Patients' Use of the Internet for Medical Information

Joseph A Diaz, MD,1 Rebecca A Griffith, MD,2 James J Ng, MD,3 Steven E Reinert, MS, !eter D "rie#mann, MD, M!$,% an# Anne & Mo'(ton, MD% A'thor information ) *op+right an# ,icense information ) -his artic(e has been cite# b+ other artic(es in !M*. Go to/

Abstract
OBJECTIVES
-o #etermine the percentage of patients enro((e# in a primar+ care practice 0ho 'se the 1nternet for hea(th information, to #escribe the t+pes of information so'ght, to eva('ate patients2 perceptions of the 3'a(it+ of this information, an# to #etermine if patients 0ho 'se the 1nternet for hea(th information #isc'ss this 0ith their #octors.

DESI !
Se(f4a#ministere# mai(e# s'rve+.

SETTI!
!atients from a primar+ care interna( me#icine private practice.

PA"TICIPA!TS
Ran#om(+ se(ecte# patients 5N 6 1,7778 0ere mai(e# a confi#entia( s'rve+ bet0een December 1999 an# March 2777. -he response rate 0as %:.2;.

MEASU"EME!TS A!D MAI! "ESU#TS

<f the %12 patients 0ho ret'rne# the s'rve+, %3.%; 52= 8 state# that the+ 'se# the 1nternet for me#ica( information. -hose 'sing the 1nternet for me#ica( information 0ere more e#'cate# 5P > .7718 an# ha# higher incomes 5P > .7718. Respon#ents 'se# the 1nternet for information on a broa# range of me#ica( topics. Si?t+ percent fe(t that the information on the 1nternet 0as the @same asA or @better thanA information from their #octors. <f those 'sing the 1nternet for hea(th information, %9; #i# not #isc'ss this information 0ith their #octor. Neither gen#er, e#'cation (eve(, nor age (ess than :7 +ears 0as associate# 0ith patients sharing their &eb searches 0ith their ph+sicians. $o0ever, patients 0ho #isc'sse# this information 0ith their #octors rate# the 3'a(it+ of information higher than those 0ho #i# not share this information 0ith their provi#ers.

CO!C#USIO!S

!rimar+ care provi#ers sho'(# recognize that patients are 'sing the &or(# &i#e &eb as a so'rce of me#ica( an# hea(th information an# sho'(# be prepare# to offer s'ggestions for &eb4base# hea(th reso'rces an# to assist patients in eva('ating the 3'a(it+ of me#ica( information avai(ab(e on the 1nternet. $e%&ords' 1nternet, primar+ care, hea(th information -he 'se of the 1nternet as a so'rce of me#ica( information has become increasing(+ pop'(ar as more patients @go on(ine.A Accor#ing to a recent Bnite# States s'rve+, %2 mi((ion a#'(ts have 'se# the &or(# &i#e &eb to obtain hea(th or me#ica( information.1 C+ 277%, an estimate# DD.% mi((ion a#'(ts 0i(( 'se the 1nternet to research hea(th information an#Eor hea(th4re(ate# pro#'cts an# to comm'nicate 0ith provi#ers.2 Access to (arge amo'nts of me#ica( information is avai(ab(e thro'gh an estimate# 27,777 to 177,777 hea(th4re(ate# &eb sites.2,3 !atient4provi#er re(ationships 0i(( probab(+ change, an# me#ica( provi#ers 0i(( face ne0 cha((enges as patients obtain hea(th information from the 1nternet, share on(+ some of this 0ith their ph+sicians, or potentia((+ t'rn to the 1nternet instea# of cons'(ting a hea(th care provi#er. A(tho'gh information is avai(ab(e on the 'se of the 1nternet for hea(th information, fe0 st'#ies have specifica((+ e?amine# 1nternet 'se among patient pop'(ations, F= an# no previo's reports have foc'se# on a primar+ care patient pop'(ation. -he goa(s of this st'#+ 0ere to 18 #etermine the percentage of patients from an interna( me#icine private practice 0ho 'se the 1nternet to obtain hea(thcare information, 28 #escribe the t+pes of information so'ght, 38 eva('ate patients2 perceptions of the 3'a(it+ of information avai(ab(e on the 1nternet compare# to their me#ica( provi#ers, an# 8 #etermine if patients 0ho 'se the 1nternet for hea(th information #isc'ss this information 0ith their #octors. Go to/

