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GUIDELINES ON MEDICAL QUESTIONS

Updated by Roxanne Cox, University of Nebraska Medical Center, October 1998

The following is a sample set of guidelines on handling medical questions. Be sure to check with your own library to see if there are other guidelines you should use instead. There is also a sample caution statement you can use as a model. Some libraries make copies of such caution statements and give them to patrons along with the library material.

GUIDELINES ON HANDLING MEDICAL QUESTIONS IN THE PUBLIC LIBRARY

GENERAL PRINCIPLES

Patrons using the library have a right to free access to any medical information in the library. Librarians have a duty to guide the patrons to the most appropriate material for their needs in terms of level of difficulty and information content, but they should never refuse to supply information a patron requests even though the librarian may feel it will be unsuitable or frightening to the patron. The patron has a right to the information and must make the decision on whether or not to read it. Librarians must be careful not to practice medicine. Our job is to provide information to the patron, but not to interpret that information nor to give medical advice. Patrons should always be reminded that we are not doctors, and that we are only providing material that they must interpret themselves. They should be told that this may not be the best or latest or most complete information on the subject, and that only a doctor is qualified to make those judgments. This caution should always be given on each and every medical question handled. When resources at hand are inadequate, the librarian should offer to carry the question further, or to refer the patron to a more appropriate source.  The librarian should always tell the patron the source of the information provided. The privacy of the patron should be respected at all times. The question should never be discussed away from work and the patron's name should not be released even in seeking help for the patron, unless the patron has given permission. Because patrons are often embarrassed about asking medical questions, special care should be taken to be tactful and to put the patron at ease.

TELEPHONE INQUIRIES

Special care should be taken in responding to medical questions over the telephone because it is so easy to mis­hear over the phone, and because the librarian must be the one to choose what the patron will be reading. If a patron comes into the library in person, we do not have the right to censor the material they receive. We must supply information on the subject requested to the best of our ability. By telephone, though, the nature of the information must be different. We cannot read the full text of articles over the phone because of the time factor, and we can't be sure we have chosen the most appropriate information. The patrons make this choice themselves when using materials in person. In many cases, even choosing which books to read from, or which sections to read, may require a medical judgment we are not competent to make. It is always bad reference practice to give out incomplete information, and with medical questions it can be especially harmful. In replying to a question, you should always scan the material first before reading it over the phone, and if you feel that by reading only sections over the phone you risk misinterpretation, you should insist that patrons come to the library so they can read the entire article.

Some particular instances where this might occur:

  • DRUG INFORMATION: Patrons often call asking for information about a particular drug. For example, they may want to know what the side effects are. The standard drug encyclopedias generally have several paragraphs on each drug, and it is often not possible to read the entire article. However, reading just the section on harmful effects may be very misleading in the context of the whole article. You may want to read only the introductory paragraph, and suggest that the patron come to the library to read the rest.

 

  • TERMINAL OR HIGHLY SERIOUS ILLNESS: Again, the risk is giving out incomplete information. While a brief definition read by phone may indicate that a condition is highly serious, a complete check of the current medical literature may show many other factors that must also be taken into consideration. Thus, such a phone response may well be inaccurate or incomplete. Because of the special nature of these requests, and the possible harmful effects of giving out inaccurate information, it is wise to ask the patrons to come to the library where they can read all of the available material about the condition. You can tell the patrons that the information requested is too long, or complicated, or that you are not sure you have the correct information at hand, and ask them to come in person.

 

  • ILLNESS OR MEDICATION WITHOUT EXACT INFORMATION: If a person does not have an exact spelling and wants a definition; or has a word which "sounds like" and wants spelling or definition, you will have to use extreme caution in using the medical tools. For example, the words "hyperthyroidism" and "hypothyroidism" sound almost alike but are opposites. If there is the slightest doubt about what is meant, you should not give out this information by phone. If a person comes to the library in person you can help them use the dictionaries, cautioning them about the many sound-alike, look-alike terms, and then let them find the word themselves. Sometimes people call with a set of symptoms and want the name of the condition and some information about it. Sometimes they have seen a doctor and have been diagnosed but can't remember the name of the condition. You should not do this kind of question by phone ­ you would in effect be practicing medicine. Even if you think you have a name which matches the symptoms, you cannot be sure. The patrons should come to the library and use the medical tools themselves.

