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Gunther Eysenbach, MD; Thomas L. Diepgen, MD, PhD

JAMA. 1998;280:1333-1335.

Context.— The Internet is increasingly used by consumers to seek health and medical information, but online medical advice has not been explored systematically.

Objective.— To explore the attitude of physicians and other providers of medical information on the Internet toward unsolicited e-mail from patients and their reaction to a fictitious acute medical problem described in such an e-mail.

Design.— E-mail in December 1997 and January 1998 to Web sites from a fictitious patient describing an acute dermatological problem. Follow-up questionnaire survey to the same sites.

Setting.— World Wide Web.

Subjects.— Fifty-eight physicians and Web masters.

Main Outcome Measures.— Response rate and types of responses.

Results.— Twenty-nine (50%) responded to the fictitious patient request; 9 respondents (31%) refused to give advice without having seen the lesion, 27 (93%) recommended that the patient see a physician, and 17 (59%) explicitly mentioned the correct "diagnosis" in their reply. In response to the questionnaire, 8 (28%) of the 29 respondents said that they tended not to answer any patient e-mail, 7 (24%) said they usually reply with a standard e-mail message, and 7 (24%) said they answer each request individually.

Conclusions.— Responses of physicians and Web masters to e-mail requests for medical advice vary as do approaches to handling unsolicited e-mail. Standards for physician response to unsolicited patient e-mail are needed.

From the Department of Dermatology, Unit for Medical Informatics, Epidemiology and Public Health, University Hospital Erlangen, Erlangen, Germany.

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