Should doctors spurn Wikipedia?

Wikipedia is a free, online encyclopedia that anyone can edit, regardless of experience or qualification. It is the most frequently used online educational resource with 17 million articles appearing in 262 languages. The English version alone claims over 3.1 million articles and attracts 65 million visitors every month.1 Anecdotally, it is a popular medical student resource with almost 9000 trainee doctors joining the online group ‘Wikipedia is helping me get through med school!’. Wikipedia use among junior physicians is as high as 70%.2 These observations are unsurprising given the increasing reliance of doctors on Internet resources. One survey of radiology trainees suggested 83% use the Internet as their ‘first port of call’.3 Despite widespread use, Wikipedia has received criticism. Doctors and medical students are frequently discouraged from relying on Wikipedia as a source of information given concerns about its accuracy and provenance. Although Wikipedia entries are often poorly structured and difficult to understand4 they are comparable in accuracy to some online resources, such as health insurance websites.5 Clauson et al. found Wikipedia answered only 40% of pharmaceutical questions compared with the Medscape Drug Reference (MDR) which answered 82.5%. Wikipedia articles were less complete (76%) than the MDR entries (95.5%) but no factual inaccuracies were identified in any drug-related Wikipedia article.6 Another survey found Wikipedia compared favorably with the Encyclopedia Britannica.5 There are particular concerns over the value of Wikipedia as an educational resource. For example, one study found it to be less efficient than Google or other search engines for medical students answering multiple choice questions.7 However, there is evidence to suggest that Wikipedia is a more dynamic source than textbooks given its potential for immediate updating. One survey of Wikipedia healthcare articles found they were well-referenced to recent scholarly literature.1 The accuracy of Wikipedia relies on two premises. First, that interested and informed parties are more likely to correct entries than casual readers. A survey of Nature contributors found that 17% regularly used Wikipedia, suggesting a substantial pool of professional scientists engage with this resource.4 However, there is little evidence to date on how many ‘experts’ actively contribute. The second premise is that such high volume readership (e.g. 2.5 billion views per month) should ensure errors are swiftly erased.8 Magnus intentionally introduced small errors into biographical articles about deceased philosophers and found 50% were corrected within 48 hours.9 There is a risk of deliberate misuse. For example, Independent columnist Johann Hari admitted in September this year to maliciously editing articles about people he disliked. These amendments introduced allegations of anti-semitism, homophobia and drunkenness.10 Similar cases have been reported on a number of occasions8 and raise the possibility of unscrupulous parties editing healthcare-related articles. However, a Nature survey of Wikipedia articles concluded that such high profile incidents are an exception rather than the rule.4 Although considered an unsatisfactory authority for doctors and medical students, Wikipedia cannot be disregarded because of its perceived credibility deficit. It is currently the seventh most frequently visited website on the Internet11 and appears within the top 10 search results when users search for specific medical terms.12 There is a growing literature to suggest patients and their relatives use the Internet to answer health concerns.13 These online information seekers depend on the accuracy of resources such as Wikipedia which, in turn, rely on the knowledge, conscientiousness and objectivity of its contributors. One risk of clinicians disengaging from Wikipedia is that only contributors motivated by personal experience (e.g. patient anecdote) or vested interests (e.g. individual clinicians, institutions or companies promoting their own ideas and products) will remain. Legitimate authorities would be discouraged from contributing to healthcare articles online. This risks crippling a significant online information resource and missing an opportunity to provide accurate and reliable health information to millions worldwide. Most reports suggest that initial skepticism about Wikipedia by the academic community may have been over-stated. There are now many examples of researchers engaging constructively with this resource, including graduate students earning credit from updating articles.14 Recent work has proposed that members of the ‘Net Generation’ naturally engage with user-created resources such as Wikipedia.15 The evidence suggests that Wikipedia can have legitimate educational uses for individuals. These include a quick resource for finding general information and as an instrument for preliminary literature searching.1 The uncertain providence of information on Wikipedia should remind doctors to exercise caution when receiving established ‘fact’ from any source, whether online, published, or spoken by a senior colleague. If medical professionals can be encouraged to actively engage with Wikipedia, they may become involved in correcting errors as they are identified. Wikipedia is a rare opportunity for doctors to interact with an educational resource while helping develop an important public health information tool.