MET(ODS
&e mai(e# a confi#entia(, se(f4a#ministere# s'rve+ to 1,777 patients se(ecte# at ran#om from the bi((ing fi(es of a primar+ care interna( me#icine private practice (ocate# in !rovi#ence, R1. -he practice consiste# of % genera( internists 0ith appro?imate(+ :,777 active patients. -he mai(ing (ist 0as (imite# to patients age 1D to :% +ears 0ith at (east 1 patient enco'nter #'ring the previo's 3 +ears inc('#ing reg'(ar fo((o04'p, ne0 patient, an# 'rgent visits. -he s'rve+ 0as first mai(e# in December, 1999G nonrespon#ers receive# a secon# mai(ing in Jan'ar+ an# a thir# mai(ing in March of 2777. As an incentive to ret'rning the s'rve+, a(( respon#ents 0ere entere# into a (otter+ for a gift certificate to a (oca( shopping center, an# as an a##itiona( incentive, a vo'cher for free parHing on the hospita( camp's 0as inc('#e# 0ith the thir# mai(ing. A cover (etter e?p(aining vo('ntar+ participation an# confi#entia(it+ 0as inc('#e# 0ith each mai(ing, an# both patients 0ho 'se# an# those 0ho #i# not 'se the 1nternet 0ere asHe# to respon#. -he st'#+ 0as approve# b+ the hospita( instit'tiona( revie0 boar#.

-he s'rve+ re3'ire# appro?imate(+ 17 min'tes to comp(ete. !rior to #istrib'tion, the s'rve+ 0as pi(ot4teste# to ga'ge participant comprehension of 3'estions an# time nee#e# for comp(etion. -he s'rve+ containe# 3'estions regar#ing #emographics, 'se of the 1nternet for me#ica( reasons inc('#ing information regar#ing specific con#itions an# me#ications, an# fre3'enc+ of 'se. Respon#ents 0ere asHe# to rate the 'sef'(ness of the 1nternet an# other so'rces of hea(th information avai(ab(e to cons'mers an# to (ist hea(th care topics that the+ ha# searche# for over the past : months. A##itiona((+, respon#ents 0ere asHe# abo't their perception of the 3'a(it+ of hea(th information on the 1nternet 5@1n genera(, ho0 0o'(# +o' rate the 3'a(it+ of hea(th information avai(ab(e on the 1nternetIA8, an# 0ere asHe# to compare this 3'a(it+ 0ith the 3'a(it+ of information provi#e# b+ their #octor 5@*ompare# to information (earne# from +o'r #octor, ho0 0o'(# +o' rate the 3'a(it+ of hea(th information avai(ab(e on the 1nternetIA8. A(tho'gh respon#ents 0ere not asHe# for specific &eb sites that the+ ha# 'se#, the+ 0ere asHe# their opinions abo't ho0 the+ J'#ge# 0hether a site 0as re(iab(e 5@&hich of the fo((o0ing #o +o' fee( maHes an 1nternet hea(th site a Kre(iab(eL so'rce for hea(th4care informationIA8. "ina((+, respon#ents 0ere asHe# if the+ share# the information ac3'ire# on(ine 0ith their me#ica( provi#ers 5@Do +o' #isc'ss hea(th information (earne# from the 1nternetE&or(# &i#e &eb 0ith +o'r #octorIA8. Civariate associations of 1nternet 'se 0ith patient characteristics 0ere teste# 0ith the in#epen#ent samp(es t test 5contin'o's variab(es8 an# the !earson M2 test 5categorica( variab(es8. 1n#epen#ent variab(es 0ith P va('es of >.27 0ere entere# in a m'(tip(e (ogistic regression mo#e( 0here 'se of the 1nternet 0as the #epen#ent variab(e. Nonsignificant contrib'tors to the mo#e( 0ere remove# thro'gh an iterative process. A(( statistics 0ere performe# 'sing Stata 5version :G Stata *orp., *o((ege Station, -e?8. Go to/

"ESU#TS
<f the 1,777 s'rve+s mai(e#, DD 0ere not #e(iverab(e b+ the !ost <ffice an# 1 s'rve+ 0as #e(ivere# to a patient 0ho #i# not 3'a(if+ for inc('sion on the basis of age. <f the remaining 911 s'rve+s, %1: 0ere ret'rne#, b't 0ere not inc('#e# in the ana(+sis 51 0as i((egib(eG 1 patient 0as 'nab(e to comp(ete secon#ar+ to #isabi(it+G an# 2 0ere comp(ete# b+ fami(+ members instea# of patient8. -h's, the overa(( response rate 0as %:.2 percent, an# %12 respon#ents 0ere ana(+ze#.

