As a result of the rapid progress in medicine and the development of related technology after World War II, diverse new methods have become available to treat disease. At the same time, serious consideration of patients' rights, autonomy, and freedom of choice gave rise to the concept of “informed consent” (IC) in the United States. IC has been rapidly adopted in our country, and patients are now are often asked to give their written IC by their doctors. However, most patients and their families obtain information about the patient's disease from their doctor alone, and it is difficult for them to gain access to other sources of information concerned with the disease or their various needs. Very few hospitals give patients access to their library. Patients' needs are varied and differ from person to person, and thus medical information alone may be not sufficient. Many social resources regarding philosophical, religious, legal, ethical, biological, and medical information must be opened to patients by cooperative professional and lay networking.

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The United States is currently experiencing extensive health care reform. Subsequently, American attitudes towards health care have significantly changed. Americans are becoming more responsible and involved in accessing health care. Americans are independently seeking more medical and health information to become well educated medical consumers. Medical consumerism in the United States was initiated in the 1970's. A 1990 survey conducted by the American Hospital Association identified that nearly 50% of 2, 167 American hospitals with adequate libraries provided service to members of the community. Well informed patients and medical consumers are becoming more empowered to determine their treatment and participate in decision making for the selection of optimum care. Today, the concepts of “Advanced Directives”, “Informed Consent” “Living Wills”, and “Patients Rights”, are well accepted in medical and hospital settings. This paper will also present the evolution of modern trends of American medical consumerism and the influence of the “Library Service and Construction Act”, that accelerated consumers access to medical information. A selection of fundamental considerations to run and manage a consumer health information center will be presented including the topics of staffing, location, and collection.

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From my standpoint as the President of JMLA, the director of a university medical library and a medical doctor as well, I discuss herein the significance of the service to convey medical information to patients and the general public, the role to play and advice to be given thereupon from my experience and also from extensive literature. I especially refer to and emphasize, at present and in the future, what and how indeed “professional” librarians can serve patients and their families, who have a “right to know”, in the hospital and/or medical libraries, especially those who are going to die and to-be-bereaved family thereafter. I also refer to several grave difficulties lying before us in putting them into effect in the present situation, which should be overcome in the near future by our sincere efforts and lawful strategies to establish a library in the hospital and post definite librarians who care about these issues and serve the people described above.

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An information service for patients and their families was inaugurated at the Niigata Cancer Center Hospital in Japan in May of 1997. Patients and their families need plain medical knowledge after an initial stage of informed consent. The service is approved by the Informed Consent Investigation Committee set up at the hospital. The aims of the service are (1) to help the user to obtain suitable knowledge about the diseases in question, (2) to promote mutual understanding between the user and the doctor based on common knowledge, and (3) to assist the user in obtaining the best treatment. The service is offered two hours a day in the corner of a small meeting room near the hospital library. A rotating pair of volunteers who are skillful in counseling, a librarian, and a caseworker work for the service. The number of books and videotapes available for borrowing in the room is 280, and there are two copies of almost every title. Between May and August 1997, 346 users visited the room, and 189 books were borrowed. Problems to be solved are (1) lack of sufficient space for service activity, which sometimes interferes with user privacy, (2) an undetermined budget that depends on the hospital management, and (3) occasional uncertainty as to whether a patient has been informed of having cancer.

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Although our hospital has thus far presented patients and regional inhabitants, with somewhat too specialized medical and health books, the utilization of medical books other than those related to psycho-internal or psychosomatic medicine, as specifically designated by doctors has been confined to the medical staff. This was for fear of patients reading such medical books, possibly hindering doctors' medical treatments or feeling unnecessary anxiety about the disease, from their own mistaken interpretations. However, our judgment that patients' knowledge and the open presentation of medical information thereto for the sake of informed consent aiming at the patients' understanding, judgment and selection are required. As such, library medical materials should be available to initiate a partially open presentation of specialized medical books to patients and regional inhabitants in general this year (1997). Guidance to the utilization of specialized books is charged by the librarian and 3 doctors including a psycho-internal physician, but even with fear of anxiety the part of a patient having learnt his own symptoms and the remainder of his life from reading medical books, such a problem as whether the librarian can hold users' privacy or how the librarian should think of this issue once priority is given to the care of patients, remains to be examined.

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Being a district municipality, facilities for patients, their families, as well as the general public to obtain medical information are scarce. Nikko Memorial Hospital has, to date, tried various media in order to provide health information to the area's citizens. With regard to medical information, it has been difficult because of specialization and difficult technical terms. Due to the wide spread use of “informed consent”, making information available has become an important topic. The establishment of the Health Information Library was based upon two factors. The right of the patient and family to know about their condition and at the same time, a feeling of self responsibility regarding their health and the treatment of their illness. The library is operated by volunteers with support of the hospital staff including doctors, nurses, pharmacists, social workers, etc. Discussed here are the activities of the Health Information Library after a five month period of operation.

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The National Cancer Center Japan has begun providing computer-based free cancer information called the National Cancer Center-Cancer Information Service (NCC-CIS) for patients and their families, and physicians and other health professionals via fax line, Internet or personal computer. This system was launched in 1996. NCC-CIS in Japanese is modeled on the Physician Data Query produced by the National Cancer Institute in the United State and produced from an independent standpoint pertaining to the medical and social environment of Japan. NCC-CIS will provide up-to-date cancer treatment (staging, prognosis and state-of-the-art treatment by disease stage) and supportive care for each type of cancer including a directory of organizations and announcements of lecture meetings in Japan to facilitate cancer enlightenment for the people and to support decision-making for physicians resulting in reduced cancer deaths.

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Web sites are becoming more common these days, The Osaka University Life Sciences Library has tried to create a useful and worthwhile Web site, which was established in July 1997, to provide up-to-date information for users. This paper describes its experience of creating a notable Web site. This Web site puts main news and information which is worthwhile for the users on the upper part of the homepage, as the users can find out whether the information is necessary or not at first access. An easily used-site and regular or frequent renewal encourage users to browse the Web site repeatedly. A maintenance system is necessary for renewing the pages effectively. Each item is taken care of by people in charge to guarantee that up-to-date information is provided. Also, a working group has been organized to manage all the pages. In addition, public relations of the Web site and continuous provision of useful information are important to continue this new service. Its purpose and contents are also discussed.

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The purpose of this study is to investigate the Juntendo University Library's collection building by Journal Citation Reports impact factors and holding title numbers. I investigated all 137 JMLA(The Japan Medical Library Association) member library's holdings. Thus I evaluated Juntendo's holdings relative to these. The following results were obtained: 1) Juntendo University Library holding's impact factor is higher than other holdings. 2) Juntendo University Library holdings differ greatly in fulfillment by category. 3) There are significant differences according to categories.

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A questionnaire survey of Jikei's library users was conducted in order to evaluate present services of the library and to make future plan for improvements and development of services. The major results were as follows. Present services and librarians' qualifications were essentially satisfactory, but there is a lack of core textbooks and core journals and a strong need for a campus-wide computer network to use Internet functions and OPAC.

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It relates a brief view about medical libraries in Peru, a country with a rich cultural background with 10, 000 years old, in spite of its difficulties it is a challenge for hospital libraries to cope the lack of resources of updated knowledge and thanks to Internet a wonderful tool of development. We are able to be in contact with the global community.

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