Medicine has been changed dramatically by the Internet's ability to disseminate rapidly vast amounts of information and facilitate the instantaneous exchange of ideas. The Internet has become a source of medical information for approximately 98 million people in the United States.1 For physicians, the Internet has increased the efficiency of patient care and has enabled collaborative research among investigators who are scattered geographically.2
The Internet has transformed the patient-physician relationship by empowering patients with information. Because physicians are no longer the primary gatekeepers of medical information, shared decision making is now emerging as the hallmark of the patient-physician relationship. Although patients now possess much more medical information, the physician's insight and input are essential to ensure that the patient can accurately comprehend the data gathered from the Internet. This added dynamic of the patient-physician relationship will fundamentally change the traditional office visit.
There are, however, virtually no restrictions on who can distribute information or conduct business on the Internet. This lack of regulation has created vast amounts of contradictory and erroneous information, which can be dangerous for patients. In addition, many dubious direct-to-consumer businesses are proliferating on the Internet. These include the auctioning of organs online3 and patient-ordered diagnostic tests conducted in shopping malls with test results distributed via the Internet.4 Through direct-to-consumer marketing, the Internet can promote harmful self-diagnosis and self-treatment by patients. It is therefore paramount that physicians play an active role in monitoring these potential dangers.
This month, MSJAMA examines the impact of the Internet on patients, physicians, medical law, and medical education. The Internet is changing communication both among patients and among physicians, as well as between these 2 groups. New legal and ethical issues are emerging because of this development. The Internet is also altering medical education, transforming some memorization-based components of the medical school curriculum into a dynamic and interactive learning experience.5
Looking forward, the Internet has great potential to improve the health care system. It can help standardize care for all patients by enabling rapid distribution of the latest medical information. The Internet can also reduce health care costs by allowing for more efficient management of patient data. As the Internet begins to reengineer the health care system, physicians must utilize the benefits it offers to enhance all aspects of patient care.
