The Pros and Cons of the Internet's Impact on Practicing Medicine

A hypochondriac with a backache can access test results online and communicate with his physician about them; he can also convince himself that he has an abdominal aortic aneurysm. Such is life with today's connected patients.

A new article in the New England Journal of Medicine, written by Pamela Hartzband, MD, and Jerome Groopman, MD, of Beth Israel Deaconess Medical Center, addresses a recent innovation that they say has caused the most fundamental change to clinical practice in recent times: the Internet.

The authors praise some of the innovations that the Internet has provided the healthcare community, such as allowing patients to receive tests results, communicate with physicians electronically, and search for disease symptoms and treatments online, but it also suggests that the retrieval of information and the reading of test results are journeys that “no patient should undertake alone.”

“Material is perceived as factual merely because it is on a computer screen,” they write. “We sometimes find ourselves in the uncomfortable position of trying to dissuade desperate and vulnerable patients from believing false testimonials. 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.”

Hartzband and Groopman use the example of a man with a backache, hypochondriac tendencies, and access to the Internet, assuming that the backache is actually an abdominal aortic aneurysm. After the individual “mustered the courage to call the doctor,” he finds out, through a normal exam and routine assurances from his physician, that the backache is only a backache and his symptoms subside.

The researchers make several suggestions for improving the use of the Internet by patients, citing one important factor above all others: the core relationship between the doctor and the patient should not change.

“Knowledge is said to be power and some of the past imbalance between patient and doctor may be equalized,” they write. “But information and knowledge do not equal wisdom, and it is too easy for non-experts to take at face value statements made confidently by voices of authority. Physicians are in the best position to weigh information and advise patients… The doctor, in our view, will never be optional.”

Hartzband is an Assistant Professor of Medicine at Harvard Medical School, and Groopman is the Dina and Raphael Recanati Chair of Medicine at Harvard Medical School and Chief of Experimental Medicine at Beth Israel Deaconess Medical Center.