Demo)ra*hics of "es*ondents and Internet Users

-he mean age for s'rve+ respon#ents an# nonrespon#ents 0as = +ears 5NSD 128 an# +ears 5NSD 128, respective(+ 5P > .718G %:; of respon#ents 0ere fema(es vers's %; of nonrespon#ents 5P > .718. -he characteristics of the %12 respon#ents are sho0n in -ab(e 1. <f the respon#ents, %3.%; 52= of %128 state# that the+ 'se# the 1nternet for hea(th information. -he mean age of respon#ents 0ho 'se# the 1nternet for me#ica( information 0as %.D +ears 5NSD 11.38 compare# to 9.3 +ears 5NSD 11.:8 for those 0ho #i# not 5P O .7718. A higher proportion of patients 0ho 'se# the 1nternet 0ere co((ege e#'cate# 5P O .7718 an# ha# ann'a( ho'seho(# incomes greater than P%7,777 5P O .7718. 1n the m'(tip(e (ogistic regression mo#e(, 1nternet 'se 0as

associate# 0ith age (ess than :7 +ears 5o##s ratio Q<RR, 3.7DG 9%; confi#ence interva( Q*1R, 1.=% to %. 28, co((ege e#'cation 5<R, 2.33G 9%; *1, 1.%: to 3. 98, an# ho'seho(# income (eve( SP%7,777 per +ear 5<R, 2.77G 9%; *1, 1.33 to 3.778.

-ab(e 1 *haracteristics of S'rve+ Respon#ents Nineteen percent 5%1 of 2=18 of those 'sing the 1nternet for hea(th information in#icate# that the+ 'se# the 1nternet at (east once a 0eeH, 0hi(e 3%; 59% of 2=18 'se# the 1nternet at (east month(+.

T%*es of (ealth Information So+)ht

Respon#ents 'se# the 1nternet for a variet+ of hea(th4re(ate# reasons. Si?t+4eight percent 51D% of 2=18 in#icate# that the+ so'ght information abo't n'trition or #iet. "ift+4eight percent 51%= of 2=28 note# 'sing the 1nternet to investigate #r'g si#e effects or comp(ications of me#ica( therap+, 1; 5112 of 2=38 to fin# information on comp(ementar+ or a(ternative me#icine, an# 1; 5111 of 2=78 to obtain secon# opinions abo't me#ica( con#itions. <n(+ 9 in#ivi#'a(s state# that the+ ha# ever p'rchase# a(ternative an#Eor comp(ementar+ reme#ies from a &eb site an# on(+ 1 respon#ent obtaine# a me#ica( prescription from an on(ine #octor. As sho0n in "ig're 1, patients 'se# the 1nternet for information on a broa# range of me#ica( topics. Man+ of the items that respon#ents searche# for 0ere common me#ica( con#itions a##resse# b+ primar+ care ph+sicians.

"1GBRE 1 $ea(th care topics so'ght on the 1nternet. Case# on 0rite4in responses b+ respon#ents 5N 6 22%8 inc('#ing b't not (imite# to the fo((o0ing/ Tasthma, sarcoi#osis, emph+semaG Ugastrointestina( s+mptoms an# #isor#ers inc('#ing ref('?, ga((b(a##er ,,,

Patients' Perce*tions of -+alit% of (ealth Information on the Internet

Respon#ents rate# the 'sef'(ness of vario's so'rces of hea(th information avai(ab(e to cons'mers inc('#ing the 1nternet 5see -ab(e 28. !atients both 'sing an# not 'sing the 1nternet for hea(th information rate# @ph+sician or n'rseA as the most 'sef'( so'rce of hea(th information. Not s'rprising(+, those 'sing the 1nternet for hea(th information note# the 1nternet as the secon# most 'sef'( so'rce, 0hi(e @te(evision ne0sA 0as the secon# most 'sef'( so'rce for those not 'sing the 1nternet for hea(th information.

