What can you possibly learn from your doctor that is not available on the Internet?

The Internet offers unlimited amounts of medical information. Now everyone can now Google primary data published in scholarly medical journals. One might ask, "What can you possibly learn from your doctor that is not available on the Internet?" Indeed, physicians are struggling to figure out how best to use this technology in the interests of their patients and themselves. The Internet is reshaping the content of the conversation between doctor and patient. Some of the past imbalance of power between patient and doctor is being equalized.

Thank God for the Internet

"Thank God for the Internet," a friend remarked after receiving a diagnosis of prostate cancer. He had been given the biopsy results by a urologist, who had offered to schedule a prostatectomy within 10 days. Concerned about incontinence and impotence, our friend searched the Web for outcome data on other treatment options. He made appointments with a radiation therapist, who advised him on the risks and benefits of treatment using implanted seeds as opposed to external-beam radiation, and a medical oncologist, who discussed the pros and cons of "watchful waiting." "I'm still thinking about it," our friend said. "And I'm reading more on the Internet."

I just end up scaring myself

But many patients have not fared so well. One woman with recently diagnosed lupus told us, "I really don't want to read what's on the Internet, but I can't help myself." Her condition is currently stable, but she finds herself focusing on the worst possible complications of the disease, such as cerebral vasculitis. Although her doctor gave her detailed information, she cannot resist going on the Web to seek out new data and patients' stories. "It's hard to make out what all of this means for my case," she said. "Half the time, I just end up scaring myself."

Novel Therapies and Junk Science

Other patients are drawn to online forums and Web sites that make unsubstantiated claims -- assertions that macrobiotic diets cure aggressive lymphoma, that AIDS can be treated with hyperbaric oxygen, that milk thistle remedies chronic hepatitis, and myriad other fallacious claims. Falsehoods are easily and rapidly propagated on the Internet: once you land on a site that asserts a false rumor as truth, hyperlinks direct you to further sites that reinforce the falsehood. Material is perceived as factual merely because it is on a computer screen. Doctors sometimes find themselves in the uncomfortable position of trying to dissuade desperate and vulnerable patients from believing false testimonials. Doctors may be perceived as closed-minded, dismissive, or ignorant of "novel therapies" when they challenge such Internet rumors.

Internet Self-Diagnosis to be Avoided by Hypochondriacs

Patients also consult the Internet in search of self-diagnosis. Sometimes, doing so leads them to seek medical attention rapidly and to suggest what turns out to be a correct diagnosis. But the Web is perilous for anyone prone to hypochondria. The differential diagnosis for backache, for example, led one of our neighbors to fret that he had an abdominal aortic aneurysm. After a sleepless week of worry, he mustered the courage to call his doctor. With a normal exam and repeated reassurance, the backache resolved.