How the Internet Is Transforming the Physician-Patient Relationship

James G. Anderson, PhD, Professor of Medical Sociology, Purdue University, West Lafayette, Indiana

Disclosures
In This Article

Healthcare via the Internet

An estimated 52 million Americans have used the Internet to find information about diseases, medical treatment, and the availability of clinical trials, according to a survey by the Pew Internet and American Life Project.[2] About 55% of the Internet users surveyed had accessed health information, but only 9% of those who used the Internet for health-related reasons had exchanged e-mail with their physician. Information technology provides patients with access to health-related information, allowing them to exert much more control over their own health care than ever before.[3]

Patients can access medical advice directly via the Internet. One system developed in the United Kingdom called NHS Direct provides advice on health and medical problems both on the Web and over the telephone.[4] In the United States, Internet-based medical services are used by an increasing number of patients. America's doctor (http://www.americasdoctor.com/) has contracts with more than 142 physicians who provide basic health-related advice. WebMD (http://www.webmd.com/) provides online group discussions with medical experts on various topics. CyberDocs (http://www.cyberdocs.com/), which was started in 1996, offers consultation or "virtual house calls" with board-certified physicians for $50 to $100 a session. By 1999 this online service reported an average of 3000 online visits per day, or about 100,000 per month.[5]

The traditional emphasis of medical informatics has been to provide information and decision support tools to professional healthcare providers. Currently there is an increasing emphasis on consumer informatics. This new branch of health informatics attempts to provide consumers -- in their role as patients -- with direct online access to health information to help them better manage their health decisions.[6] For example, medical HouseCall is a decision-support system for consumers derived from Iliad, originally designed to assist physicians in decision-making.[7] The system consists of 4 programs: symptom analysis, medical encyclopedia, drug interaction, and medical record. These modules were made available to consumers on a Web site. Consumers use HouseCall to keep their own medical record to determine questions to ask their doctor, look up medical terms in the encyclopedia, and check on drugs, and drug interactions.

Other systems under development incorporate patient preferences for different outcomes into the decision-making process regarding screening and testing.[8] One such program was designed to assist men with enlarged prostates to decide among the options of watchful waiting, medications, and surgery. The program is available online to assist men in considering these options and choosing a treatment based on their individual preferences.[9] Another application uses automated computer interviews with patients combined with multimedia presentation at the bedside to elicit preferences regarding the treatment of deep-vein thrombosis.[10]

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