REFERRING MEDICAL QUESTIONS

If your own library does not have enough information to help your patron, and if time permits, you should refer the question through your regular channels for more help.

You should include the following information in your request:

  • Exactly what it is the patron needs. Just what is the condition?
  • Get an exact spelling and definition if possible.
  • Who is the information for? Is this for the patron? Is the person a health professional?
  • What level is needed? Can the person handle technical material?
  • When is the information needed? Is there a date after which it won't be useful?
  • Purpose of the request (is it for a research paper?)
  • Does someone in the family have the condition?
  • What information does the patron already have? Where have you already looked? Has a doctor been consulted?
  • What is the age and sex of the person with the condition?
  • For interlibrary loans, be sure to include complete bibliographical information as you always do, including author, title, journal (if appropriate), date, pages, publisher, and the source where the patron heard of it.

CONTACTING HOSPITAL LIBRARIES

In general, hospital libraries are not open to the public except by written referral from a physician. Check the AMERICAN LIBRARY DIRECTORY or call the hospital library for their policies regarding usage by people not on the hospital staff and to find out whether they have a Patient Information Center.

The public can, however, have access to the collections of hospital libraries by working through another library. You, as a library staff member, can contact the hospital library for help on behalf of a patron. The medical librarians will use their discretion in supplying materials for your patron. They have fairly strict policies on what they will give out to the public, so caution your patrons that they may receive only limited information.

THE CONSUMER HEALTH INFORMATION RESOURCE SERVICE (CHIRS)

The Consumer Health Information Resource Service (CHIRS) program is a cooperative project sponsored by three independent agencies and groups: the McGoogan Library of Medicine at the University of Nebraska Medical Center, the Nebraska Library Commission, and public and academic libraries in Nebraska. Consumer health information is any information essential to making an informed decision about your own or your family's health. After a condition has been diagnosed by a physician, information about the condition can be requested directly by the patron or through the public library. Information of a general nature on topics such as diet, exercise, drug abuse, etc. may best be answered by the local library. Information not available at the local level may be referred to McGoogan Library by mail, phone, fax, or e-mail at: askus@unmcnotes.unmc.edu. However, the consumer may also contact McGoogan directly. CHIRS professional health science librarians carefully select material from the lay level and/or professional collection of the McGoogan Library. The material is photocopied and sent to either the patron or to the referring library. There is no charge for this service for Nebraska residents. Borrowing from the CHIRS collection may be made through Interlibrary loan. On site use of the entire McGoogan Library collection, with the exception of the Class Reserve items and materials located in the Rare Book rooms, is permitted by anyone.

To request CHIRS service or obtain further information call or write:

CHIRS Project
Reference Department
Leon S. McGoogan Library of Medicine
University of Nebraska Medical Center
Box 986705
Omaha, Nebraska 68198-6705
(402) 559-6221

MEDICAL INFORMATION CAUTION STATEMENT

The Material that the library is providing you may not be the most accurate, complete, or up-to-date that is available. There is a vast body of medical information that is being updated daily and we are unable to guarantee that what we have located for you reflects the latest developments. We are always glad to check professional medical literature, but remember that it is written for the medical profession and the technical writing may be hard to understand. We are not qualified to explain or interpret this information. To be sure that you have the most current information and to get advice on interpreting it, you should check with a qualified medical professional.

SAMPLE CAUTION STATEMENTS FOR PARTICULAR SITUATIONS

MEDICAL REFERENCE BY PHONE:

The information I have located is too long and complicated to read to you over the phone. Also, there may be more recent or more complete information which is not at hand. It would be best if you could come into the library to examine the materials in person.

CAUTION WHEN PROVIDING TECHNICAL, MEDICAL MATERIALS:

This material is written in highly technical language for doctors. You may want to discuss this information with your physician, who can interpret it for you and apply it to your individual case.

CAUTION WHEN PROVIDING LAY MATERIALS:

Although the author has tried to put this information into non­technical language, you may still have questions about its interpretation. If so, you may want to discuss it further with your physician who can put it into perspective for you.

PATRON GIVES SYMPTOMS AND WOULD LIKE THE NAME OF THE CONDITION:

Although I am not qualified to interpret your symptoms, I will help you locate medical reference books for you to examine. (To patron calling, add: "When you come to the library..")

