Your Patient and the Internet

First of a series, from my lecture “Dealing with Patients Who Surf the Net” at the 2011 Philippine College of Physicians Annual Convention last May. Available at

Before the Internet, physicians served as the main source of health information for patients. NOT anymore! In the clinic encounter, it has become more and more common to see patients bringing information gathered from the Internet. Gunther Eysenbach in Medicine 2.0: Social Networking, Collaboration, Participation, Apomediation, and Openness (J Med Internet Res 2008;10(3):e22), describes this shift:

The first possible approach is to use intermediaries (ie, middlemen or “gatekeepers”), for example health professionals giving “relevant” information to a patient. Trusted Web portals containing only information vetted by experts can also be seen as an intermediary. The second possibility is to bypass “middlemen” completely, which is commonly referred to as disintermediation. Examples are patients searching for information on the web, or travelers booking their flights directly on the booking system of an airline, bypassing travel agents. The third way, prevalent in the age of Web 2.0, is a special form of disintermediation: an information seeking strategy where people rely less on traditional experts and authorities as gatekeepers, but instead receive “guidance” from apomediaries, ie, networked collaborative filtering processes.


Apomediation in the Health Care Field from the Perspective of the Patient


I worry about disintermediation – patients directly accessing information on the Web! It is possible for patients to get lost in the sea of information the Internet provides. I also worry about apomediation – crowdsourcing health information! Eysenbach’s examples of apomediation (where agents “stand by” rather than “in between” as in intermediaries) include ratings on Digg, or  Can we apply the same strategy for finding information about good deals, the best hotels or destinations to health care?

Mary Cain et al. in their report Health e-People: The Online Consumer Experience (written for the California HealthCare Foundation Aug 2000) classifies online health information consumers into 3 groups:

  1. The Well – around 60% of online health consumers who occasionally browse for general health and wellness information
  2. The Newly Diagnosed – a small group (~5%) that understandably searches widely for information following their diagnosis
  3. The Chronically Ill and Their Caregivers – actively manage their illness daily and seek information regarding management online (~35%). The report identifies this group as having the most potential to be affected by health information on the Internet.

Which of these three groups have you met in your practice? I’ve met some of the newly-diagnosed clutching their web print-outs and have patiently answered queries regarding the veracity of online health information from a few caregivers of the chronically ill. What to do? More in my next post. 🙂

 Photo credit: Person: question




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