Overview

One of the most heavily used sections in the library is the one dealing with health and medicine, and people frequently come to the desk for answers to their questions. They come to us for a variety of reasons, including:

• Sometimes people feel that they cannot ask their doctors. They might think that the doctors don't have time or can't explain the problem to them in ways that they understand. Sometimes they mistrust the doctor or simply want another opinion.
• Some library users come in to use the Internet so that they can do their own research. They may then contact you for some additional help.
• In this age of HMOs and medical cost-cutting, the average citizen must increasingly assume responsibility for his or her own medical care decisions. Often they need assistance in obtaining the information necessary to make these decisions.

We can be very helpful in directing library users to useful information, but since we are not trained medical personnel, we need to be careful about what the library and we provide. As when responding to legal questions, there are some limitations about answering medical questions, and we all need to be clear about what we can and cannot do.

This section will review the major challenges we face in dealing with medical issues. They are:

• Finding out exactly what the library user wants
• Providing information and resources that the library user will understand
• Distinguishing between giving information and giving advice
• Knowing when to refer questions

Finding Out What the Library User Wants

Discovering what people want is tricky even under the best of circumstances. It can be especially difficult when dealing with health-related questions, since people are often embarrassed or reluctant to discuss their problems with strangers. Doing an effective reference interview is vital. In small libraries with limited collections, there is a good chance you will need to refer the question to another library or another source of information. If you can relay the exact question, it will make it much easier for the right specialized source to be found that will answer the information need.

First, be as tactful as you can. Use your judgment about when you think you have all the information the library user is going to provide without being uncomfortable or embarrassed. Take some steps to make library users feel comfortable: keep your voice low, talk somewhere away from other library users, and make them feel that you can be trusted to keep their inquiries confidential. If it seems appropriate, or if they ask, tell them that it is library policy to provide privacy and confidentiality to all library users.

It helps if you can explain to library users that you need as much information as possible to provide the proper resources to answer their questions. Also, tell them that if you need to refer the question, it is best to include as many details as possible. For example, if a library user asks for nonspecific information about diabetes, all you or a reference center can do is to provide very general information. However, if the real question is learning about the complications of diabetes and pregnancy, then the library user is more likely to be provided with what she needs.

The reasons library users seek medical information are as diverse as the users themselves. The teenager asking about sexually transmitted diseases may not be working on a school report. A library user may ask about rather uncommon conditions such as yellow fever, malaria, or influenza. They may be doing research, or they may be traveling outside the United States and want travel information. With these questions, it's especially important to know how the information will be used in order to find the best source for the answer. Gently ask for details.

The privacy of library users must be respected at all times.

Providing Information: Print Sources

The library can supply quite a bit of information to assist with medical questions. For example, we can:

• Help locate books, articles, and information on the Internet
• Help library users understand how to use information sources
• Help library users identify other useful resources in the community

You probably have some books on medical topics in your collection—perhaps a general book on health and some on particular topics like heart disease, nutrition, allergies, pregnancy, and so forth. Beyond what is offered in the main portion of the text of these resources, point out any special features that might be overlooked, such as a list of useful references, websites, organizations, or support groups. Before recommending a website from a book, make sure that it is still up and that it is still a source of good information.

As you direct library users to these resources, remind them that health information becomes out-of-date very quickly and that even the newest publications may have been superseded by more current research. Also, remind them to make note of who the author and publisher are, as some will be more reliable than others. Medical dictionaries, such as Dorland's Illustrated Medical Dictionary or Stedman's Medical Dictionary, general encyclopedias—and even almanacs or statistical resources in print or on the Internet—may be useful.

Your library may have one or more of the following resources in its collection. As long as they are current, they may give the library user the information they need, or may provide a good start for their research. A very good site for checking for new editions and titles is the Connecticut Consumer Health Information Network's Recommended Books for a Consumer Health Library (library.uchc.edu/departm/hnet/corelist.html). This site lists titles recommended for any size library, for larger libraries, and marks newly added titles or titles with new editions. It is updated several times a year.

• American Medical Association Family Medical Guide (4th edition, 2004)

  Published by the American Medical Association (AMA), the national, professional association for physicians, this is one of the most helpful medical books for the layperson. Most of the common medical conditions are described in easy to understand language accompanied by clear diagrams. There are color illustrations to help people identify conditions; there is an index in the back, and a glossary of medical terms. The AMA sponsors this guide, and the advice constitutes fairly standard medical opinion. Library users may want to supplement this with "alternative" medical advice. For example, they may want to know more about holistic medicine, biofeedback, or acupuncture than you will find here. You will need to use other books and magazine articles to help the library user find that kind of information.