PATRON ASKS ABOUT SAFETY OF A PARTICULAR PRACTICE: 

(For example, consuming foods with artificial colors)

There may be some general information that has been published about the safety of that and I'll be glad to help you find it. I can't tell you whether it's safe for you in particular since that may call for a medical opinion which your doctor will need to provide.

Adapted from "Suggestions for Answering Medical and Consumer Health Reference Questions" compiled by Jill Conner, Metropolitan Cooperative Library System, 1984.

WORKSHEET: MEDICAL QUESTIONS

NAME OF THE CONDITION: Is this a lay term or one used in the physician's diagnosis? Is the patron sure of the spelling?

DESCRIPTION OF THE CONDITION: How would the patron describe the illness or disorder? What part of the body is affected?

AGE AND GENDER OF THE PATIENT:

COMPLICATING FACTORS IN THE PATIENT: Does the patient have other chronic illness or conditions (i.e. diabetes, pregnancy, prior surgery)

SPECIFIC INFORMATION NEEDED:

  • Cause______
  • Diagnosis______
  • Treatment______
  • Prognosis (likely outcome)______
  • Prevention_______

PURPOSE: Why is the patron seeking the information? (For a diagnosed medical condition in the family or a friend? For a research paper? Curiosity prompted by a media report?) Knowing this will enable the librarian to guide the patron to the most suitable materials.

SOURCES CONSULTED: Which sources of information has the patron already consulted?

TYPE OF INFORMATION NEEDED:

  • Brief definition______
  • Professional medical information_____
  • Lay level sources______
  • Directory information (organizations, etc.)_____

DRUG INFORMATION NEEDED:

NAME OF DRUG: Is this a generic name or a trade name? Is the drug available by prescription only or over-the counter? Is the patron sure of the spelling?

SPECIFIC INFORMATION NEEDED:

  • side effects______
  • reason for prescribing_____
  • drug interactions_______

LEGAL CONSIDERATIONS:

The librarian should be certain not to interpret the information to the patron. Never give a dosage from a book over the phone. The library could be liable for incorrect information given out by its staff. It is best to refer the patron to his or her physician or pharmacist for interpretation of drug information. The same caution should be used with information on herbal treatments or supplements.

MEDICAL INFORMATION ON THE WORLD WIDE WEB

In recent years, the World Wide Web has become a very popular outlet for finding medical information. In fact, often consumers will bypass traditional sources and consult the web first for their medical information needs. Although the Web does offer a wide variety of valuable information, the librarian must exercise caution when using the Web, as there are many unreliable sites as well. It would be beneficial to direct consumers to other resources as a compliment to their Web searching and to give them tips on how to find quality material on the Internet. Emphasis should be put on the following areas:

  • Authorship/Authority Is the site maintained by a credible organization, physician, or university? Is it by an individual with a disease or disorder who is putting up his/her personal experiences? Although on a support level, the latter might be useful to a consumer, the former would be more likely to give out objective and accurate information.
  • Bias Is the site objective, or is it trying to sell products that will ease the woes of the consumer's condition? Again checking authorship might be essential here, as a drug company might take a different outlook on a disease than a non profit organization would. Having a philosophical or bioethical viewpoint does not negate the validity of a site, but rather can foster debate and examination of issues. However, it is preferable that a site should clearly represent its persuasion.
  • Content/Scope What type of information is contained in the site? Is it annotated and is it comprehensive or does it cover a specific area of a topic?
  • Currency How current is the Web site? Does it give a "last updated" message? If not, it is questionable how timely the site is. Perhaps they have put up the site and never maintained it.
  • Ease of Use Is the Web site easy to navigate? Do the links work and is the site designed so as to have self explanatory categories? Are the graphics too large or cumbersome and does the site load quickly or slowly? Many people get annoyed and impatient with sites that take too long to load or have dead links. This is an important consideration.
  • Level Is the site intended for professionals or consumers?
  • Purpose What does the site intend to do? Give objective facts and information, sell something, or persuade?
  • Reliability/Accuracy Does the site include references to back up its claims?
  • Uniqueness Does what the site offers have certain value? Does it contain material that either cannot be found elsewhere or presents it in a better way than other sources?

The University of Nebraska Medical Center McGoogan Library of Medicine provides a list of links to consumer health online resources at: Consumer Health Information Resourceshttp://www.unmc.edu/library/consumer


For more information, contact Lisa Kelly.