During the last 10 years the Internet has grown from a small network that allowed the exchange of information between academic, military, and government officials to a global infrastructure that has radically changed the way people obtain information. The practice of medicine has not escaped this revolution. As a result, physicians must now become facile with the world of "cybermedicine."
Medicine in the electronic age will include more flexible communication with patients, easier retrieval of medical information, faster access to patient data, and streamlining of medical office management. But capitalizing on the power of the Internet requires both technical proficiency as well as an understanding of why these technologies are important from a societal perspective.
The most important of these "cybermedical" skills may be proficiency in using e-mail for communication with patients. As opposed to the early acceptance of the telephone to answer patients' questions, many physicians are leery of professional e-mail.1 However, because patients are demanding this service, physicians will need to develop appropriate standards regarding e-mail communication. One compelling reason to use e-mail, rather than the telephone, is that it provides unambiguous documentation that can be placed in the medical record.
Another immediate concern is patients using of the Internet for medical information. In this age of consumerism and personal activism, patients regularly visit physicians' offices with information obtained from the Internet. According to a recent telephone survey, 41 million people in the United States use the Internet for health information.2 Physicians must discern which of this is accurate and which may be harmful, and they must understand how patients obtain this information so as to better evaluate its source. A recent study regarding the quality of cancer information on the Internet showed that grossly erroneous information can be obtained from even reputable Web sites.3 Such readily available misinformation could have grave consequences if patients decide to pursue improper treatment.
To address this problem, physicians could design their own Web sites that include links to other sites that they feel provide quality information to patients. A 1999 study showed that more than half of US Internet users would be willing to visit a Web site designed by their physician, but only 9% actually knew if their physician had a Web site.4
Soon there will be greater availability of computerized medical records accessible from remote locations.5 These databases will expand further as the price of computer memory continues to fall, data compression technology is enhanced, and security standards are developed. A patient may no longer have separate medical charts located at different providers' offices; rather there might be 1 computerized record containing routine information such as periodic health exams and also adjunct data such as electrocardiograms and radiographic films. Physicians, by learning how to input and access these databases, will facilitate communication with other providers, curtail the unnecessary duplication of tests, and reduce time spent locating medical records.
Physicians will increasingly have access to telemedicine, loosely defined as using telecommunication and other electronic means to provide medical care when the provider and patient are located at a distance from each other.6 Real-time audio and video communication, transmission of radiographic films, and, eventually, even robotic surgeries between long distances might become common practice. Physicians should learn how to take advantage of this technology, and while preliminary studies have shown patient satisfaction with telemedicine,7 steps should be taken to maintain the quality of care.
Finally, the near future will see quick tests of patients' DNA using cDNA microarrays.8 These data could then be compared with central databases of genetic information such as Genbank, the database of the Human Genome Project. Chip analysis will provide physicians with more information about a patient's health, including their sensitivity to certain medications and propensity for developing certain diseases. While learning how to use this technology, physicians will also need to understand its medical, legal, and ethical ramifications.
Because physicians need to develop the skills to practice medicine using these technologies, it should be the responsibility of medical schools to ensure that students are competent to use them. For those who have already started their medical careers, specialty and state medical societies should offer classes on the Internet and other new medical technologies. Because of what the Internet can offer, including quicker access to more information, society can only benefit from physicians cultivating a facility with these new technologies.
