On-line health information is an area that has exploded over the past five years from approximately 3.2 million on-line health information users in 1995 to approximately 24.8 million on-line health information users in 1999 (Reents, Cyber Dialogue). This facet of the internet has outstripped both weather and stock quotes as the principle subject of internet inquisition among the internet community. The rapid growth of this field brings with it several important issues. For example, how reliable is the information and where is the reliable information? Health information is not like most other types of information. If someone gives fraudulent information that could be harmful to an individual and someone takes it seriously, a death or serious impairment could result. Can the internet be used as a tool to enhance the effectiveness of support groups? Can internet support groups replace standard support groups? What are the impacts of the internet on the Doctor-Patient relationship? The internet provides a powerful tool for connecting people to information as well as each other and the internet is now a large enough presence that the health industry can no longer afford to ignore it. By analyzing many of these issues, options for integrating these two entities in a productive and effective manner can be explored.

The internet is amazing in its usability and the shear volume of information that can be gleaned from it. To acquire information on nearly any topic, all one has to do is type in a key word on any one of several search engines and relevant sites will inundate the monitor. With all of this information there is a price, and that price is the quality of the information available. Anyone can post anything they want on the web, and many people do just that. These individuals can provide home remedies that have no scientific backing, that have not been peer-reviewed by people in the field, and in some instances may invoke a false sense of hope to a critically ill patient or be harmful to another individual. Other individuals bias information to help them market their new drug, product, or technique. These shortcomings are summed up in a quote by the editors of the Journal of the American Medical Association:

Even with all the bad information out there, there is still a large volume of accurate, good quality, reliable information that can obtained from the internet. People with rare diseases that may have stumped their physicians and new techniques that may not have made the rounds through the medical community at large can benefit from the information distributed by the internet. People inquiring about their rare affliction can stumble into other people who have suffered the same illness and found ways to beat it or find direct sources of new studies conducted on their problem and the corresponding results. These pieces of information can then be tried and may lead to a recovery of the patient who can share the information he used to beat his illness with others that may come along and his physicians. No new treatment or technique should be tried without first contacting one's personal physician so that the relative safety of a treatment can be assessed. New techniques or treatments that come along may take time to trickle through the medical community. Motivated patients who take the time to research their options in an attempt to become more informed can accelerate this process. Patients can bring these new treatment options to the table when talking with their physicians and discuss their various merits and shortcomings in order for the patient to make a more informed choice as to their treatment decisions.

Where is the good, reliable information located? The best places to search for quality information on the web are places like leading medical centers, the National Institutes of Health and related government sources, and university and research hospitals. Even these sources are prone to bias, and should be carefully evaluated before openly trusting them. Ways to determine the validity of the information presented by alternative sources include looking for a source cited for the information. If the material is from a reliable source like a leading medical journal, it has a better chance of being useful than if the source was some unknown or foreign source. Statements without any source listed are more likely opinions of the author than backed up scientific evidence. Sites should be updated at least monthly due to the rapid changes and advancements in the medical field. Old sites may be outdated and have potentially unsuccessful treatment methods that have been replaced with much more effective techniques. A certain amount of skepticism is important in wading through the piles of information encountered on-line since health is one commodity that cannot be taken back for a refund.

Health information distribution is not the only or even the most profound impact of the internet on the health industry. Another area of substantial internet impact on the health industry is in support groups. Support groups are collections of individuals suffering from the same chronic, debilitating, and often fatal condition like cancer that are facilitated by a trained individual and used to boost morale and improve the quality of life of these patients. Intense research into the effectiveness of these groups has shown that with a few exceptions, support groups improve the quality of life of the patient, decrease depression and anxiety, improve the physical condition of the patient, and provide an emotional platform from which the patient can restore himself as a functional member of society. Patients in support groups as compared to patients with the same illnesses but not in support groups generally live longer with their illness, are more integrated and functional in society, have better recovery rates, and lead a higher quality of life. Most support groups meet once a month and have activities like motivational speakers, group building activities, discussions about death, dying, daily pain, and coping, health education, problem-solving techniques, and stress management. Patients benefit from the universality, mutual aid, and peer support provided by these meetings.

