[Fall 1998; Vol.25 No. 2]
Editor: Last fall we began a series on information technology in The Maryland Psychiatrist. (TMP) You and your husband Glenn Brynes, MD wrote an article “Getting Started With Computers” and the editorial for the issue was titled, “Caught in the Web”. Since then, we have followed up on those subjects in each issue. On the Internet, web pages are blossoming everywhere. There are web pages where you can shop, visit the Smithsonian, watch movies, or read Shakespeare.
Medical web sites are also proliferating. The usefulness to professionals would be hard to exaggerate. To name a few possibilities, you can read journals or textbooks, or research topics that interest you. The Maryland Psychiatric Society and Med Chi both have Web pages. The vast resources of the National Library of Medicine and other outstanding medical libraries are available on line. The public also has extensive access to medical information via the web. They can learn about health and illness as well as about types of treatment. As you have pointed out, there are numerous therapists offering their services electronically.
Some people find individual physicians through various web sites, such as the AMA’s. In addition to hospitals and large medical groups, small groups and solo practitioners are developing their own web sites. Among other purposes, these web sites can help to develop their practices. You have a successful site for your practice. A few other local psychiatrists have their own web sites, but most do not. Many of us, including myself, feel somewhat intimidated by the new technology. More psychiatrists might consider starting their own if they could learn from your experience.
Can you tell us briefly what a web site is and how someone could find it?
Dr. Watkins: I will try to avoid technical language as much a possible. A web site is an address on the Internet (known as a URL), where one can be located. The URL can be located directly or through links from other web sites. It usually takes no more than a few seconds to locate a web site. Once you reach the web site, you may find only a single page, or you may find volumes of material and many links to other sites. For example, you can easily reach the Library of Congress on the Web. Once there, you’ll find a world of material.
Editor: Why might a physician consider establishing a web site?
Dr. Watkins: There can be many purposes. The most common is probably to help build a practice. Other purposes would include such things as providing medical information as a public service or advocacy of particular points of view. Others might be to advertise software products or some other medical business venture. My own web site serves several purposes. It provides medical information as a public service, helps build our practice and even has assisted us in recruiting professionals to fill vacant positions. It is also fun for me to develop and maintain the web site. Because of the many responses we get, it provides contact with a wide variety of people from around the world.
Editor: Is this primarily for large practices, or should solo practitioners also consider setting up a web site?
Dr. Watkins: Solo practitioners should consider it for themselves too. Our own practice consists of two psychiatrists and two social workers. You can learn more about our practice and our philosophy from our web page. This can be helpful for prospective patients who may want to know more about us before making an appointment.
Editor: When did you start your web site?
Dr. Watkins: That’s easy to remember. It was about a year ago, in July of 1997. As a birthday present, my husband and children gave me a whole day to myself to start learning how to set up a web site. I think I actually got it launched a week or two after that. I have statistics on the number of page hits that I’ve gotten since January of 1998.
Editor: That would be for about the past six months. How many were there?
Dr. Watkins: Over 40,000.
Editor: Wow.
Editor: Where do they come from?
Dr Watkins: They come from all over the world.. I have a print out of the top 50 countries. The majority are from the USA and after that the top five are from English speaking countries, but they come from everywhere. I received a phone call several months ago from a reporter representing the St Petersburg Times. He had seen something about seasonal depression on my web page and wanted to know more about it. I was surprised and asked him why someone from Florida would be concerned about this, since you don’t have as much of it down there. It turned out he was calling from St Petersburg, Russia. We had a nice discussion. Fortunately, a lot of our hits (visitors) come from Maryland and adjacent Pennsylvania, which is the area from which we draw our patients.
Editor: Many web sites get few hits. How do you get so many?
Dr Watkins: I can’t say for sure, but it is not due to graphics and layout, which I haven’t developed much. I focus on content, and I find that the more original content I put on the site, the more people come to see. They find the articles through search engines like Lycos, AltaVista, Excite and HotBot, which link to topics on my site. For example, an article I wrote on child and adolescent depression is on my main site and is reached through these links. It has been the top rated article on Lycos in its category. Some of the things I have done to attract hits include asking popular pages to list my page, meta tags (using HTML language to help search engines list my site in an advantageous way), and coming to the main page through specific content pages. My family pages are completely separated from my professional pages. My site contains a lot of material written to help nonprofessionals understand mental health issues. This includes many book reviews of popularly written books on mental health for children, adolescents and adults, and is constantly updated
Editor: Are these articles you have previously published elsewhere or are they appearing for the first time ever on your site?