-ab(e 2 Eva('ation of Bsef'(ness of Vario's So'rces of Me#ica( 1nformation Si?t+4t0o percent 51:D of 2:98 of respon#ents 'sing the 1nternet for hea(th information rate# the 3'a(it+ as @e?ce((entA or @ver+ goo#,A an# 32; 5D% of 2:98 fe(t the 3'a(it+ 0as @goo#.A <n(+ :; 51: of 2:98 fe(t the 3'a(it+ of information 0as @fairA an# none of the respon#ents rate# the information as @poor.A Si?t+ percent 51%% of 2%98 of the respon#ents 'sing the 1nternet for me#ica( information fe(t the information on the 1nternet 0as the @same asA or @better thanA that from their #octor. "ifteen percent 539 of 2%98 rate# the 3'a(it+ as @0orse thanA their provi#er an# 2%; 5:% of 2%98 0ere @not s'reA or ha# @no opinion.A 1n bivariate ana(+sis, no persona( characteristics 0ere associate# 0ith the 3'a(it+ ranHings of hea(th information avai(ab(e on the 1nternet. E#'cation (eve( 0as the on(+ characteristic that approache# statistica( significance 5P 6 .79=8, s'ggesting that higher 3'a(it+ ratings 0ere given b+ (ess4e#'cate# respon#ers. &hen patients 0ere asHe# to i#entif+ factors associate# 0ith a @re(iab(eA 1nternet hea(th site, sponsorship b+ a me#ica( societ+ 0as chosen b+ sevent+4t0o percent of respon#ents 519= of 2= 8. <ther important factors inc('#e# @site recommen#e# b+ a ph+sician or hea(th care professiona(,A :7; 51:% of 2= 8, @sponsore# b+ a 'niversit+,A %9; 51:2 of 2= 8, an# @sponsore# b+ a hospita(E$M<,A %1; 51 7 of 2= 8. ,ess4 fre3'ent(+ se(ecte# factors 0ere @sponsore# b+ a nonprofit organization,A 37; 5D1 of 2= 8, @site recommen#e# on -V, ra#io, ne0spaper, or magazine,A 1D; 5 9 of 2= 8, @sponsore# b+ a pharmace'tica( compan+,A 1:; 5 of 2= 8 an# @site a#vertise# on -V, ra#io, ne0spaper, magazine, or 1nternet,A 13; 53% of 2= 8.

Disc+ssion of Internet Searches &ith Doctors

"ift+4nine percent 51%D of 2:98 of those 'sing the 1nternet for me#ica( or hea(th information state# that the+ #i# not #isc'ss this information 0ith their #octor. Neither gen#er, e#'cation (eve(, nor age (ess than :7 +ears 0as associate# 0ith patients sharing or not sharing information 0ith their #octors. $o0ever, respon#ents 0ho share# information obtaine# on the 1nternet 0ith their provi#ers rate# the 3'a(it+ of hea(th information on the 1nternet higher than those 0ho #i# not share 0ith their provi#ers 5<R, 1.D G 9%; *1, 1.7: to 3.218. E(even percent 529 of 2::8 of those 'sing the 1nternet for hea(th care information in#icate# that the+ ha# 'se# the 1nternet instea# of seeing or speaHing 0ith their #octors. -hese respon#ents ha# a(so 'se# the 1nternet for a variet+ of me#ica( topics. $o0ever, compare# to a(( respon#ents, a greater percentage in#icate# 'sing the 1nternet for secon# opinions 5:9; vs 1;8 an# for information on comp(ementar+ or a(ternative me#icine 5D3; vs 1;8. -he 2 most common reasons respon#ents gave

for 'sing the 1nternet instea# of their provi#ers 0ere that it 0as @more convenient to get Kon4(ineL a#viceA an# @(ess e?pensive to get a#vice Kon4(ine.LA <f these 29 patients, severa( respon#ents 0rote in a##itiona( reasons for 'sing the 1nternet instea# of their #octor. -hese inc('#e#/ @0ante# to see if m+ prob(em 0arrante# seeing m+ #octor,A@#octor 0asn2t open to #isc'ssion of m+ s'ggestions,A@(itt(e faith in #octors,A@not s're #octor 'n#erstan#s m+ concerns,A an# @0ant more of an e#'cation on topic than #octor has time to give.A Go to/

