Out of Five Stars

High quality content *****
Up to date *****
Good presentation  *****
Level of unfettered access *****
Useful patient information **
Interactive CME *****

website :  http://firstwatch.jwatch.org

Looking for a new medical website to review does have a less-than-random science to it, though I have often wondered how true that statement might have been in the past.

I think we, as users, look for certain things in websites - most commonly perhaps it is the CME content and many of us have already discovered that one size doesn't fit all.

A few months ago I came to the realisation virtually every medical school in the US had its own incarnation of a postgraduate online CME service, and, to try and look at them all methodically would eventually become an absurd and somewhat pointless exercise.

In addition to all those diligent academic institutions flying the flag there are also the commercial companies, whether in the "physician database" market or merely capitalising on the industry advertising service to primary care.

There are a number of things which I personally have valued in a good medical website:
• high quality, brief and informative "medical news" - preferably without any political or medico-political content (of little relevance to me in Godzone)

•  a comprehensive, unaffiliated and overtly objective CME service which will give up-to-date medical and clinical content for topics which are perpetually in need of adaptation to "shifting goalposts"

•  a text-content component such as e-Medicine or even Wikipedia/Medpedia, which eventually gives content we can refer to without "hoping for the best" and getting distracted on a Google search

•  simple and straight-to-the-point interactivity such as podcasted CME, etc

•  direct access where possible to a range of full text journal articles and texts such as the current edition of Harrison's

•  and probably a few others also.

Journal Watch is an off-shoot from the New England Journal of Medicine. It is an unashamed commercial venture from the Massachusetts Medical Society (MMS) - publishers of the NEJM - but it does provide a high quality medical news feed service.

As with a number of other sites the user is able to tick the subspecialties of greatest interest - always a difficult task for the primary care physician - that supposedly affordable, accessible and perpetual purveyor of all medical knowledge and skill.

Journal Watch does cater for an international audience and one can register for free to receive the same content as the full subscription service but six months behind, or one can subscribe directly, for US$99 per annum, for up to the minute news releases sent out at weekly or fortnightly intervals throughout the year.

What is sent out appears to be a comprehensive review of a wide range of medical articles from international journals across all specialties.

Even the subspecialties within each specialty are numerous and this does allow the user to fine tune their search to a smaller number of subspecialty articles.

Journal Watch has a variety of features such as audiofeeds, blogs and beta sites which could provide the truly OCD primary physician with too much time to kill with infinite interactive clinical opportunities to maintain their balance on the clinical treadmill.

Once again I had problems trying to register through Firefox and I would recommend this is done through Internet Explorer.

There is an option for a 14-day free trial of full content, but one would need to ensure the "bill me later" box was ticked or your credit card just might be debited without any correspondence after the 14-day trial.

Personally and from a primary care perspective, I would be more than happy with summaries six months behind, though there is always a certain excitement experienced with the release of important new articles - perhaps a little bit like new movies.

I tested out Journal Watch from its home page where an article on mechanisms and management of altitude sickness had been summarised from the Lancet Neurology (specifically

"Update on Altitude Sickness: A comprehensive review of the pathogenesis, molecular mechanisms, and genetics of both healthy and maladaptive responses to hypobaric hypoxia").

The article was very good, the perfect length for a GP, and it was double the content of the Lancet Neurology abstract (indeed abstracts have always had the intentionally tantalising quality of just giving enough to provide a one-to-two line punchline of relevant findings but without much else to convince us as "skeptical human Medpedias" to believe wholeheartedly in the paper or review) perhaps to try and get us to purchase the full text article for around US$30.

The other article which caught my sometimes cynical eye was the one in last week's British Medical Journal from the Nordic Cochrane Centre advising us "Organised Screening leads to Breast Cancer Overdiagnosis" - how strange it has taken us five to 10 years to find out something quite obvious while at the same time we have been subjected to what at times seems like a slightly patronising series of sermons on how bad it really could be to perform a simple, painless and inexpensive PSA blood test in order to reassure our non-female patients about the reasonable state of their prostate health.

Importantly it should be noted Journal Watch has been going for some 15 years now - albeit perhaps not always in an electronic format - and accordingly provides an impressive resource in the archives, for example, over 3000 articles in both the cardiology and the women's health specialty listings alone.

Thus, the advantage of having an enduring and commercially well-established publisher such as the MMS can be very persuasive in the search for a good quality medical e-service.

Maybe once our crazy swine flu entangled 2009 winter subsides and a few hundred locums or new GP graduates appear from over the horizon then we can all take some time to catch up on some of the things we know we should know.