Review article
Untangling the Web—The impact of Internet use on health care and the physician–patient relationship

https://doi.org/10.1016/j.pec.2007.05.016Get rights and content

Abstract

Objective

The use of Web (i.e. Internet)-derived health information within the health care encounter is rapidly increasing. In this article, an extensive review of the complex effects and sometimes contradictory roles of the Web in regard to health care delivery and the physician–patient relationship is presented.

Methods

A review of relevant literature was conducted, with key points integrated into a physician guide for effective interaction with Web-activated patients.

Results

An emerging consumerist model with “triangulation” of patient–Web–physician can be expected to significantly impact dynamics of the physician–patient relationship. Potential advantages of Web-acquired information include helping patients make informed health care choices (with potential to decrease health care disparities), shared decision-making with a collaborative, teamwork approach, more efficient use of clinical time, augmenting of physician-provided information, online support groups, and/or access to patients’ own health information. Alternatively, factors such as misinformation due to highly variable quality of Web information, possible exacerbation of socioeconomic health disparities, and shifting of conventional notions of the physician–patient relationship (“traditional” medical authority) present their own set of challenges for the health care provider.

Conclusion

A tangible guide to the integration of patients’ use of the Web within a medical practice is thus offered with recommended communication skills.

Practice implications

The “net-friendly” clinician can be effective by engendering a genuine partnership with patients, thus contributing to quality health care.

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)

  • E. Coiera

    The Internet's challenge to health care provision

    Brit Med J

    (1996)
  • J.P. Kassirer

    Patients, physicians, and the Internet

    Health Affair

    (2000)
  • B.S. Gerber et al.

    The patient–physician relationship in the internet age: future prospects and the research agenda

    J Med Internet Res

    (2001)
  • T. Ferguson

    Online patient-helpers and physicians working together: a new partnership for high quality health care

    Brit Med J

    (2000)
  • R.J. Campbell et al.

    Teaching elderly adults to use the internet to access information: before–after study

    J Med Internet Res

    (2005)
  • Fox S, Rainie L. Vital decisions: how Internet users decide what information to trust when they or their loved ones are...
  • C. Robinson et al.

    Internet access and use among disadvantaged inner-city patients

    J Am Med Inform Assoc

    (1999)
  • J. Neuberger

    The educated patient: new challenges for the medical profession

    J Int Med

    (2000)
  • Taylor H. The Harris Poll, June 26,...
  • Fox S, Rainie L. Pew Internet and American Life Project. The Online Health Care Revolution: how the Web helps Americans...
  • P.J. Pemberton et al.

    The Internet and the changing roles of doctors, patients, and families

    Med J Aust

    (1998)
  • A. Broom

    Virtually healthy: the impact of internet use on disease experience and the doctor–patient relationship

    Qual Health Res

    (2005)
  • B. Sharf

    Communicating breast cancer on-line: support and empowerment on the Internet

    Women Health

    (1997)
  • A. Laing et al.

    Healthcare and the information revolution: reconfiguring the healthcare service encounter

    Health Serv Manage Res

    (2004)
  • T. Ferguson

    The first generation of e-patients

    Brit Med J

    (2004)
  • K.B. Johnson et al.

    Hopkins teen central: assessment of an internet-based support system for children with cystic fibrosis

    Pediatrics

    (2001)
  • H.G. McKay et al.

    The diabetes network internet-based physical activity intervention

    Diab Care

    (2001)
  • G. Eysenbach et al.

    Shopping around the Internet today and tomorrow: towards the millennium of cybermedicine

    Brit Med J

    (1999)
  • R.A. Greenes

    ecare and ehealth: the internet meets health care

    J Med Pract Manage

    (2001)
  • C. Silagy

    Introduction to the new edition: the post-cochrane agenda: consumers and evidence

  • Cited by (362)

    View all citing articles on Scopus
    View full text