DISCUSSIO!
1n this s'rve+ of estab(ishe# patients in an interna( me#icine private practice, more than ha(f of respon#ents reporte# having 'se# the 1nternet for hea(th information. Even 0ith the most conservative estimate, ass'ming a(( nonrespon#ers #i# not 'se the 1nternet, at (east 2=; of patients from this primar+ care pop'(ation have 'se# the 1nternet for me#ica( information. -hese patients 0ere seeHing information on a 0i#e variet+ of topics, inc('#ing treatment si#e effects, secon# opinions, comp(ementar+ or a(ternative me#icines, an# specific #iagnoses. 1n a##ition, the maJorit+ of respon#ents appeare# confi#ent that the+ 0ere accessing re(iab(e information, an# most #i# not share this information 0ith their #octors. -o #ate, fe0 st'#ies have e?amine# patient 'se of the 1nternet to obtain me#ica( information. Man#( et a(. con#'cte# a s'rve+ on 1nternet 'se in a more socioeconomica((+ #iverse pop'(ation in a pe#iatric emergenc+ room setting.% <f the 21 in#ivi#'a(s 0ho comp(ete# the s'rve+, on(+ 31.3; 5patients an# parents8 note# 'sing the 1nternet specifica((+ for me#ica( information. -he st'#+ #i# not eva('ate ho0 the+ perceive# the 3'a(it+ of hea(th information avai(ab(e on the 1nternet or ho0 that 3'a(it+ compare# to their hea(thcare provi#ers. More recent(+, <2*onnor an# Johanson reporte# the res'(ts of a s'rve+ of gastroentero(og+ patients.: 1n their pop'(ation, 2%.%; of patients in#icate# searching the 1nternet for me#ica( information 0ithin the past +ear. -his is simi(ar to the most conservative estimate of 1nternet hea(th 'sers, 2=;, in the c'rrent st'#+. A(tho'gh more c(inica((+ genera(izab(e than s'rve+s of the genera( pop'(ation, <2*onnor an# Johanson s'rve+e# patients from a s'bspecia(t+ practice an# #i# not report the n'mber of patients that share information from &eb searches 0ith their me#ica( provi#ers. 1n November of 2777, the !e0 1nternet an# American ,ife !roJect re(ease# the res'(ts of more than 12,777 te(ephone s'rve+s an# estimate# that %%; of fift+4t0o mi((ion American a#'(ts 0ith 1nternet access have 'se# the 1nternet for hea(th or me#ica( information.1 1nc('#e# in this report 0as a s'bset of %21 @specia( s'rve+sA of 1nternet 'sers 0ho 'se# the 1nternet for hea(th care information. <f this pop'(ation, :9; #i# not ta(H to @a #octor or n'rseA abo't the information obtaine# from the 1nternet. -his is a higher proportion than the %9; of patients in o'r st'#+ 0ho #i# not share this information 0ith their provi#er. $o0ever, the !e0 st'#+ samp(e 0as a ran#om #igit te(ephone samp(e con#'cte# among the genera( pop'(ation, 0hereas the c'rrent st'#+ foc'se# specifica((+ on patients from a primar+ care practice. 1t is not Hno0n 0hat

percentage of the !e0 st'#+ samp(e ha# estab(ishe# re(ationships 0ith me#ica( provi#ers. -he $ea(th <n the Net "o'n#ation 5$<N8D con#'cts seria( &eb4base# s'rve+s on(ine to assess the @'se of the 1nternet for me#ica(Ehea(th p'rposes.A9 -he $<N s'rve+s are confine# to sites that have (inHs to the $<N "o'n#ation &eb site,17 an# the respon#ents are most (iHe(+ reg'(ar &eb 'sers. -he res'(ts of a recent $<N s'rve+ in#icate# that :9; of patients comp(eting the s'rve+ #isc'ss &eb searches 0ith their me#ica( provi#ers,11 in contrast to the 1; of patients from the present st'#+. $o0ever, this ma+ be secon#ar+ to the oversamp(ing of me#ica( professiona(s comp(eting the $<N s'rve+. A(tho'gh patients ma+ p'rs'e @on(ineA information abo't comp(ementar+ or a(ternative me#icine treatments that man+ ph+sicians #o not a##ress in the office, this st'#+ s'ggests that patients are a(so 'sing the 1nternet to research information abo't their me#ica( con#itions, treatment si#e effects, an# for secon# opinions. 1n the present st'#+, man+ of the hea(th topics so'ght b+ respon#ents 0ere topics common(+ enco'ntere# b+ ph+sicians in the primar+ care setting. Despite the e?istence of man+ re(iab(e me#ica( an# hea(th4re(ate# &eb sites, severa( revie0s have #emonstrate# that patients ma+ enco'nter potentia((+ mis(ea#ing or inacc'rate information 0hen navigating the 1nternet.12F1% 1n fact, m'ch of the avai(ab(e information on the &or(# &i#e &eb #oes not pass thro'gh a tra#itiona( e#itoria( process, an# man+ sites #o not provi#e a so'rce of a'thorship or origin.1:,1= Near(+ si?t+ percent of the patients 0ho 'se# the 1nternet for me#ica( information in#icate# that the+ #i# not share this information 0ith their #octors. A(tho'gh not specifica((+ a##resse# in this st'#+, one important reason 0h+ patients ma+ not share &eb searches 0ith ph+sicians is that ph+sicians ma+ not be asHing. $o0ever, as the 'se of the 1nternet increases, it 0i(( become more important for ph+sicians to i#entif+ patients 0ho 'se the 1nternet an# to 'n#erstan# ho0 the+ 'se it as a so'rce of me#ica( information. -he 1nternet has the potentia( to #ramatica((+ change the #octor4patient re(ationship in that it offers an opport'nit+ for patients to increase their Hno0(e#ge, become more informe#, an# increase their invo(vement in their hea(th care #ecision4 maHing process. -he present st'#+ represents a sma(( samp(e of 1nternet 'sers from a private practice in the Bnite# States. -hese patients 0ere primari(+ Eng(ish speaHing, 0hite, e#'cate#, an# from higher socioeconomic strata. Responses 0ere se(f4reporte# an# patients2 act'a( 1nternet 'se co'(# not be verifie#, nor co'(# the va(i#it+ or repro#'cibi(it+ of the s'rve+ be confirme#. A##itiona((+, it is possib(e that those 0ho ret'rne# the s'rve+ 0ere more (iHe(+ to 'se the 1nternet. $o0ever, the s'rve+ 0as mai(e# an# not &eb4base# in an attempt to inc('#e those 0ho #o not 'se the 1nternet an# those 0ho 'se it (ess fre3'ent(+. -his st'#+ foc'se# on estab(ishe# patients from an interna( me#icine practice an# is therefore more genera(izab(e to primar+ care settings than are &eb4base# or ran#om4#igit #ia(ing te(ephone s'rve+s. As note# above, patients ten#e# to give higher ratings to the 3'a(it+ of hea(th information on the 1nternet. -his raises concern, given that Cer(an# et a(. recent(+ note# that patients 'sing the &eb for me#ica( information ma+ have #iffic'(t+ @fin#ing comp(ete an# acc'rate informationA an# s'ggeste# that #eficiencies 0ith

