Online Access to Health Information:
The Internet's Impact on the Patient-Physician Relationship
“It’s a massive revolution. It altogether shifts what goes on when
a patient comes in with pages of downloaded stuff and half the time the doctor
looking at it has never seen it before. There’s a whole new set of emotions
present.”
–Dr. Rita Charon, an internist at Columbia’s College of Physicians
and Surgeons
How Is the Internet Transforming Healthcare?
Technology has had a significant impact in the healthcare arena. From new
testing techniques to surgical equipment, today’s medicine is very different
from that of just ten years ago (CNN). Now,
with the rapid proliferation of the Internet, technology may actually be serving
to alter the traditional relationship between doctors and their patients. As
more and more people use the Internet to gather information, many are relying
on this developing technology to address their health needs and questions as
well.
Indeed, by providing access to medical information, medical advice, and online
support groups, the Internet is making it possible for patients to assume much
greater responsibility for their healthcare. Traditionally, the relationship
between the physician and the patient is out of balance, as the physician has
better access to information and more experience than the patient. But the Internet
is changing this dynamic. Previously, the doctor-patient relationship was the
only way to bridge the medical information gap. The Internet is changing the
status quo by providing interpreted medical information directly to patients
(Ballas
2001).
Essentially, the Internet changes everything for the doctor-patient relationship
by balancing the knowledge in the relationship and by moving us away from a
paternalistic model and toward a facilitative model of doctor-patient interaction
(Nash 2001).
Healthcare on the Internet
The traditional emphasis of medical informatics has been to provide information
and support to professional healthcare providers. Nevertheless, a new branch
of health informatics is emerging, one with an increasing emphasis on computer
informatics. This revolution enables patients to access medical information
directly via the Internet. One system developed in the United Kingdom –
NHS Direct – provides advice on health and medical problems both on the
web and over the telephone. In the United States, Internet-based medical
services are being used by an increasing number of patients (Medscape). But while patients
may find this eruption of information a helpful convenience, they sometimes
forget that their online research often challenges the traditional role of the
physician in providing care.
The Patient-Physician Relationship
The impact of the Internet on the doctor-patient relationship comes from
the ready potential for patients to be better informed about their health situation
because of the ease of access to health information (Lundberg
2000). The information provided by the Internet is restoring balance to
the physician-patient relationship (Bader and Braude); the physician may no
longer single-handedly control the patient’s decision (Ballas
2001).
As Dr.
George Lundberg has explained, the surge of health information on the Internet
has one of two effects on the doctor-patient relationship. For physicians who
are comfortable with the Internet and with patients declaring their autonomy,
and for patients who have explored sites with trustworthy information, the patient-physician
relationship is enhanced and improved. But for those patients who access flawed
information and then bring it to their physicians, and those physicians who
prefer to practice in a more paternalistic mode or who are not up-date with
the Internet, there will be harmful consequences on the relationship.
Patients who use the Internet are becoming more educated about their medical
decisions. They no longer go to their physicians for medical information, but
rather to seek medical advice to confirm their own suspicions. Indeed, the mutuality
that once existed between physicians and their patients is no longer. Instead,
the physician-patient relationship is now established when the cyber doctor
provides information to the Internet user. If the information extends beyond
generic information and becomes patient-specific, and if it constituted diagnosis
or specific advice, it seems reasonable for the user to assume that some semblance
of a professional relationship exists.
The physician who is foolish enough to believe he or she cannot establish a
patient-physician relationship over the Internet, or who relies on disclaimers
in the face of offering patient-specific information, is compromising his or
her professionalism and taking legal risks. It is not inconceivable that cyber
doctors will one day provide detailed assessments to Internet users who grant
them access to their personal medical records. It also conceivable that cyber
doctors could actually be brought into the treatment loop and used as a type
of consultant to the user’s attending physician. Moreover, “audio
and visual computer technology may move Internet medicine, closer to telemedicine,
further muddying the distinctions between user and patient” (Blum
2001).
Effects on the Healthcare System
Economists believe that the healthcare system of the future will be completely
consumer-centric and consumer-focused, a revolution triggered in part by unfettered
consumer access to information via the Internet (Nash). Consumer reports
and profiles about the performance of healthcare professionals and organizations
are increasingly being made available to the public via the Internet (Medscape), and thus patients
are basing their decisions – at least in part –on outcomes information
acquired on the web. Consumer advocates argue that the disclosure of performance
data will help consumers to choose high-quality providers. Opponents, however,
argue that performance ratings unfairly penalize healthcare providers and organizations
that treat high-risk patients. Such ratings may discourage surgeons from operating
on high-risk patients for fear of losing credibility.
