In the ideal world doctors would rely on evidence from systematic reviews to inform practice.

Patients usually rely on information obtained from the internet as an information source. Given the complexities of issues such as screening (in this case breast cancer), to what extent do you think that patients are able to make an informed evidence-based choice on the merits of breast screening? What this question is truly asking, is how able are the general populace to discern 'good data' from 'bad data' - an interesting and important question! And despite this, I must ask - how able is the average doctor from being able to discern a good published study from a bad? Many I know rely on the reputation of the journal - indeed most only read one or two journals in their field and usually even then just the discussion and results! As Epidemiology taught us in Year 1/2/A; To stay up to date, GP's need to read 19 articles per day, every day of the year. In addition, 50% of information on health research is unpublished, the positive results carry undue weight and with >2 million health research papers being published every year it is nigh impossible to stay on top of it all. Textbooks are on average up to ten years behind best practice and continue to recommend treatments for the same time after they have been shown to be ineffective or inefficient. Despite this, medical practitioners are the 'experts' in medical knowledge and more than anything else have the means to identify good from bad information. I will raise a case in point of this conversation - vaccinations. The Australian Vaccination Network (AVN) website has been running for years now, advertising itself as a 'source of balanced information to help inform you on the benefits and pitfalls of vaccination'. Despite this, it clearly has an anti-vaccination agenda and has done considerable harm to the public view of vaccination through misleading and misinterpretation of information. Yet it appears a reputable source! Even the government has found it so misleading that a court order has been made to force the group to change their name and website (yet to happen as the ruling is currently being appealed). Now any good doctor who has reviewed the data and studies will clearly see the benefits of vaccinations, yet a simple google search will yield many more results on negative or downright false beliefs (Autism, anyone?) of vaccinations. What this comes back to are two key points; 1. Humans are for a large part emotionally driven beings and 2. Anyone with an opinion can relatively quickly and easily put their views forward on the internet As medical students (and indeed, continuing into doctor-hood) we are taught and trained to study the data, the journals and the reviews. To critique that which is put before us and to ask ourselves 3 questions; Is this study valid? Are its results important? Will this change the way I manage/treat my patients? Now these are questions the general populace wouldn't know to ask (and indeed validity is a large and complex question) - indeed they usually present with a single query and seek the shortest, easiest to understand answer to their specific question. The quality of the website they find most suits their own criteria will have a drastic impact on their understanding of the issue as well as their ability to make a fully informed judgement. It is for this reason that the doctor play a vital role in educating the patient (in fact the latin root of doctor is 'teacher'), with many doctors actively encouraging the patient to bring in any information they want to discuss to clarify the quality of it. While the potential of the internet to provide accurate, comprehensive and unbiased information exists - it is perhaps the role of the doctor to clarify, discuss and critique with the patient to ensure the most up to date and factually correct information is the information being used as a foundation for decisions to be made upon.

Back to the case in point, there are numerous handouts, campaigns and advertisements as well as social informants who provide information to patients on the topic of breast screening. While all of these may have a place in the decision making process, the doctors role is to provide scientifically accurate information on both the positive and negative elements. Clinical guidelines, RTC's and peer reviewed and validated studies provide the best source of information and it is thus the doctors role to convert that information into a clear, concise message appropriate to the individual patient to consume.