What does the internet have to offer these groups? The internet can help enhance the effectiveness of these groups by providing a forum through which an afflicted individual can go to at any time to find support. "Virtual Communities" (http://dispatch.mail-list.com/archives/hbv_research/msg01976.html) form in which individuals that may be unwilling or unable to attend a traditional support group can participate in a supportive environment. The internet allows individuals to expand their support groups. Traditional support groups have discrete memberships by necessity. The internet provides an unlimited capacity for the size of a support group. The internet can also provide a place for people on support group waiting lists to go to get help. Individuals with extremely rare afflictions that may be too dispersed to allow the formation of a traditional support group can find common ground to establish a support group on the internet.

Internet support groups are also somewhat limited in the scope of what they can accomplish. A motivational speaker is much less effective as a blinking cursor in a chat room as he is in person. Many of the team building skills and group bonding activities are also compromised in the electronic forum. There has also been little to no research done on how effective or functional these groups actually are in practice. How strong a relationship can someone form with another person through the internet? The internet provides a powerful supplementary tool for the traditional support groups, but as a replacement it has many shortcomings.

The Doctor-Patient relationship is another aspect of the health industry that is rapidly changing as a result of the internet. The traditional doctor-patient relationship has been one of respect and unquestioning belief that the doctor was providing the treatment that was best for the patient. As patients have become more adept at using the internet, they are becoming smarter consumers. They are learning more about the products they buy and the services they desire by exploring the internet for information about these things. People are beginning to use the internet to "shop" for doctors and come to them with information regarding their treatment options. This result has begun to change the Doctor-Patient relationship to a relationship of equality. The patient wants to be informed of his options and no longer takes the advice of the physician as paramount, in essence, the patient wants a partnership in managing his health.

Doctors can take advantage of the internet to enhance not only their relationships with their patients in the partnership context, but their practice and the efficiency of their available time. Doctors can maintain web sites with information like directions to their office with maps, medical history forms and other mundane paperwork, office policies, insurance information, and contact information. These inclusions can streamline the patient's visits by allowing the patient to prepare the information in advance and get straight to the interview. The doctor's office can benefit by saving this information in computers to reduce the filing tasks of the secretaries, as well as the benefiting the patient by only requiring changes to the forms each time they visit. Doctors can make their visits more effective by providing links to their web site or another web site that contains detailed information about the patient's treatment to include complications, side effects, and compliance. The patient can then view the web site for information if he has any questions he forgot to ask at the office. Doctors can recommend web sites for general or specific health information to patients to help them satisfy their own medical questions and limit the amount of frivolous office visits. If the patient still has questions, e-mail is a powerful tool useful for quick responses to issues that may not require an office visit. E-mail can also be used to remind patients of check-ups, prescription refill reminders, transactions, appointment scheduling, billing questions, and medical advice. The effective use of e-mail can simplify the jobs of the secretaries by allowing them to deal with patients more quickly than with lengthy phone conversations that can only service one patient at a time and lead to frustration on the part of the patients trying to make contact.

Obviously the internet has had and will continue to have a profound impact on the health industry. People are searching for health information at rapidly increasing rates. While much of the information available is unreliable or dangerous, a good portion of the information can be trusted and is useful in understanding medical conditions, possible treatments, and expected outcomes. Support groups have benefited by using the internet as a supplement to give members access to compassionate parties at any time when they feel the need to communicate. Many on-line support groups have sprung up as alternatives for support groups for individuals who would otherwise not go to groups or are unable to go due to physical condition or geographical separation. The effectiveness of these groups as compared to the traditional support groups has yet to be explored. One of the most significant impacts of the internet on the health industry has been its shift in the perspective of the Doctor-Patient relationship from one with a high degree of control on the part of the doctor and a low degree of control on the part of the patient with a more partnership oriented philosophy in which the patient selects the doctor as an educated consumer to cooperatively manage the patient's health. In response to this shift in perspective, the doctor can more effectively utilize his resources and time by maintaining a web page with an assortment of useful information, directing patients to reliable sources of on-line material to enhance patient education, and utilize e-mail to simplify the administrative aspects of the job. The overall impact of the internet on the health industry has been a positive one and has forced a more traditional field to modernize its operations and improve the quality of its operation.

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