Dr J, Sport Health, VOLUME 22 ? ISSUE 1 ? AUTUMN 2004

http://www.injuryupdate.com.au/image...revolution.pdf

For those of you who are now
comfortable at using email and
reading the newspaper on the
web and therefore feel you have
already lived through the big wave
of the Internet revolution, strap
yourself in for the next ve to 10
years. Publishing on the Internet,
particularly publishing that is driven
by underlying databases, is going
to change the way that most of us
do business (as both producers and
consumers). In some industries this
has already happened, and the way
in which it has occurred or appears
about to occur is a guide to what
most businesses should expect in the
near future.

One of the major revolutions driven
by teenagers (incidentally an age
cohort that will be extremely powerful
in the next few years because they
have grown up expecting to use
computers in every aspect of life) has
been the downloading of free music.

The major record labels have been
carrying on like pork chops about
music piracy, but it hasn?t affected
them enough to reduce the price of a $25 CD, which costs them about 20 cents in material costs to make, plus labour costs. We know about the 20 cents, because
that is all a blank CD bought in
bulk costs us if we want to make a
CD copy for ourselves on a home
burner. We also know the record
labels can get labour pretty cheap by
the fact they can afford to give away
promotional CDs with $1.50 Sunday
newspapers. But we also keep buying
enough of the $25 CDs to keep
the recording companies nice and
protable for now.

The future in this industry is very easy
to see (and even happening over the
next few months): the availability of
legal pay per download music from
the Internet set up by the recording
companies at a price around $1-2 per
single and $5 per album. This will be
quite similar to the newspapers who
to date have not minded setting up
free Internet sites in competition to
their own print newspapers on the
basis that they are still selling plenty
of the hard copy variety.

Another impressive way that Internet
databases are changing the way
people behave is in the real estate
industry.

Buying or renting a property is still a
major pain, but instead of spending
entire Saturdays driving by a dozen
properties, most of which you will
reject in the rst 30 seconds of
viewing, you can now screen for most
features on the Internet. Consumers
expect photos of all rooms and oor
plans on real estate Internet sites,
which is a big improvement on the
?renovator?s dream? information you
get in a 4-line ad.

Buying and selling used cars haven?t
been as revolutionised just yet but
expect the same to happen for the
same reasons, and the percentage of
sellers who lie on the Internet to be
no higher than in the ?real world?! The
big difference between traditional
publishing and Internet publishing
is price per word, with the Internet
being hundreds of times cheaper, so
that far more information becomes the
industry standard.

A very similar (almost completely
new) industry is on-line dating
which, however clinical it sounds, is
successful for the same reasons that
floor plans on real-estate sites are
popular. Some reactionary people,
usually over 30 and incidentally
members of a generation that has
an appalling track record with
respect to successful relationships,
don?t understand or don?t want to
understand the benets of online
dating, but it is very hard to argue
against the huge numbers of
particularly younger people who are
using the Internet to meet partners.

The bottom line is that as humans
we are all fussy to a degree in
relationships. For up to two dozen
personal criteria on which you may
or may not care to have a preference
(e.g. smoker/non-smoker, likes
pets/doesn?t like pets, wants to
have children/doesn?t want to have
children, strongly religious/mildly/
atheist, straight/gay/bats both ways,
meat eater/vegetarian, wants to
stay put/nomadic, etc.), there are
potential partners whom you might
meet in everyday circumstances who
will t some of your preferences.
When it comes to meeting someone
who ts the vast majority of your
preferences and vice versa (which
has to correlate with ultimate success
of the relationship), it is much easier
to nd someone highly compatible if
you are searching through a database
of 100,000 singles than if you are
searching through the crowd of 10
people you are speaking to at the pub.

Importantly, this doesn?t mean either
that a computer is selecting your
potential partner or that you will
hit it off with someone in real life
who seems very compatible over the
Internet. It just gives an enormous
head start in making the right choices,
which is why many young adults
particularly are in the habit of meeting
people using the Internet and thinking
that it is actually the desperates who
would rather search for a partner at a
pub or nightclub.

How do these anecdotes have
relevance to sports medicine practice?

Traditionally, the number one and two
criteria used to select a practitioner
when a patient is injured have been
location and word of mouth. If there
is a physiotherapist, for example,
within a couple of kms who your
friend was happy with, then you
might go there yourself to have your
own injury treated. It?s not a bad way
to start, but it isn?t perfect. Just say
you are recovering from a dislocated
shoulder. How do you know that the
practitioner you are planning to see is
an expert at, and is regularly treating,
dislocated shoulders?

