Patients' Use of the Internet for Medical Information

Primary care providers should recognize that patients are using the World Wide Web as a source of medical and health information and should be prepared to offer suggestions for Web-based health resources and to assist patients in evaluating the quality of medical information available on the Internet.

Patients' Perceptions of Quality of Health Information on the Internet

Respondents rated the usefulness of various sources of health information available to consumers including the Internet . Patients both using and not using the Internet for health information rated “physician or nurse” as the most useful source of health information. Not surprisingly, those using the Internet for health information noted the Internet as the second most useful source, while “television news” was the second most useful source for those not using the Internet for health information.

In this survey of established patients in an internal medicine private practice, more than half of respondents reported having used the Internet for health information. Even with the most conservative estimate, assuming all nonresponders did not use the Internet, at least 27% of patients from this primary care population have used the Internet for medical information. These patients were seeking information on a wide variety of topics, including treatment side effects, second opinions, complementary or alternative medicines, and specific diagnoses. In addition, the majority of respondents appeared confident that they were accessing reliable information, and most did not share this information with their doctors.

To date, few studies have examined patient use of the Internet to obtain medical information. Mandl et al. conducted a survey on Internet use in a more socioeconomically diverse population in a pediatric emergency room setting.⁵ Of the 214 individuals who completed the survey, only 31.3% (patients and parents) noted using the Internet specifically for medical information. The study did not evaluate how they perceived the quality of health information available on the Internet or how that quality compared to their healthcare providers.

More recently, O'Connor and Johanson reported the results of a survey of gastroenterology patients. In their population, 25.5% of patients indicated searching the Internet for medical information within the past year. This is similar to the most conservative estimate of Internet health users, 27%, in the current study. Although more clinically generalizable than surveys of the general population, O'Connor and Johanson surveyed patients from a subspecialty practice and did not report the number of patients that share information from Web searches with their medical providers.

In November of 2000, the Pew Internet and American Life Project released the results of more than 12,000 telephone surveys and estimated that 55% of fifty-two million American adults with Internet access have used the Internet for health or medical information.¹ Included in this report was a subset of 521 “special surveys” of Internet users who used the Internet for health care information. Of this population, 69% did not talk to “a doctor or nurse” about the information obtained from the Internet. This is a higher proportion than the 59% of patients in our study who did not share this information with their provider. However, the Pew study sample was a random digit telephone sample conducted among the general population, whereas the current study focused specifically on patients from a primary care practice. It is not known what percentage of the Pew study sample had established relationships with medical providers.

Nearly sixty percent of the patients who used the Internet for medical information indicated that they did not share this information with their doctors. Although not specifically addressed in this study, one important reason why patients may not share Web searches with physicians is that physicians may not be asking. However, as the use of the Internet increases, it will become more important for physicians to identify patients who use the Internet and to understand how they use it as a source of medical information. The Internet has the potential to dramatically change the doctor-patient relationship in that it offers an opportunity for patients to increase their knowledge, become more informed, and increase their involvement in their health care decision-making process.

The present study represents a small sample of Internet users from a private practice in the United States. These patients were primarily English speaking, white, educated, and from higher socioeconomic strata. Responses were self-reported and patients' actual Internet use could not be verified, nor could the validity or reproducibility of the survey be confirmed. Additionally, it is possible that those who returned the survey were more likely to use the Internet. However, the survey was mailed and not Web-based in an attempt to include those who do not use the Internet and those who use it less frequently. This study focused on established patients from an internal medicine practice and is therefore more generalizable to primary care settings than are Web-based or random-digit dialing telephone surveys.

As noted above, patients tended to give higher ratings to the quality of health information on the Internet. This raises concern, given that Berland et al. recently noted that patients using the Web for medical information may have difficulty “finding complete and accurate information” and suggested that deficiencies with health information online may “negatively influence” patients' decisions. Providers should recognize that in their eagerness to participate in health care decisions, patients may turn to the Internet for information. Both physicians and patients need to be aware of the sources of health information available online and the variable quality of this information.

Physicians may best assist their patients by acknowledging patient use of the Internet and by serving as guides to help them find reliable material. As part of the medical history, physicians should routinely inquire about their patients' use of the Internet to obtain medical information. For patients who are already connected to the Internet, health care providers should be prepared to offer suggestions for Web-based health resources and to assist patients in evaluating the quality of medical information available on the World Wide Web.