Dermatology Online Journal
Use of the Internet among dermatologists in the United Kingdom, Sweden and Norway
- Author(s): Gjersvik, Petter Jensen
- Nylenna, Magne
- Aasland, Olaf Gjerløw
- et al.
Use of the Internet Among Dermatologists in the United Kingdom, Sweden and Norway
1. Department of Dermatology, Rikshospitalet, University of Oslo, Journal of the Norwegian Medical AssociationCenter for Health
Administration, University of Oslo 2. Journal of the Norwegian Medical Association 3. Center for Health Administration, University
Petter Jensen Gjersvik1 Magne Nylenna2 Olaf Gjerløw Aasland3
Dermatology Online Journal 8(2): 1
The Internet is increasingly important for doctors in all branches of medicine, but to what extent it is used by dermatologists is not known. In May 2001, we sent a questionnaire by post to 1,291 members of the dermatological societies of the United Kingdom, Sweden, and Norway. Six hundred fifty-three (51%) responded. Excluding those from retired doctors and non-dermatologists, 522 questionnaires were available for analysis. Ninety-five percent of the respondents had access to the Internet, at work (77%) and/or at home (83%). Seventy-nine percent used the world wide web for medical updating and other professional purposes. In a multivariate logistic regression analysis, age and private practice were negative predictors for Internet use (p<0.001). Sixty-two percent found medical databases on the Internet and 25% believed the Internet version of medical journals to be important for their continuing medical education. This may be compared to those who found medical journals on paper(83%), medical meetings(81%), and various forms of contact with peers and colleagues(62-66%) to be so. This study shows that a large proportion of dermatologists, especially younger doctors, use the Internet for medical and educational purposes, but Internet use has not yet replaced traditional ways of obtaining continuing medical education.
The Internet has changed the practice and science of medicine, including dermatology. Medical information is now easily available to clinicians, scientists and patients on the world wide web [1-4], and communication by electronic mail (e-mail) between doctors and between doctor and patient is increasingly important. [5,6]
Dermatological diagnoses are to a large degree based on visual inspection of the skin. This makes the Internet, with its ability to transmit images, a potentially important and practical tool for dermatologists. 
We wanted to find out to what degree and how the world wide web and email are being used and viewed by dermatologists in the United Kingdom (UK), Sweden and Norway.
Material and methods
We designed a four page questionnaire based on a recent study among physicians in Norway and a pilot study. The questionnaire included questions about the Internet, medical journals, continuing medical education, access to medical information, and general background information. It was translated into English and Swedish, and then translated back into Norwegian for control of consistency.
Excluding those living outside their respective countries, the questionnaire was sent in May 2001 by regular mail to all members of the dermatological societies in the UK (n = 685; female proportion not available), Sweden (n = 436; 54% female), and Norway (n = 170; 36% female). Some of the members are not specialists in dermatology; some are junior doctors in dermatological training; and some are retired. Member lists were provided by the societies. A reminder was sent by mail one month later.
Six hundred fifty-three questionnaires (51%) were returned: 312 from the UK (46%), 212 from Sweden (49%) and 129 from Norway (76%). A dermatologist was defined as a certified specialist or a junior doctor in training in dermatology (in Sweden and Norway, dermatology and venereology). Excluding questionnaires from retired doctors (n = 68) and from non-dermatologists (n = 17), and those returned with insufficient answers (n = 16), 552 questionnaires were available for analysis. Some questions were not answered by all respondents.
The results are presented as percentages of the number of respondents. Groups were compared by the use of chi square test, and simultaneous effects were studied with logistic regression models. P-values <0.05 were considered statistically significant. Time reported used on Internet per week is reported as the median with 10 and 90 percentiles.
The demographic characteristics of the respondents are shown in table 1.
|UK N=286||Sweden N=154||Norway N=112|
|Age (mean, years)||44.6||50.7||48.0|
|Years after university graduation (mean)||20.3||22.7||21.0|
|Junior doctor ++ (%)||21||12||12|
|Private practice (%)||3||27||43|
|University +++ (%)||7||13||11|
Five hundred twenty-two dermatologists (95%) had access to the Internet, 12% at work only, 18% at home only and 65% both at work and at home. Seventy-one percent of the UK, 80% of the Norwegian dermatology consultants and 77% of the Norwegian junior doctors had Internet access at work. Of those in private practice, 52% had access at work and 80% at home.
Seventy-nine percent used the web for medical updating and other professional purposes with no significant difference between females and males. The proportion using the Internet was highest among junior doctors (94%) and those in universities and other research institutions (90%), and lowest (57%) among those in private practice, particularly in Sweden (46%) and among the few private practitioners in the UK (38%). The mean age of those who used the web for medical purposes was lower (45.6 years) than of those who did not (51.6 years). Seventy-three percent used e-mail for professional purposes.
In a multivariate logistic regression analysis with use of the web for medical purposes as the dependent variable, and gender, age group, type of position, and country as independent variables (Table 2), older age and private practice had significantly negative effects (p<0.001). Swedish and Norwegian dermatologists used the Internet more often than the British (p<0.05).
|Odds ratio||95% CI||p-value|
|Age group||<40 years||1||(reference)|
The reported median time spent per week on the Internet (the web and e-mail combined) for medical and professional purposes was 90 min (10 and 90 percentiles 0 and 300 min). This use was highest among university dermatologists (210 min; 10 and 90 percentiles 60 and 600 min). The similar reported time of Internet use per week for non-medical (private) purposes was 60 min (10 and 90 percentiles 0 and 180 min). The median reported time spent per week on reading medical journals and other medical literature was the same among Internet-users as among those not using the Internet (120 and 60 min, respectively).