• Merck Manual of Medical Information (2nd edition, 2003)

  This is another excellent guide to medicine in lay language. Almost every conceivable medical condition is covered, with additional chapters that highlight women's, men's, and children's health issues. Specific information is also provided on the aging body. Charts and illustrations are provided, as well as a section on herbal supplements and their possible interactions with prescribed medications. Also available online (see below).

• The Physicians' Desk Reference (PDR)

  The PDR is published yearly and is a compilation of information about prescription drugs approved for use in the United States. Drugs used experimentally or in other countries won't be included. The major portion of this resource is devoted to "product information," where detailed descriptions of drugs and their effects are given. Each company's products are listed together. Because the drug manufacturers have provided the descriptions, the PDR is not the best place to find critical evaluations of the drugs. However, the information must legally include all side effects that have ever been reported, even if they were only reported once.

  The descriptions in the PDR are long and quite technical, so you may not have time to read a full section over the telephone. You must use extreme caution in choosing what sections to read. Some libraries feel that it is best for library users to come to the library to read from the PDR themselves.

  The PDR includes several helpful indexes: generic (or chemical name), brand names, category of drug, and manufacturer. Most medications can be found in more than one index. For example, Abbott Laboratories produces a drug they call Nembutal Sodium Capsules. This drug is listed in these places in the PDR:

  • Product category index, under "Sedatives"
  • Product identification (a picture)
  • Brand name index, under "Nembutal Sodium Capsules"
  • Generic and chemical name index, under "sodium pentobarbital"
  • Main listing, under "Product information"
  • Manufacturers index, under "Abbott"
  
  It is often hard to tell whether a prescription name is a brand name or a generic name, so you will need to check both indexes.
  
  
• Current Medical Diagnosis and Treatment

  This publication is published annually by Lange Medical Publications and is primarily aimed at health professionals, but it can also be an excellent source when you can't find anything written for the general public or when the library user wants to see professional-level material. It is intended to be a quick handbook that summarizes common health problems and gives the most widely accepted current medical treatment. For most conditions it gives symptoms, treatment, and prognosis (outlook). While it is written for the professional, much of it is quite understandable and helpful to the general public. There are separate publications for pediatrics, obstetrics and gynecology, and for conditions that are commonly treated with surgery rather than medication or therapy.

The following are very reputable publishers of health information that publish general health books as well as books on specific topics:

• The Harvard Medical School
• The Mayo Clinic
• The American Medical Association (see above)

Medical Information from Web Sources

The Internet provides a wealth of reliable information, but as with any resource each site must be evaluated to make sure that it contains accurate, up-to-date information that can be trusted.

Some recommended sites that provide free and dependable information are:

• MedlinePlus (medlineplus.gov)
  MedlinePlus is a directory site that includes information about conditions, physicians, and medications, with links to self-help groups and consumer organizations. The Medline database is mostly comprised of articles written for health professionals.
  
  
• Entrez PubMed (www.ncbi.nlm.nih.gov/entrez/query.fcgi)
  This is the address for PubMed, where the National Library of Medicine provides access to over 15 million citations for biomedical articles back to the 1950's. These citations are from MEDLINE and additional life science journals; data provided is often quite technical.
  
  
• NOAH: New York Online Access to Health (noah-health.org)
  This searchable directory provides access to "full-text health information for consumers that is accurate, timely, relevant and unbiased." Use the search function or browse by body area, medical procedures, groups, or general topics such as statistics, patients' rights, or nutrition. Librarians and health professionals select the sites. Available in English and Spanish.
  
  
• MayoClinic.com (www.mayoclinic.com)
  Here you can find information on hundreds of topics from acne to Zollinger-Ellison syndrome. Topics can be browsed alphabetically or searched by keyword. It includes a "health tools" section with calculators for body mass index, calories, pregnancy due date, risk for heart disease, target heart rate, and skin type, as well as a self-assessment test for depression.
  
  
• InteliHealth (intelihealth.com)
  This searchable site is sponsored by the Aetna insurance company and includes information provided by the Harvard Medical School. Medical, dental, and mental health topics are addressed. A medical dictionary is included.
  
