Review articleUntangling the Web—The impact of Internet use on health care and the physician–patient relationship
Introduction
Clinical Scenario: Mr. Jones presents to your office complaining of “back pain” which feels like “spasms” at times. The pain, he reports, moves from side to side and spreads down the legs. He denies any urinary or bowel complaints. Pause. You consider the scenario. Based upon the symptoms, an MRI of the back is requested.
Surprise, surprise. It is not you who mentions the MRI – you have not yet uttered a word – rather, it is the patient suggesting a course of action. Welcome to the world of Web savvy patients—they’re already navigating cyberspace with ease and you just might want to get on board.
The use of Web (i.e. Internet)-derived health information within the health care encounter is rapidly increasing and has been termed the e-patient revolution [1]. The number of Web users seeking health information in the U.S. increased from 54 million in 1998 to 110 million in 2002 [2] and to approximately 117 million in 2005 [3]. In the U.S., 80% of adult Web users had surfed the Web for online health topics [4]. Patients’ communication during clinical encounters is often influenced by what they have learned from the Web. Fifty-seven percent of adults who obtained health information online (2005 poll) reported discussing this information with their doctor at least once [3]. In a 2001 study among British primary care physicians, 75% reported having patients present with information retrieved from the Web at some point in time [5], but nearly half of patients use Web health information without revealing this to their physician [6].
Given the continually expanding role of Web-acquired health information in the physician–patient encounter, this article reviews the Web's impact on patients’ decision-making, potential advantages and/or challenges of the use of Web-acquired information, and how the “triangulation” of patient–Web–physician communication can impact the dynamics of the physician–patient relationship. A tangible guide to the integration of patients’ use of the Web within a medical practice with suggested communication strategies is also presented.
Section snippets
Methods
A review of relevant Internet-health care literature spanning the years 1996–2006 was conducted with key points integrated into a physician guide for effective interaction with Web-activated patients. PubMed was searched for articles with medical subject headings (MeSH) including “Internet”, “World Wide Web”, and “medical informatics”. Specifically, a search was conducted for articles addressing patient or physician use of the Internet either during or in between office visits. Reference lists
The Web and the physician–patient relationship
Numerous studies have explored the complex effects and contradictory roles of the Web in altering health care delivery and the physician–patient relationship. The rise of the “Internet-health consumer” [1] suggests a shifting of power within the health care relationship. On the positive side, Web health information may lead to an emerging consumerist model in which patients may more effectively partner with their doctors in managing and being more responsible for their own care.
The Web is
Discussion
Patient use of Web-acquired health information continues to grow. The resulting triangulation of patient–Web–physician in the health care encounter has remarkable potential for improving the physician–patient relationship as more collaborative models emerge. The use of Web-derived health information can yield better informed patients with a higher likelihood of adherence and improved health outcomes. Potential benefits for the physician–patient relationship include enhanced communication,
References (61)
- et al.
Provider–patient dialogue about Internet health information: an exploration of strategies to improve the provider–patient relationship
Patient Educ Couns
(2007) - et al.
The online patient meeting
J Neurol Sci
(1996) Patients, gastroenterologists, and the world wide web
Gastroenterology
(1998)- et al.
Who uses the patient portal? the patientsite experience
J Am Med Inform Assoc
(2006) - et al.
Internet and computer access and use for health information in an underserved community
Ambul Pediatr
(2005) - et al.
Doctor–patient relationship: changing dynamics in the information age
J Postgrad Med
(2004) - Taylor H. The Harris Poll, May 1, 2002;...
- Krane D. The Harris Poll, July 28, 2005;...
- Fox S. Online Health Search 2006. Pew Internet & American Health Project;...
- et al.
Health and the Internet—changing boundaries in primary care
Fam Pract
(2004)