Eighty-one percent of the respondents found the Internet useful or very useful for medical updating. Fewer found the Internet to be useful or very useful for obtaining information on courses, congresses, and meetings (47%), on career opportunities (18%), and on drugs and medical equipment (24%).
Search in medical data bases on the Internet had great or very great importance for their continuing medical education and updating for 62% of the respondents, including 82% of the consultants, 80% of the junior doctors, and 36% of those in private practice. 25% of all the dermatologists (18% in the UK, 31% in Sweden, 35% in Norway) thought reading the Internet version of medical journals had great or very great importance. The proportion of respondents who regarded reading the paper version of medical journals and attending medical courses, congresses, and meetings similarly, were higher (83% and 81%, respectively). Formal meetings at work and informal contact with colleagues were also highly regarded by many (62% and 66%, respectively).
Ninety-five percent had seen patients presenting medical information from the Internet to them, although 39% only rarely. Fifty-one percent of the dermatologists thought this had not affected the doctor-patient relationship, and 33% thought it had affected the relationship, most often in a positive way.
Twenty-five percent had received questions or requests for appointments from patients by e-mail. Forty-one percent had used e-mail to communicate with colleagues about patients, although 22% only very rarely.
This is, to our knowledge, the first published study on the use of the Internet among dermatologists, documenting an extensive use for medical updating and other professional purposes.
The proportions of female respondents from Sweden and from Norway were not significantly different from the proportions of those receiving the questionnaire. According to available statistics, the proportion of female doctors among specialists in dermatology are much higher in Sweden than in Norway (59% vs. 35% in 2000/01) and higher in the UK than in Norway (32% vs. 25% in 1994/95; retired doctors included), and mean age at start of medical school are higher in Sweden and Norway than in the UK.[8,9] This pattern is also found among the respondents, indicating that our sample is representative with respect to gender, age and years of practice. The proportions of dermatologists working in private practice reflect differences in the countries and their health care systems.
The member lists of the dermatological societies include members not active in dermatology (as reflected in the number of questionnaires excluded in the analysis). It may be that these members were less inclined to return the questionnaire, partly explaining the low response rates in the UK and Sweden. It is also possible that dermatologists not using the Internet were less inclined to return the questionnaire.
Ninety-five percent of the dermatologists in the study had access to the Internet in 2001. In a study among Norwegian doctors in 2000, 90% had Internet access, up from 72% in 1999 and 38% in 1997. [7,10] We are not aware of similar studies in the UK and Sweden. In a Swiss study published in 2001, 75% of primary care physicians reported Internet access. 
In our view, access to the Internet at work should now be regarded as compulsory for physicians working in a hospital or research setting. We find it unsatisfactory that some consultants and junior doctors reported no such access. Fewer dermatologists in private practice had Internet access at work than those working in other settings. This may be explained by legal rules restricting Internet connection to computers used for patients files, and that many private practitioners prefer to have Internet access at home.
As expected, more younger than older doctors use the Internet for medical and educational purposes. A large part of these activities takes place outside ordinary work time (data not shown). We interpret this as a reflection of high expectations and a high degree of professional ambitions and dedication.
Most dermatologists in private practice work alone or in small units without the professional teaching network common to many hospital and university colleagues. The Internet offers educational benefits to all dermatologists regardless of work setting. [1,2] Nevertheless, fewer private practitioners in this study use the internet for medical and educational purposes than other groups of dermatologists. The Internet appears to widen rather than narrow the gap between doctors with a professional teaching network and those without, and has so far not become an equalizing factor within the dermatological community.
Medical updating was found to be the most important application of the Internet among dermatologists. Reading medical journals in their paper version and attending medical meetings, however, were more highly regarded by the respondents as part of their continuing medical education than reading the Internet version of medical journals. It seems that the Internet adds to and enhances the access to traditional ways of information seeking instead of replacing them. Judged by these results, paper journals still have an important role in the continuing medical education of dermatologists. This may change when more medical journals are available in full text on the Internet. It is uncertain to what extent the Internet will or should replace face-to-face learning through contact with peers and colleagues at or outside the work place, but it can never substitute for clinical experience.
The proportion dermatologists who are using the Internet for medical purposes was lower in the UK than in Sweden and Norway (age and type of position considered), and may reflect a more strict funding of the health services.
Patient-to-doctor communication by the use of e-mail and the web is still in its infancy, as reflected by the results of this study, but will probably be increasingly important for medical practice in the future. [1,2,6,13]. We find it encouraging that most dermatologists did not think that patients bringing with them medical information from the Internet influenced the doctor-patient relationship in a negative way.
This study shows that the Internet has become an integrated part of most dermatologists' professional life. The use of the Internet for clinical and educational purposes will probably develop further, and there is potential for more and improved doctor-patient communication over the Internet.
We thank The British Association of Dermatologists, Svenska Sällskapet för Dermatologi och Venereologi, and Norsk Dermatologisk Selskap for providing their member lists, and to the dermatologists for responding to the questionnaire.
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