Running head: CRITIQUE MERCK MANUAL

Critique of The Merck Manual: Home Health Handbook Online Version

Malgorzata Borowy
Olivet Nazarene University
Introduction to Informatics and Baccalaureate Nursing
BSN 164 NRSG 301
Catherine Schlosser
June 1, 2012

CRITIQUE MERCK MANUAL

Critique of The Merck Manual: Home Health Handbook

Patient education is a pivotal role of a professional nurse. The nurse is responsible to
each patient or client to inform them of the ways they can be caring for themselves. Patient
education can include ways of monitoring current condition and identifying problematic trends,
such as continuous increases or decreases in blood glucose checks which the patient must in turn
notify the care provider to prevent further complications. Patient education can also address
preventative information that would help identify certain signs and symptoms in which should
cause alarm and further workup by the physician This preventative knowledge is so important to
the patient as the nurse had direct impact on the patients future wellbeing.
The Internet has become the imitate access encyclopedia. Patients can access any topic
of health knowledge just by browsing the web. With such advantages of instant access at any
convenient time, an individual can efficiently have any question regarding health care answered.
Nevertheless, with such conveniences come drawbacks. The Internet is an open network and not
all information is reliable and can be dangerous to ones health (Zimmerman & Barnason, 2007,
p. 33). It has been estimated that 58 % to 68 % of Americans use the Internet in their home
(Zimmerman & Barnason, 2007, p. 33). With such high rates of access, the Internet can be a
beneficial tool to self-education, once the patient is aware of its limitations and can distinguish
inappropriate medical teaching information (Health Summit Working Group, 2000)
The Health Summit Working Group proposes criteria of assessing the reliability of a
medical patient education website. The criteria include assessing the domains credibility,
content, disclosure, links, design, interactivity and caveats (Health Summit Working Group,
2000). By reviewing the following points and applying them to the education of patients of

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appropriate medical information websites, the professional nurse can allow the patient to be more
self-sufficient in his health.
The Merck Manual: Home Health Handbook (MM) is a free online version of the Merck
& Co., Inc. Manuals (The Merck Manual: Home Health Handbook for Patients and Caregivers,
2004-2012). There are several manuals published but only the Patient and Caregiver version will
be reviewed.
Credibility
Credibility is the review of the authors and sources of information. This criteria poses the
question whether and individual can trust the authors of this website in presenting them with the
most current and reverent information. Looking into the sources of the medical information on
the MM, the organization logo and name should be displayed as this institution will be associated
and credited with the information that is presented. The MM clearly displays the name The
Merck Manual: Home Health Handbook for Patients and Caregivers across each accessed page.
By following the link on the title, the editors of the manual are presented. The editors of this
online MM version include doctors of medicine, doctors of pharmacy, doctors of osteopathic
medicine, and nurse practitioners. These authors are relevant in this educational topic as all of
them have professional medical knowledge. While reviewing the Merck Publishing Group on
the companys website, the authors are all presented with their credentials, fields of practice, and
current affiliations with medical institutions. MM is published Merck Sharp & Dohme Corp.
which is a part of the Merck pharmaceutical company (The Merck Manual: Home Health
Handbook for Patients and Caregivers, 2004-2012). Even though this pharmaceutical company is
presenting disease treatment information such as medications to patients, after reviewed the site,
there is no apparent overwhelming push of Merck drugs. The site manly lists generics with links

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to common brand names. While reviewing the Atherosclerosis section of MM, the date of the
last review is listed along with the author, such as Las full review/revision January 2008 by
Jules Y.T. Lam, MD, FRCP (C). Browsing a large section of the articles on MM, updates range
from 2008-2012. The website does state that the date does not reflect any immediate corrections
or minor changes that were made. The information is relevant to the topic the article discusses as
it includes a general overview, causes, risk factors, symptoms, diagnosis, and prevention and
treatment with links to more in-depth information. In regards to the site being evaluated by a
peer-review committee, the MM is peer-reviewed by its own editors and professional
contributors, whether this is not biased is difficult to reason.
Content
The content of health information on the Internet must be accurate and complete; and
appropriate disclaimer should also be provided (Health Summit Working Group, 2000). While
reviewing several articles in the MM, especially Atherosclerosis, the information seems
concise with a general understating of the disease process and treatment options. The statistical
data presented is not presented with statistical jargon and is easily understood by lays people.
Over 55% of our aging population lack formal higher education therefore the information must
be relayed in a simple format without complex medical and mathematical jargon (Pearson,
2011). An important detail presented by Health Summit Working Group, though not applied to
this website, is the importance of the reader to understand that testimonials by other individuals
cited on websites are not evidence and should be hesitantly trusted. The MM website stats that
all information on the website is based upon the published Merck Manual book which is written
with the collaboration of over 300 contributors (www.merckmanaual.com/home/index.html).
The article on atherosclerosis reviews multiple therapies proposed to treat and prevent the

