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Last modified: Wednesday, September 5, 2007

Patients and the Internet

In the early years of the Internet, there was a huge proliferation of Web sites about health. Patients could search on-line for medical information, and a debate arose about whether this would put patients on a more equal footing and thereby threaten the authority of physicians.

It hasn't worked out that way.

"What the Internet has actually done is allow patients to formulate good questions for their physicians," said Paul Helft, M.D., an oncologist at the Indiana University School of Medicine and director of the Fairbanks Center for Medical Ethics.

That has benefited both patients and physicians in many cases, Helft said, without harming the relationship between them.

"I think it hasn't changed the fundamental aspects of the physician-patient relationship at all," he added.

Problems with the new Internet were apparent early, he said. Observers pointed out that some of the medical information available on the Internet was inaccurate. Others noted that some patients would print out 15 pages of information from a computer and bring it to their physician, who only had 15 minutes to spend with the patient. Would the Internet actually do more harm than good for patients who relied on it?

"The danger of the Internet is that people may see poor information and make poor decisions on the basis of that," Helft said. "But I'm finding that patients can tell the difference between high-quality and low-quality medical information."

For example, patients will trust a ".gov" site over a ".com" site, he said.

Research has shown that the majority of Americans have looked up medical information on the Internet, and there have been some clear benefits from that. For example, Helft no longer has to explain to patients with pancreatic cancer where the pancreas is and what it does, as he often did 10 years ago.

On the other hand, there is no single answer to the question of how the Internet has influenced doctor-patient relations, he said, because doctors must deal with a whole spectrum of patients. Some patients want as much information as they can get, others want little or no information about their illnesses, and between those extremes is a range of different types of people.

Medical decision-making is now very complex for many patients because there are more options, more risks and more benefits to consider, he said. The Internet may be helpful in narrowing down the possibilities for the patient, but there is still no substitute for the judgment of the patient's physician.

"A common fallacy about the Internet is that the answer to any medical question is there somewhere, and patients just need to keep reading long enough to find it," Helft said. In reality, patients who go to a general Internet search engine and type in a general medical term are likely to get far too many hits for them to read. On the other hand, entering a highly specific description of a medical problem may produce no hits at all.

Regardless of what the Internet can contribute, what still matters most is the relationship between patient and physician.

"In general, patients more engaged in their own care and treatment can forge deeper relationships with their physicians," he said. "The ideal model is 'partners in health care.' In the past, patients went to doctors for wisdom, and that's still true. The patient wants to know, 'What should I do in my situation?' The Internet hasn't changed that."