hea(th information on(ine ma+ @negative(+ inf('enceA patients2 #ecisions.1D !rovi#ers sho'(# recognize that in their eagerness to participate in hea(th care #ecisions, patients ma+ t'rn to the 1nternet for information. Coth ph+sicians an# patients nee# to be a0are of the so'rces of hea(th information avai(ab(e on(ine an# the variab(e 3'a(it+ of this information. Severa( researchers an# organizations have assesse# an# propose# instr'ments an# g'i#e(ines to assist patients an# provi#ers in eva('ating the 3'a(it+ of me#ica( an# hea(th information on the 1nternet.19F2 Despite these efforts, the re(iabi(it+ an# va(i#it+ of these eva('ation too(s are sti(( in 3'estion.22F2% !rovi#ers, ho0ever, can become proactive b+ fami(iarizing themse(ves 0ith organizations s'ch as the $ea(th on the Net "o'n#ation 5000.$<N.ch8,D the 1nternet $ea(thcare *oa(ition 5000.ihea(thcoa(ition.org82: an# $ea(th 1nternet Ethics 5000.hiethics.org8,2= that are #e#icate# to the 3'a(it+ of hea(th information on(ine. !h+sicians ma+ best assist their patients b+ acHno0(e#ging patient 'se of the 1nternet an# b+ serving as g'i#es to he(p them fin# re(iab(e materia(. As part of the me#ica( histor+, ph+sicians sho'(# ro'tine(+ in3'ire abo't their patients2 'se of the 1nternet to obtain me#ica( information.2D "or patients 0ho are a(rea#+ connecte# to the 1nternet, hea(th care provi#ers sho'(# be prepare# to offer s'ggestions for &eb4base# hea(th reso'rces an# to assist patients in eva('ating the 3'a(it+ of me#ica( information avai(ab(e on the &or(# &i#e &eb. Go to/

Ac.no&led)ments
-his 0orH 0as s'pporte# in part b+ grant %D2D!E%171:479 from the C'rea' of $ea(th !rofessions, $ea(th Reso'rces an# Services A#ministration, for a "ac'(t+ Deve(opment !rogram in Genera( 1nterna( Me#icine, Cro0n Bniversit+ Schoo( of Me#icine an# Rho#e 1s(an# $ospita(, !rovi#ence, R1. Go to/

