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Although institutional inertia and professional skepticism seem likely to slow the adoption of network computing in health care provision, consumers have aggressively embraced this new tool for acquiring health information. According to a recent Louis Harris poll, seventy million Americans used the Internet to seek health information in 1999.9 Seeking health information is one of the top reasons why people log onto the Internet. In doing so, consumers are bypassing both the health care delivery and health insurance systems and seeking the information they need to frame their interaction with both systems.
The traditional relationship of a physician to a patient, relative to medical knowledge, has been steeply asymmetrical. Indeed, one can think of physician income as the rent physicians extract from their command of medical knowledge. The Internet will not eliminate this disparity in knowledge, but it will enable patients to begin their dialogue with physicians at a much higher level and provide them with leverage to influence the care process.
The growing complexity of medicine and the increasing burden of micro accountability for clinical decision making imposed by managed care have conspired to rob physicians of the time they need to remain current in their own fields. The decay rate of scientific knowledge that physicians acquire in the basic science portion of their medical education is scarily rapid. By 1998 the number of citations in the National Library of Medicine's Medline service was estimated at 9.2 million, growing at a rate of 31,000 new citations a month.10
Into this expanding knowledge vacuum charges the cyber assisted patient. Patients have discovered that Web based search engines and so called health portals have given them access to the same scientific databases, clinical trials listings, new drug information, and other sources that their own physicians often do not have time to analyze carefully, along with a lot of other information of perhaps more questionable value.
The sheer volume and variability in the quality of health information on the Internet, as well as the laboriousness of acquiring it from multitudes of sources, are universally acknowledged as serious developmental problems. One wag has likened the current Internet to a "virtual Haight/Ashbury."
Many physicians with whom I have interacted resent the patients who show up with articles from the Internet. Physicians often do not have time to read all of the materials patients bring them, let alone to search the Internet themselves. The idea that physicians should rely on patients to update them on developments in their own field is a stunning reversal of the traditional information flow in medicine. Yet physicians may come to discover that some of their patients are reliable bridges to emerging medical knowledge.
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