenberg
The Cincinnati Enquirer

[IMAGE] Dr. Mitchell Rashkin provides online medical answers on the Netwellness Web site
(Brandu Stafford photo)
| ZOOM |
It's not that people don't trust their physicians, Dr. Mitchell Rashkin says. It's just that sometimes they want to hear something again, even if they don't like what they're hearing.

Rashkin knows this firsthand. The 52-year-old Blue Ash physician is one of 200 doctors, pharmacists and assorted health care professionals tied into, an online service that answers any medical question a reader e-mails in. And that's a lot of questions: The site gets 12 million hits a year.

Quick answers

If the physician who gets the e-mail first doesn't know the answer, he or she forwards it to a colleague who does. Most questions are answered in a matter of hours by one of the experts, all faculty members at UC's Medical Center, Ohio State or Case Western.

Rashkin, professor of internal medicine, pulmonary care division, is the expert in asthma, allergies, lung disease, breathing difficulties, anything related to getting outside air inside the body. Oh, and he recently hit a landmark: He fielded the service's 20,000th question ("Will beta-blockers aggravate my bronchiectasis?" His answer, in fairly blunt, non-medspeak, was yes, sometimes).

Which makes you wonder: Why the heck didn't this guy ask his own doctor?

"That's a good and a valid question," Rashkin says. "And after I answer a question, I refer them back to their personal physician because there's no substitute for that personal touch. But I also understand why people go online to ask us.

"One reason is they want to hear it from someone else, or the doc told them something they didn't quite understand, so they write asking for clarification. I get e-mails saying 'The doc said such and such, and I just want to be sure I have it right.

"Or, sometimes they go into an appointment intending to ask something and then forget, maybe because they're flustered or because something else came up in the course of the appointment. Also, sometimes they're just too embarrassed to ask the question face-to-face.

"Sometimes it's clarification on how to use the medicine."

And sometimes, says Stephen Marine, associate director of UC's Academic Information Technology and Libraries, NetWellness visitors want to hear it from an academic institution. There's a level of expertise there that visitors appreciate."

No matter what Rashkin answers, there's one thing he always tells them - NetWellness doesn't take the place of an individual physician. "Online, we don't get the nonverbal clues that a doctor relies on, and we don't always have the ability to ask a follow-up question."

Oops. Make that two things he always tells them: "Quit smoking. I get a lot of 'what's that spot on my lung mean?' It's true, a spot isn't always deadly, but it's almost always something. I tell them to go back and see their doctor. And quit smoking right now."

Rashkin can answer some of the questions off the top of his head. Others require research. "That's one of the reasons I do this - to keep learning things. It's the fun part. Sometimes people ask questions and you wonder, why ask that?

"But then I start to wonder about it and I do the research. You find out all kinds of things you don't know. Sometimes I get so excited I take the information home to my wife Karen, (also a doctor), and say, 'did you know this?' She says no but is happy to learn it.

"Of course, it doesn't get me out of cleaning up dinner dishes."

The research is a little easier now, thanks to NetWellness' attention to detail. Most the questions the site has been asked are archived - 30,000 pages, Marine says - and are easily accessible to the public as well as the physicians.

The archives have also reduced the number of questions coming in, but Rashkin still gets some zingers: "I think the one that most surprised me was, 'I've seen 15 doctors and they all say this. What do you think?' It's the Wizard of Oz syndrome - they don't see us as a real person because we're out in cyberspace."

$14M spent

But cyberspace isn't cheap. Since its 1994 inception, NetWellness has gone through $14 million in federal, state and private money. And that's with the physicians donating their time.

"It's expensive, but it pays off because we're able to provide free expertise to people who really need it. We consider it part of our academic mission," Marine says.

Rashkin considers it part of his personal mission: "It fits nicely between teaching and my practice. It feels good to be able to do it, and it's nice to be able to sit down a while in the middle of a hectic day.

"And what's more, it keeps me off eBay spending money I shouldn't."

Top questions

Some health topics on get more questions than others. The top six hit categories and a few of the frequently asked questions.

1. Myasthenia Gravis

Q: Is it fatal? (Not anymore)

Q: Can MG patients be prescribed birth control pills? (Yes)

2. Gynecology

Q: Any connection between menopause and depression? (No).

Q: Can changing your brand of birth control pills cause nausea? (Yes)

3. Diet and Nutrition

Q: What diet is OK for a person with diverticulosis? (High fiber)

Q: I lost so and so many pounds and now I'm always cold. Why? (Loss of insulation)

4. Medications

Q: How long does it take for my hypertension medication to take effect? (Generally 24 hours).

Q: Does Prozac lose effectiveness after a couple of years? (Depending on storage conditions, it can retain 70 to 80 percent potency for one to two years).

5. Ear, Nose and Throat

Q: Is there a disease of the nose that can cause bad breath? (Yes, sinusitis and tumors).

Q: What causes chronic nose bleeding? (Drying of the nose, tumor, heredity, blood thinners).


Q: I've had periods of nausea, no appetite and diarrhea. Why? (See a gastroenterologist).

Q: Is there a relationship between chronic indigestion and a white-coated tongue? (No).


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