Most physios if confronted would
say that they are experts in this area,
but so would most osteopaths and
sports physicians and surgeons. Some
chiropractors might manipulate your
spine for treatment and maybe even
some rogue podiatrists might even
correct your pronation in order to
stabilise your shoulder a bit more.

The traditional best resource for a
patient to find basic information about
a practitioner has been the Yellow
Pages, which will list phone number,
suburb and type of practitioner at
best. If you want more information
you can dial a number in the
directory, but the best information
you are likely to get is opening
hours and costs for treatment. From
the reception desk over the phone,
you are highly unlikely to get
detailed information that you might
want. Is someone in the practice
specically an expert at treating
dislocated shoulders, for example?
Does your type of dislocation require
an appointment with a doctor or a
physiotherapist or someone else?

This is where the potential of the
Internet gets exciting.

The Internet can function like a much
more interactive version of the Yellow
Pages. You specify your location and
your problem and you get not only a
list of practitioners in that suburb, but also links to large amounts of detail about the specifics of each practice and the problems they treat.

It is at this point that I hope you
can appreciate the analogy with a
dating website. Traditionally it would
be the height of rudeness to ask an
eligible person whom you had just
met whether they planned to have
some (or more) children but, on a
dating website, if you don?t specify
this information your prole won?t
turn up on any searches based on
this criterion (which is specied as
relevant by the vast majority of users
on dating websites).

Not just traditionally, but even
in 2004, a patient calling up an
orthopaedic surgeon?s office to ask
the surgeon?s charge for a shoulder
arthroscope and the number of these
procedures he or she performs in
a year will probably not get a full
answer. From a consumer?s ideal
viewpoint, this is unsatisfactory. At the
moment, very few surgical websites
list charges and experience for various
operations on their websites. This is
like the record companies who are
doing good enough business at their
current CD prices to not lower them,
or the married person who can?t
understand why anyone single would
look for a date on the Internet.

With respect to sports medicine,
eventually the cycle will be broken.
Once some surgeons start listing
their prices for operations on their
websites, there will be some patients
who will avoid surgeons who don?t
provide this information. As some
practitioners list the types of injury or
parts of the body or types of injury
that they are most expert at treating,
practitioners who don?t provide this
information or claim to be experts
at everything will be treated with
scepticism.

The Internet has been predicted to
spell the death of many industries and
processes, most of which have proven
remarkably resilient. The printed page
has never been more popular, which
is due to the fact that more people are
reading more often, even though an
increasing percentage of this is done
on the Internet. A great illustration
of the use of this combination is
the site Amazon.com, at which you
can read previews and reviews of
books and then order the real thing
over the Internet. More people than
ever (both professional and lay) are
reading scientic papers, with many
getting to what they want to read
about via the PubMed site. If you
have never used PubMed or Google
to look up something in the sports
medicine eld, then you really need
to get (less of) a life! Even shopping
for groceries, one of those joyful
tasks of ?real life? that we would miss
terribly if we didn?t have to do it, is
becoming popular on the Internet.
Yes, I still like to pick my fruit and
vegetables at the store in person to
make sure I like the individual pieces,
but I sometimes wonder why I bother to wait 10 minutes in line when I am
buying packaged goods that I could
be getting delivered online.

The Internet won?t mean that people
will stop picking up at pubs and
weddings, or will stop enjoying
browsing through the shelves of the
local bookstore. Unfortunately it also
won?t mean that real estate agents
become extinct! It won?t mean that
practitioners who don?t have websites
will go out of business either.

I can see more patients coming to
sports medicine clinics via the Internet
in the future and, because the ones
who do are more likely to be satised
(because they will have made sure in
advance that they are heading to the
right place), they will use the services
more often and there will be more
business for all.

Like the many other examples listed
above, the Internet will create new
growth rather than cannibalise
existing business.

OK, I?m sure that many of you will
have picked the conict of interest in
my opinions on this issue given that
I run a sports medicine website called
www.injuryupdate.com.au. If you
have any problems with this opinion,
log into the feedback section of the
website (called ?Forum?) and post
your complaint. Get ready for me to
write back and say ?I told you so?.
VOLUME 22 ? ISSUE 1 ? AUTUMN 2004