  
• Merck Manuals (www.merck.com/pubs)
  The publishers of the Merck Manual make many of their books available online at no cost. At the above address are links to full text version of the Home Edition, the Manual of Diagnosis and Therapy, the Manual of Geriatrics, the Manual of Health and Aging, and the Veterinary Manual.
  
  
• healthfinder® (healthfinder.gov)
  Sponsored by the U.S. Department of Health and Human Services; provided in both English and Spanish. Link from the homepage to the Health Library, clinical trials, doctors and hospitals, prescription drugs, or to the "just for you" section, where information is provided for specific groups by age, gender, ethnicity, and others.
  
  
• Traveler's Health (www.cdc.gov/travel) The Center for Disease Control's National Center for Infectious Diseases sponsors this Traveler's Health site. Immunizations and vaccinations, medical concerns for destinations, traveling with children (and pets), and many other topics are covered.
  
  

The Internet can provide other medical information for library users. Searching Google on a medical topic, for example, will no doubt result in an overwhelming amount of information. As you direct a library user to an Internet search, make sure to explain to them how to evaluate a website. They must be aware that a lot of information on the Internet may be out of date, unreliable, or just plain wrong. They should look for current information published by a person or organization with authority on the subject, such as the National Cancer Institute (cancer.gov), the American Heart Association (americanheart.org), the Scleroderma Foundation (scleroderma.org), or the Depression and Bipolar Support Alliance (dbsalliance.org). Most of the time, the most up-to-date information can be found on the web.

Sometimes specialized medical sites will include a link to an email discussion group or to "chat" sessions with others interested in the same topic, which can be something of a support group. Advise them to look for this feature. If the library user has never participated in any kind of interactive communication online, offer assistance in doing so.

Perhaps you will direct a library user to an online database. Your library may have access to Thomson Gale's Health and Wellness Resource Center or EBSCO's Health Source: Consumer Edition. In these, library users can find full text periodical articles, pamphlets, articles from a medical encyclopedia, and more. Library users can also find citations to articles in print subscriptions held by your library, in a larger library, or through Interlibrary Loan (ILL).

Finding resources that are just right can be a challenge. For common conditions like diabetes, nutrition, or heart attacks there is quite a bit available for the layperson. For some other lesser-known conditions, little or nothing has been written for a person without a medical background. If you need to refer a question of this type for help in answering, you should take care to point this situation out to the library user. Then find out whether they might be able to use more technical information or if the source must be in lay language.

Before leaving library users with a pile of medical books and Internet print outs, make sure that they are comfortable with the type and level of information they have. If possible, return to them later to ask if they have found what they were looking for.

When It's Not in Person

The situation is somewhat different when you are asked medical reference questions by users who are not in the library: by phone, e-mail, or other methods. When people visit the library in person, they can choose what they want to see and read the entire passage or article about their topic. Since you usually can't spend the time to do this over the phone or type in the entire text of something in an email message, you must choose what to convey and what to leave out, and that could be misleading. When the question is tricky, you are much better off to insist (and you sometimes have to be firm) that the remote user come to the library and read the material there, rather than having you try to summarize over the phone. If your library subscribes to a database that offers remote access such as Health and Wellness Resource Center or Health Source: Consumer Edition, ask the user if he has a library card and a web connection. If this is the case, let him know the library provides access to quality resources from home. Offer to help him use the database; if it's busy, you can agree on a time for you to speak later. You can also provide web address(es) for quality sites that you think would be useful.

Special care should be taken in responding to medical questions over the telephone because it is so easy to mistake terminology. You must be sure that you have correctly heard what was asked. Some medical words that sound very similar and are spelled almost alike have very different meanings. If you aren't sure about the term, ask for a spelling (or a guess at it) and as much of a definition as the library user has, such as what body part or function is affected or what the medication is meant to treat. Use a medical dictionary and/or a search engine to verify the term. If doubt remains, you might want to say something like, "I am not absolutely sure what information you are looking for, and it is difficult to resolve this over the phone. It would be best if you could come into the library to look at our information in person."

Information, Not Advice

As with all reference questions, the library's role is to provide information to the library user—not to interpret that information. It is extremely important to be careful of this with regard to medical topics. We are not doctors, and only a health professional is qualified to give medical advice. Remember: you do not have medical malpractice insurance!