Moreover, Internet health sites have taught patients enough about different
procedures that patients have actually begun to demand certain procedures and
treatments from their physicians. If their demands are not satisfied, they simply
find another physician (Ballas
2001).
The explosion of health-related information on the Internet has provoked a significant
decline in consumers’ reliance on the choices of managed care provider.
The Challenge of Internet Health Information
While there is a plethora of health-related information on the Internet,
currently there is no way to authenticate it (Sonnenberg). Indeed, there is
an immense amount of misinformation available on the web. This unfortunate reality
creates situations in which physicians may have to un-teach what their patients
have learned. Physicians cannot devote hours each day to reading information
about a particular disease, especially a rare or obscure disease, that could
be found by a zealot who devotes extensive amounts of time to the Internet.
Resultantly, “there are patients who will have the pseudo-sophistication
of those that dabble without many of the basics that physicians have gone to
great trouble to acquire during their education and training” (McMenamin
2000).
Indeed, at present the quality of information on the Internet is extremely variable
in terms of completeness and reliability. Nevertheless, physicians can work
to assist patients in finding and interpreting reliable information. Convincing
physicians to take the lead in building new relationships with their patients
by using newly available Internet technologies is the latest challenge facing
the medical community (Medscape).
The Internet is here to stay, and physicians must recognize and embrace this
fact and manipulate it in such a way as to help their practices. They should
be proactive and recommend sites to their patients, or perhaps even develop
websites of their own. Every physician should become familiar with the Internet
sites that are out there, determine which sites are the best for patient use,
and then recommend appropriate sites. Recommending a website is no different
than recommending a newspaper article, a magazine article, or a book; a website
is simply a source of information, and a perfectly acceptable reference (Lundberg
2000).
The availability of information on the Internet is certainly a wonderful thing
to have at one's fingertips. However, if the patient-physician relationship
is to maintain its integrity, using such online information must be part of
a cooperative effort. Internet medicine is not a substitute for hands-on, face-to-face
care between a real live doctor and a real live patient. As Dr.
Kelly Shanahan explains, "the Internet is another tool for patient
and physician; tools wielded properly can build magnificent things, but used
improperly, can destroy."
Works Cited
Bader, S. and Braude, R. "Patient Informatics: Creating new partnerships in medicial decision making." Academic Medicine 73: 408-11. 1998.
Sonnenberg, F.A. "Health Information on the Internet: Opportunities and Pitfalls." Archives of Internal Medicine 157: 151-152. 1997.
Related Links
WebMD - "...WebMD Health is the leading consumer-focused healthcare information Web site. Our mission is to be the most objective, credible and trusted source of consumer healthcare information that helps people play an active role in managing their own health. At WebMD Health, consumers can access health and wellness news, support communities, interactive health management tools and more. Our online communities and special events allow consumers to participate in real-time discussions with experts and other people who share similar health conditions or concerns" (WebMD, "About Us").
AmericasDoctor - "Founded by physicians in 1994, AmericasDoctor provides pharmaceutical and biotech companies and contract research organizations an exclusive source for conducting phase II-IV clinical research. By integrating a leading, private-practice physician network, comprehensive site management and a solid patient recruitment program, AmericasDoctor provides a broad range of services fundamental to executing sound clinical trials expeditiously and economically" (AmericasDoctor, "about us").
AMA - American Medical Association
Medscape - "With over 575,000 members registered as physicians and 1.6 million allied healthcare professionals worldwide, the Medscape from WebMD portal reaches more healthcare providers than any other online professional destination. Our mission is to provide clinical information and education tools that are the most objective, credible and relevant to our members, their patients and their practice...Medscape from WebMD's content includes the Web's most robust and integrated medical information and education tools, including our market-leading online CME, online coverage of medical conferences, access to over 100 medical journals, specialty-specific daily medical news and much more" (Medscape, "About Medscape").
drugstore.com - "You always get something more at drugstore.com."
Mission Statement:
AboutMyHealth - "You are the world's leading expert on your health. Your healthcare provider is a highly trained expert who may be missing data that only you can provide. AboutMyHealth, a new Internet service from GE Medical Systems, gives you and your provider a way to communicate and record everything you both need to know about your health - from medications to family history to allergies. We combine health information from you, your provider, and authoritative medical resources into a single location to help you better manage your healthcare. And we use advanced Internet security technologies, policies, and procedures to make sure your personal information remains private and confidential" (AboutMyHealth, Overview).