The meteoric rise of the medical Internet has been most impressive. Until recently it lagged behind the entrepreneurial Internet in pushing e-commerce’s and e-information’s envelope, but I’m not sure that’s still true. A large percentage of web searches now involve health-related topics and the marketplace is responding. I am unable to open any current medical journal or newspaper without seeing multiple references to medical web sites. Internet home pages such as msn.com have physician and hospital locators as well as articles on health issues and recent medical advances. Microsoft has even allied with WebMD.com to share content including columns authored by physicians and other healthcare professionals. The explosion of readily available information is beyond belief. Web pages (individual pages within a site) in current circulation number many hundreds of millions.
Since Gutenberg’s invention of movable type in the mid-1400s, knowledge has been less and less the prerogative of civilization’s elite. The dissemination of technical or other specialized information has empowered people through the ages. Our open society harnessed atomic energy to the steam turbine electric generator 50 years ago but now is forever enslaved by the threat of thermonuclear war. As a result our Internet-based society must bear the burden of having plans for atomic bombs posted on uncensored web sites.
Knowledge pollutes the predictability of tyranny. History is littered with regimes that attempted to restrict the exchange of information between its citizens. The brutally enforced censorship of the Soviet Union crumbled with the Berlin Wall, and the personal computer played an important role. With the raised fist of anarchy replacing the iron hand of Communism, Russia today resembles our 19th-century western frontier. The power of accessible information can topple kingdoms and may push the revolutionary pendulum too far to the other side. Communist China faces a similar threat as it tries to restrain newly-annexed Hong Kong’s freewheeling capitalism.
Programs exist to filter web content but are inherently flawed, their algorithms incapable of differentiating the intricacies of English or circumventing the human mind bent on subversion. While an Internet monitor set to recognize the words "skin" or "naked" may filter out a few sexually explicit sites, it cannot distinguish between these and a dermatology web site or one key-worded to "naked truth". Conversely, a trip to WhiteHouse.com will even shock most gynecologists.
The only real limitation on today’s Internet is available bandwidth. Those of us who regularly surf the net often encounter long waits while downloads try to jam many bytes of data through existing copper-wire telephone lines. You may have discovered cable modems or Digital Subscriber Lines (DSLs), but even these occasionally become overloaded. Technology will eventually triumph but until then we must wait one or two minutes for a single complex page to download. Just as DSLs raised the information highway’s speed limit by a factor of 30, even faster technologies will be developed for legacy data pipes. As we speak worldwide consortiums are laying fiberoptic cables capable of channeling data at 180 megabits per second, 3000 times faster than your poky 56K modem. Tomorrow’s information will literally travel at the speed of light. Imagine MedLine searches completed in milliseconds or the entire text of Williams’ Obstetrics including photos written to your hard drive in minutes. Patients already have more free medical information at their fingertips than any physician will read.
Americans tend to be impatient, with unreasonably lofty expectations of our medical care system. Dennis Streveler, a senior strategist at Healtheon Corporation, claims the Internet will "become a sort of central nervous system for healthcare". His column in the December 1999 issue of California Physician characterized this change as fiercely resisted by some physicians while embraced by others "who know that personal care is what healthcare is all about".
| "I’m going on record as saying that I will never again choose a PCP who refuses me to be able to communicate with him or her by e-mail when I need advice, want to get a prescription filled or make an appointment. Of course, I fully expect that my e-mail will be triaged and answered by the appropriate party in the office... An empowering era has been thrust upon us, signaling the demise of the patient patient." |
Our patients now have the opportunity to become experts on certain diseases, particularly their own. Tom Ferguson, editor of The Ferguson Report: The Newsletter of Online Health, observes,
"A doctor may have a working knowledge of 50 conditions and be able to treat, with some consultation, another 200. A patient only needs to know about one."
|
We will be challenged to keep up with our patients’ questions like never before. Sometimes I am relentlessly cross-examined by these Internet-empowered patients. While pleased that they take responsibility for their health care, and remembering the intoxication of newly acquired wisdom, I deplore pop knowledge masquerading as legitimate medical tenet.
Occasionally a patient will become adamantly defensive if I question her independently acquired information, apparently valuing unattributed opinion over formal medical education, training and experience. When this happens I listen openly, debate fairly, offer references, and try to use logic when counseling a misled patient. If she can cite the web so can I. It is certainly reasonable to supply patients with web bookmarks for physician-audited sites dispensing authoritative, scientifically sound information
|