"E/E"E!CES
1. !e0 1nternet an# American ,ife !roJect. -he on(ine hea(th care revo('tion/ ho0 the &eb he(ps Americans taHe better care of themse(ves. Avai(ab(e at http/EE000.pe0internet.org. Accesse# Jan'ar+ 1=, 2771. 2. *+berat(as. -he mess Hno0n as on(ine hea(thcare http/EEc+berat(as.internet.comEbigWpict'reE#emographicsEartic(eE7,1323,%9=1W3=9231, 77.htm(. Accesse# J'ne 1D, 2777. 3. E+senbach G, Sa ER, Diepgen -,. Shopping aro'n# the 1nternet to#a+ an# tomorro0/ to0ar#s the mi((enni'm of c+berme#icine. CMJ. 1999G319 Avai(ab(e at/ http/EE000.bmJ.comEcgiEcontentEf'((E319E=227E129 . Accesse# Ma+ 2D, 2777. . E+senbach G, Diepgen -,. !atients (ooHing for information on the 1nternet an# seeHing te(ea#vice/ motivation, e?pectations, an# misconceptions as e?presse# in e4 mai(s sent to ph+sicians. Arch Dermato(. 1999G13%/1%1F:. Q!'bMe#R %. Man#( X, "eit S, !ena C, Xohane 1. Gro0th an# #eterminants of access in patient e4 mai( an# 1nternet 'se. Arch !e#iatr A#o(esc Me#. 2777G%/%7DF11. Q!'bMe#R

:. <2*onnor JC, Johanson J". Bse of the &eb for me#ica( information b+ a gastroentero(og+ c(inic pop'(ation. JAMA. 2777G2D /19:2F . Q!'bMe#R =. -a+(or MRG, A(man A, Manchester DX. Bse of the 1nternet b+ patients an# their fami(ies to obtain genetics4re(ate# information. Ma+o *(in !roc. 2771G=:/==2F:. Q!'bMe#R D. http/EE000.hon.chE. Accesse# A'g'st 2%, 2777. 9. http/EE000.hon.chE,ibrar+E!apers$<NEme#netWs'rve+Wmai9D.htm(. Accesse# A'g'st 2%, 2777. 17. http/EE000.hon.chES'rve+Emetho#.htm(. Accesse# A'g'st 2%, 2777. 11. http/EE000.hon.chEcgi4binES'rve+Es'rvWen%.p(Istat. Accesse# A'g'st 2%, 2777. 12. !an#o(fini *, 1mpicciatore !, Conati M. !arents on the 0eb/ risHs for 3'a(it+ management of co'gh in chi(#ren. !e#iatrics. 17%518/e1. 2777 Jan. Q!'bMe#R 13. Sacchetti !, Yvara !, !(ante MX. -he 1nternet an# patient e#'cation reso'rces an# their re(iabi(it+/ foc's on a se(ect 'ro(ogic topic. Bro(og+. 1999G%3/111=F27. Q!'bMe#R 1 . 1mpicciatore !, !an#o(fini *, *ase((a N, Conati M. Re(iabi(it+ of hea(th information for the p'b(ic on the &or(# &i#e &eb/ s+stematic s'rve+ of a#vice on managing fever in chi(#ren at home. CMJ. 199=G31 /1D=%F9. Q!M* free artic(eR Q!'bMe#R 1%. Ciermann JS, Go((a#a+ GJ, Greenfie(# M,, CaHer ,$. Eva('ation of cancer information on the 1nternet. *ancer. 1999GD:/3D1F97. Q!'bMe#R 1:. A+onrin#e <. !atients in c+berspace/ information or conf'sionI !ostgra# Me# J. 199DG= / 9F%7. Q!M* free artic(eR Q!'bMe#R 1=. ,in#berg DA, $'mphre+s C,. Me#icine an# hea(th on the 1nternet/ the goo#, the ba#, an# the 'g(+. JAMA. 199DG2D7/1373F . Q!'bMe#R 1D. Cer(an# GX, E((iott MN, Mora(es ,S, et a(. $ea(th information on the 1nternet/ accessibi(it+, 3'a(it+, an# rea#abi(it+ in Eng(ish an# Spanish. JAMA. 2771G2D%/2:12F 21. Q!'bMe#R 19. Si(berg &M, ,'n#berg GD, M'sacchio RA. Assessing, contro((ing an# ass'ring the 3'a(it+ of me#ica( information on the 1nternet/ *aveant (ector et vie0orZ,et the rea#er an# vie0er be0are. JAMA. 199=G2==/12 F%. Q!'bMe#R 27. &inHer MA, "(anagin A, *hi4,'m C, et a(. G'i#e(ines for me#ica( an# hea(th information sites on the 1nternet/ princip(es governing AMA 0eb sites. JAMA. 2777G2D3/1:77F:. Q!'bMe#R 21. $ea(th on the Net "o'n#ationZ$<N co#e of con#'ct. 5$<Nco#e8 for me#ica( an# hea(th &eb sites. Avai(ab(e at/ http/EE000.hon.chE$<Nco#eEcon#'ct. Accesse# Ma+ 27, 2777. 22. Xim !, Eng -R, Deering MJ, Ma?fie(# A. !'b(ishe# criteria for eva('ating hea(th4 re(ate# 0eb sites/ revie0. CMJ. 1999G31D/: =F9. Q!M* free artic(eR Q!'bMe#R 23. Shepper# S, *harnocH D, Gann C. $e(ping patients access high 3'a(it+ hea(th information. CMJ. 1999G319/=: F:. Q!M* free artic(eR Q!'bMe#R 2 . Jones J. Deve(opment of a se(f4assessment metho# for patients to eva('ate hea(th information on the 1nternet. !roc AM1A S+mp. 1999/% 7F . Q!M* free artic(eR Q!'bMe#R 2%. Ja#a# AR, Gag(iar#i A. Rating hea(th information on the 1nternet/ navigating to Hno0(e#ge or to Cabe(I JAMA. 199DG2=9/:11F . Q!'bMe#R 2:. http/EE000.ihea(thcoa(ition.org. Accesse# "ebr'ar+ 2:, 2771. 2=. http/EE000.hiethics.org. Accesse# "ebr'ar+ 2:, 2771. 2D. Ca#er SA, Cra'#e RM. @!atient informaticsA/ creating ne0 partnerships in me#ica( #ecision maHing. Aca# Me#. 199DG=3/ 7DF11. Q!'bMe#R

