Q. How are online health resources changing the ways doctors and patients relate to each other?

A. The best and the brightest of the patients who've "gone to medical school" on the Internet are now sometimes coming into the doctor's office knowing more than their doctor about some aspects of their condition. Others sometimes come in thinking that th ey know more than they really do. And it's not always easy to tell the difference.

Q. That must pose quite a problem for doctors.

A. It does. But simply dismissing the validity of the information patients find on the Net and insisting that "doctor knows best" is not always the best response.

Q. What should the doctor do?

A. For each patient, the physician needs to decide whether (1) this patient is seriously mistaken and needs to be gently corrected, (2) this patient may prefer a perfectly appropriate course of action which I don't know much about, (3) this patient may ha ve discovered something useful which I don't know about and may thus be able to help me learn something new. It's not always an easy call, but it's usually best to express your concerns, discuss the situation openly with the patient, and to attempt to find a mutually-acceptable course of action.

Q. How can physicians use the Internet to market their practices?

A. An easy first step is to encourage your patients to communicate with you by e-mail. And once you feel you can handle it, invite them to pass on brief e-mailed questions from their friends. If you show that you're willing to help those in need, some of those you help will end up in your office.

Q. Only a small percentage of physicians now exchange e-mail with patients. Why aren't the others doing it?

A. Unfamiliarity with the technology and/or the medium. Fear of being overwhelmed by unwanted messages. Lack of time. Lack of direct reimbursement. Feeling uncomfortable at being so accessible to patients. Paradoxically enough, these rarely turn out to be problems for doctors who do exchange e-mail with patients.

Q. Do online patients really want to send e-mail to their doctors?

A. Yes, they really do. Most patients say they would prefer to get the online health information they need from their own doctors.

Q. Do patients feel less intimidated when e-mailing their doctors as opposed to face-to-face or phone interactions?

A. Many patients have told me that using e-mail makes them feel more comfortable in communicating with their doctors. They can take all the time they need to pose their question. And they needn't worry about "interrupting" their doc.

Q. Do you have any fears that the Internet may promote the "commoditization" of healthcare or degrade the provider-patient relationship?

A. I think it will have just the opposite effect. Electronic links can provide greater convenience, depth, and personalization of the provider-patient relationship.

Q. Will the role of the patient change as the result of online communications?

A. It's already changing. Some well-informed, highly-motivated patients are now playing a more active and responsible role in managing their own care than they could possibly have done in pre-online days.

Q. How should our health care system as a whole respond to these new "smart patients?"

A. I think we should recognize them as in important new resource, encourage their involvement, and do all we can to help them manage as much of their own care as possible.

Published in The Ferguson Report, Number 3, May 1999

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