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condition. It links the reader to other condition in which atherosclerosis is present or plays a
large factor such as Coronary Artery Disease, Cholesterol Disorders, Hypertension, Obesity,
Exercise and Fitness (Lam, 2008). The website does state a disclaimer that informs the reader
that with the extended efforts of the editors to ensure that the information is accurate and
conforms with standards accepted at the time of publication there are constant changed to
information. Such changes result form continuing research and clinical data, therefore the reader
should always discuss read information with a doctor, pharmacist, nurse, or other health care
practitioner.
Disclosure
The MM does address its reader to review its privacy policy and terms of agreement.
The editors state Merck is committed to providing excellent medical information and, as part of
that effort, continues to proudly provide all of The Merck Manuals as a service to the community
(The Merck Manual: Home Health Handbook for Patients and Caregivers, 2004-2012). The
access to this website is free and available with no self-release of personal information.
Links
The MM only includes links within its own site. There are links forwarding the reader to
learn correlating diagnosis, risk factors, or treatment options. In Review of the MM page
dedicated to Pain, there are links to drug information, complimentary alternative medicine
treatments, rehabilitation treatments, and conditions related to pain such as depression and
seizures. These links do not take the reader to marketing sites proposing treatments or selling
products. Selecting a link and following it to a different page of the MM site, moves the reader
directly to the section discussing the topic. The reader does not have to skim and move about the
page to find the specific discussion previously motioned on the primary page.

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Design

The design of the website is just as important as the information within the site. A clean
professional site allows the reader to navigate with ease. The MM website is simple and easy to
use. The website is uniform in geographical set up with the search bar in the upper right corner,
the outline of categories in the left column, with the outline of the current topic directly
underneath. This stagnant design allows the reader to be focused on the presented information
and not wonder the page in distraction. Such Links are presented in red bold lettering and
include the pretext (see: ) which tell the reader the exact topic page the proposed link will
take them to. Medications, which have more information, are boxed in grey and hovering over
the work will present a temporary box with more information in regards to that medication. The
site also includes links that are suffixed by an icon that displays whether the link will take the
reader to a chart or a table of information. The font of the page is uniform and headings are
emphasized by uniform red font and size making the sections easy to distinguish while skimming
the page. The internal search is formatted to populate results by topics so it brings up most
relevant information instead of searching for words within articles. When following a link from
a populated search, the searched word is highlighted on the page allowing easy view of the
searched material on that page. The text does not present medical jargon and does include links
to definitions of possibly difficult topics. The site does not say whether they are writing for a
specific health literacy group. This is a crucial distinction as more than a third of the United
States population is at a basic or below basic level of health literacy, and these levels are
considerate inadequate for managing ones health care needs (Leichty, 2011). The MM has an
extensive gallery of medical photos, graphs, and illustrations to help the reader understand the
material. This website favors to multiple learning styles such as those who are more visual

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learners and prefer graphics and interactive models. On the right side of the webpage is a
stagnant box that includes audio pronunciations of medical words and drug names. Lastly, the
site does not run in Flash so most all web browsers display MM uniformly.
Interactivity
The MM does not offer an interactive component with the editors of the website. It also
does not link the reader to any possible blogs or forums where the reader can interact with peers.
Caveats
This website is produced by a pharmaceutical company it does go into detail regarding
medications in the treatment sections. It does not however state which drugs are more favorable
then others in the treatment. The terms portion of the website does inform the reader of its
reputations and position as a pharmaceutical company although also states that it is a peerreviewed source of medical information.
In conclusion, as Imogen King, a nursing theorist of the Theory of Goal Attainment
expressed that the goal of nursing is to help individual maintain their health so they can function
in their roles (Hood, 2010, p. 176). Kings theory is easily applied to the nurses role of patient
educator. A nurse provides the individual with knowledge to help heal or prevent complications.
With the growing trend of the Internet as a primary source for medical information and advice, a
nurses role must expand to a new-age patient educator and advocate. A study by Gilmour,
Huntington, Broadbent, Strong & Hawkins (2011) reviewed and evaluated nurses use and
appraisal of online health information. They presented that even when patients were presented
with online material and encouraged to use them, misunderstandings were presented by many
patients related to online material. Therefore, nurses must reevaluated educational needs and
teaching methods continuously to ensure appropriate understanding of presented information.

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The criteria for assessing the quality of health information on the internet proposed by the Health
Summit Working Group provides a foundation for deciphering reputable medical information.

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9
References

Gilmour, J. A., Huntington, A., Braodbent, R., Strong, A., & Hawkins, M. (2011). Nurses use
of online health information in medical wards. Journal of Advanced Nursing.
doi:10.1111/j.1365-2648.2011.05845.x
Health Summit Working Group (2000, December 6). Criteria for assessing the quality of health
information on the internet - policy paper.
Hood, L. J. (2010). Leddy & Peppers Conceptual bases of professional nursing (7th ed.).
Philadelphia: Lippincott, Willliams, & Wilkins.
Lam, J. Y. (Ed.) (2008). Atherosclerosis. Retrieved May 20, 2012, from
www.merckmanuals.com/home/heart_and_blood_vessel_disorders/atherosclerosis/athero
sclerosis.html
Leichty, J. M. (2011). Health literacy: Critical opportunities for social work leadership in health
care and research. Health & Social Work, 36(2), 99-107.
Pearson, M. (2011). Gerogogy in patient education - revisited. The Oklahoma Nurse, 12-13.
The Merck Manual: Home Health Handbook for Patients and Caregivers. (2004-2012).
www.merckmanual.com/home
Zimmerman, L., & Barnason, S. (2007). Use of a telehealth device to deliver a symptom
management intervention to cardiac surgical patients. Journal of Cardiovascular
Nursing, 22(1), 32-37.