Artic(es from Jo'rna( of Genera( 1nterna( Me#icine are provi#e# here co'rtes+ of Societ% of eneral Internal Medicine

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Artic(e [ !'bRea#er [ e!'b 5beta8 [ !D" 532:X8

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Crief report/ &hat t+pes of 1nternet g'i#ance #o patients 0ant from their ph+siciansIQJ Gen 1ntern Me#. 277%R !atients2 'se of the 1nternet for pain4re(ate# me#ica( information.Q!atient E#'c *o'ns. 277=R -he 0or(# 0i#e 0eb an# robotic heart s'rger+.Q$eart S'rg "or'm. 2773R !atients 'sing the 1nternet to obtain hea(th information/ ho0 this affects the patient4hea(th professiona( re(ationship.Q!atient E#'c *o'ns. 277:R Bsing hea(th 0eb sites for patient e#'cation.QJ &o'n# <stom+ *ontinence N'rs. 2773R

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See more... !atients (ooHing for information on the 1nternet an# seeHing te(ea#vice/ motivation, e?pectations, an# misconceptions as e?presse# in e4mai(s sent to ph+sicians.QArch Dermato(. 1999R

!atients (ooHing for information on the 1nternet an# seeHing te(ea#vice/ motivation, e?pectations, an# misconceptions as e?presse# in e4mai(s sent to ph+sicians.QArch Dermato(. 1999R Bse of the 1nternet b+ patients an# their fami(ies to obtain genetics4re(ate# information.QMa+o *(in !roc. 2771R Gro0th an# #eterminants of access in patient e4mai( an# 1nternet 'se.QArch !e#iatr A#o(esc Me#. 2777R Bse of the &eb for me#ica( information b+ a gastroentero(og+ c(inic pop'(ation.QJAMA. 2777R !arents on the 0eb/ risHs for 3'a(it+ management of co'gh in chi(#ren. Q!e#iatrics. 2777R Eva('ation of cancer information on the 1nternet.Q*ancer. 1999R !atients in c+berspace/ information or conf'sionIQ!ostgra# Me# J. 199DR Me#icine an# hea(th on the 1nternet/ the goo#, the ba#, an# the 'g(+.QJAMA. 199DR $ea(th information on the 1nternet/ accessibi(it+, 3'a(it+, an# rea#abi(it+ in Eng(ish an# Spanish.QJAMA. 2771R Assessing, contro((ing, an# ass'ring the 3'a(it+ of me#ica( information on the 1nternet/ *aveant (ector et vie0or44,et the rea#er an# vie0er be0are.QJAMA. 199=R

Deve(opment of a se(f4assessment metho# for patients to eva('ate hea(th information on the 1nternet.Q!roc AM1A S+mp. 1999R Revie0 !'b(ishe# criteria for eva('ating hea(th re(ate# 0eb sites/ revie0. QCMJ. 1999R Revie0 Rating hea(th information on the 1nternet/ navigating to Hno0(e#ge or to Cabe(IQJAMA. 199DR \!atient informatics\/ creating ne0 partnerships in me#ica( #ecision maHing. QAca# Me#. 199DR

]o' are here/ N*C1 ^ ,iterat're ^ !'bMe# *entra( 5!M*8 &rite to the $e(p DesH