NEJM: Patient/physician dynamic changing due to internet

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The internet has had profound effects on healthcare by putting access equally in the hands of patients and physicians, thereby redefining their roles, according to an opinion article published in the March 25 edition of the New England Journal of Medicine.

"Although the internet is reshaping the content of the conversation between doctor and patient, we believe the core relationship should not change,” wrote Pamela Hartzband, MD, and Jerome Groopman, MD, from Beth Israel Deaconess Medical Center in Boston.

”Knowledge is said to be power...[b]ut information and knowledge do not equal wisdom, and it is too easy for nonexperts to take at face value statements made confidently by voices of authority.”

According to the authors, information traditionally flowed from doctor to patient but the internet has upended that scenario. Now patients can visit web sites or scholarly journals that educate and inform physicians through portals such as Google or Yahoo. With this access, patients frequently encounter conflicting advice and opinions from a range of professional views.

”Patients also consult the internet in search of self-diagnosis,” Hartzband and Groopman stated. While this leads some patients to seek medical attention rapidly and to suggest what turns out to be a correct diagnosis, the internet is ”perilous for anyone prone to hypochondria,” the authors noted.

In addition, web portals set up by medical centers to allow patients to view their laboratory, radiology and pathology results remotely are ”efficient, avert the need for multiple phone calls and the mailing of information," Hartzband and Groopman wrote. These portals are also "welcomed by most patients...[but t]he benefits must be weighed against the potential negative effects of receiving clinical data without context,” they said.

The internet has also changed information access for physicians as doctors routinely consult the web in search of diagnoses, according to the authors. Citing a 2006 report that tested the diagnostic accuracy of Google searches by entering symptoms and signs from 26 published case records, the authors noted that internet searching was more effective for conditions with unique symptoms and signs for correct diagnosis.

”Physicians are in the best position to weigh information and advise patients, drawing on their understanding of available evidence as well as their training and experience. If anything, the wealth of information on the internet will make such expertise and experience more essential. The doctor, in our view, will never be optional,” the authors concluded.