Dr. Watkins: Some of each, but most of them are things I prepare for the web. There is much less hassle publishing things this way, and if I decide there is something I want to change later, it is an easy thing to do.
Editor: Can you briefly describe the content of your web site?
Dr. Watkins: That’s hard to do in a few words. There are about 49 sub pages within the site and it is growing fast. There is an index page listing the main subdivisions. There are two link pages. One is aimed at the general public and the other is aimed at nonphysician therapists and primary care physicians. There is some overlap, but the one for physicians contains more technical information. For example, it has a whole section related to fetal alcohol effect and fetal alcohol syndrome.
Editor: What are some of the sub sites?
Dr. Watkins: Some are just articles I have written, including articles on various aspects of ADD and depression. I also have a section on the use of computers in doing medical and psychiatric research. It is a tutorial that often needs updating. I won’t overload you with an attempt to list everything.
Editor: Do you offer diagnostic or treatment services on line?
Dr.Watkins: No, we steer away from this. In addition to medicolegal issues, we would be concerned about quality of service.
Editor: What part of your web site gets the most hits?
Dr.Watkins: I have a big section containing managed care humor. This gets about 1000 to 2000 hits (visitors) a month. I keep it updated by adding a new joke every week. People come to read the jokes and often go on to other topics on my site and they keep coming back .I believe it is the largest managed care humor web site on the Internet. I have fun doing it.
Editor: And I am one of many who enjoy reading the jokes. I have also noticed that you have some well-written book reviews, many of them written for children, adolescents and parents. In addition to yourself as a book reviewer, I notice that a lot of lively reviews are written by Nicole, a ten year old. Is she related to you?
Dr.Watkins: Nicole is my daughter. She loves doing the book reviews and she also helps me in other ways with my web site.
Editor: So it’s a family enterprise.
Dr.Watkins: Yes, and my husband Glen, who is in psychiatric practice with me and who knows his way around computers is a big support, especially in fixing technical glitches.
Editor: How long did it take you to set up your web site?
Dr.Watkins: It took a couple of weeks to get it up and running. During that time I was also conducting my practice and looking after my family. It also requires regular maintenance. Even though it has become a large site, with the help of Nicole it takes me two or three hours a week to maintain it.
Editor: What does it take for someone to set up his or her own web site?
Dr.Watkins: Less than you might think. You could use your own computer with a dedicated phone line, but most people rent space on a larger computer, known as a server. Email access is needed to communicate with the server. If you don’t have your own computer, most public libraries will allow you to use their computer. A reasonable fee is charged for server space to set up your own site. Knowledge of HTML (Hypertext Markup Language) can be useful, However, many people use a program such as Microsoft Front so that they will not have to remember the complex HTML commands. With new services available, it gets easier and cheaper every day. Some of this may sound daunting to those who are new to computers, but colleagues such as Dr Marcio Pinheiro, MD with little previous computer background, have been able to set up their own web sites.
Editor: Once you have a web site, how do you let people know it’s there?
Dr. Watkins: There are many ways. I have touched upon some of them, such as getting links from other sites via search engines. There are entire books of yellow pages published for web sites, but these quickly become outdated. You can also have your web site URL listed in the local Bell yellow pages along with your name address and phone number. When prospective patients look up your number, this gives them an opportunity to learn more about you before calling for an appointment.
Editor: These are lean times in psychiatric practice. It is obvious that your web site is widely enjoyed. Is it possible to say how much it has helped to develop your practice?
Dr. Watkins: Although I have been able to give you some information about the number of hits that we get, I don’t have figures about how it has built our practice so far. It is possible to say however, that it makes a noticeable difference in the number of referral sources and of new cases. An added bonus is that by providing patients and families with useful information, our web site has improved the quality of our clinical work and our relationships with patients.
Editor: We don’t know how many psychiatrists in Maryland have their own web sites so far, but you are one of the successful pioneers. It won’t be long before many more join you. We’ll be counting on you to help us report on these developments as they evolve. Before we sign off, this is a good time to mention to our readers that the Computers in Psychiatry Committee under the leadership of yourself and Dr Glenn Brynes will be offering instruction to our members on the use of computers, starting this fall. Dr. Watkins’ web site can be found at
http://www.ncpamd.com or http://www.baltimorepsych.com
Thank you.
Gerald D Klee MD, Editor