Dr. Eastern is Clinical Associate Professor of Dermatology at Seton Hall University School of Graduate Medical Education.

The internet has been in widespread use for only a couple of decades, but already it is hard to remember how we survived on a day-to-day basis without it. Virtually any information you need is readily available at the other end of your keyboard.

The downside, of course, is that there is so much information, in so many forms, that it is often difficult to tease out exactly what you need in a reasonable amount of time. In the frantic setting of a busy private dermatology practice, quick and efficient searching has become an indispensable skill. Detailed below are some of the tricks I've picked up for finding all sorts of information both quickly and efficiently.

Don't limit yourself to one search engine

Although Google is obviously the engine du jour (and has been for quite a few jours now), there are lots of other options, each with its own variations and advantages. If you're not finding it on Google, try AltaVista, AlltheWeb, Teoma, Yahoo, Lycos, or HotBot.

Put quotes around words you want searched as a phrase

This is an old trick, but an important one. If you want to know if melasma has been linked to isotretinoin therapy, search "isotretinoin and melasma" so that the search engine won't waste your time finding a million web pages containing the word "isotretinoin" and another million containing the word "melasma."

Exclude words by putting a hyphen (think of it as a minus sign) before any word you want screened out

For example, if you're researching tigers, you'll have to wade through scores of baseball sites unless you design the search as "tigers - Detroit." Conversely, if you are looking for information about the baseball team and want to exclude anything relating to big cats, the search should be "tigers + Detroit", meaning that the word "Detroit" must be present.

Widen your search by putting the "tilde" symbol before a word to get pages containing that word and anything similar

For example, "~tigers" will pull up tigers, lions, leopards, and many other kinds of cats.

Widen a search with an asterisk at the beginning or end of a word

Searching "acro*" yields any word beginning with those four letters, eg "acrochordon", "acronym", "acrocyanosis", and so on. Similarly, searching "*genic" yields "cryogenic", "photogenic", "dysgenic", etc. (AltaVista seems to do this best.) You can also use an asterisk as a wildcard when you can't remember every single word in a phrase or name that you're seeking. For example, a search using "*lupus erythematosus" will yield "systemic", "discoid", "drug-induced", etc.

Phrase your question in the form of an answer

Many people have been taught the opposite - to ask questions as questions - but you're not looking for websites that ask your question, you're looking for the answer! So "capital of California is" works much better than "what is the capital of California?"

For medical searches, consider limiting domains

If you're researching metastatic disease, you probably don't want thousands of extracts from cancer patient chat rooms, or commercial sites aimed at the general public, lawyers, etc. To find only those pages posted on academic sites, use the "site:" syntax tool to limit your search to the .edu domain - in this case, "metastasis site:edu". (Don't leave a space after the colon, or the engine will consider "site:" as a separate search word.)

You can search news articles using the same techniques

If you need to know what your patients are reading about a particular drug - isotretinoin, for example - click "news" on the Google home page and search in the same way as you would search websites. If you want to see all new articles on a particular subject as they appear, go to Google Alerts and type "isotretinoin" and all its brand names into the search box; Google will e-mail you each time a story on that subject shows up online.

Search for clinical photographs in the same way

Say you're asked to give a talk on short notice. On the Google site, go to "Images" and search the subject of your presentation. Narrow your search to PowerPoint files by using the "filetype" syntax tool (for example, "psoriasis filetype:ppt"), and you'll often find entire presentations, ready to download!

If you click a link and get the dreaded "Error 404, Document Not Found" message, do not despair

The message confirms that the site exists, and the web page you want may still be there. Delete the last part of the address until you come to the next "/". Hit enter and see what you get. If it's another 404 message, repeat the process. Eventually you'll end up on the home or index page, which may very well have a search box, or a link to the page you're looking for.

Finally, keep in mind that, in many cases, websites at the top of your search results are there because the owners of those sites have paid for prominent placement. Some search services are clearer than others about what has been paid for and what has not. Take the time to read the "help" section, which usually spells out the service's policies, and frequently offers valuable tips for making the most efficient use of that particular engine. And check back regularly; the best services frequently add new features to keep up with the competition.

Once you have become skilled at finding the information you need, a new problem arises: the information changes! All the good medical, news, and other information-based websites (such as this one), change and update their content on a regular but unpredictable basis. And checking each one for new information can be very tedious, if you can remember to do it at all.

Many sites offer an e-mail service to notify you of new content, but multiple e-mail subscriptions clutter your inbox and often can't select out the information you're really interested in. RSS feeds are a more efficient and increasingly popular method of staying up to date on all of the subjects, medical and otherwise, which interest you.

RSS

Which stands for either "Rich Site Summary" or "Really Simple Syndication", depending on whom you ask, is a file format (or a similar one called "Atom") that websites use to produce a summary file, or "feed", of new content, along with links to full versions of that content. When you subscribe to a given site's feed, you will receive a summary of new content each time the site is updated. Thousands of sites now offer RSS feeds, including most of the large medical information services, all the major news organizations, and many blogs. To subscribe to feeds, you must download a program called a "feed reader", which is basically just a browser specializing in RSS and Atom files. Dozens of readers (also known as "aggregators") are available; some can be accessed through browsers, others are integrated into e-mail programs, and still others run as stand-alone applications. Many readers are free, but you'll pay a nominal fee for those with the most advanced features.  It is not always easy to find out whether a particular site offers a feed, because there is no universally recognized method of indicating its existence. Look for a link to "RSS" or "Syndicate This", or an orange rectangle with the letters "XML" (don't ask!) or "RSS". These links aren't always on the home page. Sometimes, on the site map, you'll find a link to a page explaining available feeds and how to find them.

Some of the major sites have multiple feeds to choose from. For example, you can generate a feed of current stories related to the page that you're looking at on Google News by clicking the RSS or Atom links on any Google News page. Once you know the web address (URL) of the RSS feed you want, you provide it to your reader program, which will monitor the feed for you. (Many RSS aggregators come preconfigured with a list of feed URLs for popular news sites.)

In addition to notifying you of important news headlines, changes to your favorite sites, and new developments in any medical (or other) field of interest to you, RSS feeds have many other uses. Some of the more popular ones include notification of arrival of new products in a store or catalog, announcements of new newsletter issues (including e-mail newsletters), weather and other changing-condition alerts, and notification of additions of new items to a database or new members to a group.

It can work the other way too. If you want readers of your practice's site to receive the latest news about your office, such as new treatments and procedures you're offering, you can create your own RSS feed. Any competent web administrator will know how to do this, or you can do it yourself if you're so inclined. Some will insist on doing it from scratch but, for the rest of us, a multitude of tools is available to simplify the process. (If your site includes a blog, for example, many blogging tools automatically create RSS files.)

Detailed instructions abound. You can find them easily with - what else - your favorite search engine!