For example, if a library user has read a paragraph about a certain disease in a book in the library and then turns to you and asks, "Does that mean that if I have these symptoms, I have that disease?" This is a question involving medical advice that you just can't answer. You must let them know they have to seek professional medical advice. Or perhaps you have read a definition of a medical word over the phone to a library user, and she asks you to explain it because she doesn't understand the definition. What you need to do is to try and find another definition that she might understand better, or ask her what part of the definition is confusing, and look up the definition of that word.

Sometimes people will want to give you a list of symptoms and ask what disease would be consistent with what they describe. Again, this is the sort of question you cannot answer. To do so would be giving advice rather than simply finding appropriate information, and it is inappropriate to diagnose a condition. There are books you can recommend (try the subject heading "Symptoms" in your catalog), or the NOAH, Mayo Clinic, or InteliHealth sites discussed above can be searched using the keywords symptoms AND <nameofsymptom>.

The distinction needs to be made between providing information to read and giving medical advice or interpretations. It sounds simple, but in practice you may be tempted to be as helpful as possible and try to answer all the library user's questions. Library users can be very insistent when asking questions, but you simply have to be firm and explain that your role is to provide information and that anything further will have to be handled by a medical professional.

The Pacific Northwest Region of the National Network of Medical Libraries has a web page called Reference Interview Resources (nnlm.gov/healthinfoquest/help/interviews.html) where you can find guidelines on handling medical questions, examples of interviews for a "sensitive subject," and an "in the news" question. There is also a link to the King County (WA) library's pamphlet called Please Ask Your Doctor (www.kcls.org/findit/askdr.pdf), which is something a patient can use when talking with a health professional about a condition. You or your library may find this helpful.

If you are not sure where your role ends in a certain situation, ask your supervisor.

"Bad News" Information

What do you do when library users ask for information that you think would be upsetting to them? For example, what if you were asked to read the definition of a disease that the library user has, and your source says that it is fatal?

That's a tough situation to be in, and it does happen from time to time. You need to remember that the library user does have a right to the information, and you cannot take on the role of censor with regard to what they should or should not see. If the person comes to the library for help and information, you should provide the materials needed, but you should also provide the reminder that other circumstances could be involved and that a doctor should be consulted.

Library users have a right to free access to any medical information in the library. You have a duty to guide them to the most appropriate materials for their needs and to caution them about the nature of the resource, but you should never refuse to supply information they request, even though it may seem unsuitable or frightening. The library user has the right to the information and must make the decision about whether to read it.

"No advice" does not mean "no information." It does mean, however, that you must not interpret the information you provide.

Referring Medical Questions

When your own library does not have enough information to help the library user, and if time permits, you should offer to research the question further or to refer them to a more appropriate source. Refer medical questions as you would any other questions, but make sure that the library user understands that they will be getting "library" information, not professional medical advice.

Hospital Libraries

If you have a hospital with a medical reference library near you, try to become acquainted with the librarian. Find out what their collection is like and what their policies are on helping you or the public. Many hospital libraries have a policy of not serving the general public without a doctor's permission, but they are generally willing to help the public library if you call them.

The hospital librarian can often provide copies of useful articles and give you advice about how to handle tricky questions. Medical librarians will use their discretion in supplying materials for the library user. They may have policies regarding what they will give out to the public. Though many of these libraries are set up for the hospital staff, they usually have some popular-level materials; what they can provide will often be technical in nature.

Headquarters or Reference Center Referrals

Another way to access advanced medical information is by referring your question to the main library or a reference center. Staff at these locations may contact the local medical library or other experts for assistance. There is some information that should be included in any referral:

• Exactly what it is that the library user needs? Just what is the condition? Get an exact spelling and definition if possible. Try to get a brief description of the condition, including the parts of the body affected.
• What is the age of the person who has the condition?
• Is the information for the for the library user? Is the person a health professional?
• What level of material is needed? Can the person handle technical material?
• When is the information needed?
• Is the information for a research paper? Does someone in the family have the condition?
• What information does the library user already have? Has a doctor been consulted? Where have you and the library user already looked?
• 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 library user heard of it.

Gathering as much information as you can from the library user is critical in answering or referring a question.

Summary

No matter what you provide to the library user, you need to always point out that medical information changes so rapidly that books, and sometimes databases and websites, cannot claim to have the latest knowledge available. Library users should be reminded that a doctor or other health professional should be consulted. The library user may not choose to take that advice, but it should be given.

The reference interview is extremely important with medical questions, and it may be especially difficult because of the nature of the queries. Find out if the library user is willing to read technical material. Avoid giving any advice or interpretations of material.

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