There have been many studies showing the variable quality of Internet health information and it has often been assumed that patients will blindly follow this and frequently come to harm. There have also been reports of problems for doctors and health services following patient Internet use, but their frequency has not been quantified. However, there have been no large, rigorous surveys of the perceptions of Internet-aware doctors about the actual benefits and harms to their patients of using the Internet.
To describe Internet-literate doctors' experiences of their patients' use of the Internet and resulting benefits and problems.
Online survey to a group of 800 Web-using doctors (members of a UK medical Internet service provider, Medix) in September and October 2001.
Responses were received from 748 (94%) doctors, including 375 general practitioners (50%). Respondents estimated that 1%-2% of their patients used the Internet for health information in the past month with no regional variation. Over two thirds of the doctors considered Internet health information to be usually (20%) or sometimes (48%) reliable; this was higher in those recently qualified. Twice as many reported patients experiencing benefits (85%; 95% confidence interval, 80%-90%) than problems (44%; 95% confidence interval, 37%-50%) from the Internet. Patients gaining actual physical benefits from Internet use were reported by 40% of respondents, while 8% reported physical harm. Patients' overall experiences with the Internet were judged excellent 1%, good 29%, neutral 62%, poor 9%, or bad <1%. Turning to the impact of patient Internet use on the doctors themselves, 13% reported no problems, 38% 1 problem, and 49% 2 or more problems. Conversely, 20% reported no benefits for themselves, 49% 1 benefit, and 21% 2 or more benefits.
These doctors reported patient benefits from Internet use much more often than harms, but there were more problems than benefits for the doctors themselves. Reported estimates of patient Internet usage rates were low. Overall, this survey suggests that patients are deriving considerable benefits from using the Internet and that some of the claimed risks seem to have been exaggerated.
While predictions have been made [
However, increased information can improve the patient's understanding of the patient's condition, self-care, and state of mind [
The Internet is not only about exchanging information: it can also provide access to services, such as buying drugs and other health products. It remains unclear how harmful or beneficial such services may be [
To explore the range of benefits and problems that Internet use by patients produces for themselves and for health services, we conducted a survey through an Internet service provider exclusively for UK doctors. Although not a representative sample, as early adopters, such users are likely to be more familiar with the Internet themselves and, thus, more aware of their patients' Internet use. While this cannot be a definitive survey, it explores the range of benefits and problems seen with patient Internet use in order to guide future research.
We did not ask patients about their experiences, but only their doctors. By surveying doctors, we could concentrate on Internet use that has a palpable effect on the patient's health and for the health care system. However, we need to bear in mind that some patient Internet use will be obscure to the clinician. Moreover, respondents' views of patients' experiences will be filtered through their own perceptions. We suspect that doctors' responses to questions about benefits or harms from their patients accessing Internet health information will vary according to their personal attitudes to the Internet and their general willingness to share information with patients. We therefore included questions to explore these suspicions, implemented as questions the trustworthiness of Internet financial advice and views on patient leaflets.
An anonymous questionnaire was presented via Medix [
Two versions of the questionnaire were presented to any Medix member registered as practicing full- or part-time (based on information given at first registration). One version of the questionnaire (
When Medix members log on to visit the Web site [
Data were analyzed in SPSS for Windows 10.0.0 (SPSS Inc.). Confidence intervals for medians were calculated in Stata 5.0 (Stata Corporation) by bootstrapping. This involved calculating 999 simulated (bootstrap) samples from the empirical distribution function (see [
The questionnaire was answered by 748 doctors (374 for each version), a 94% response rate. Fifteen doctors said they did not see patients and are excluded from further analysis (10 doctors from the positively-framed questionnaire and 5 from the other questionnaire). On the key question of "Overall, how would you describe your patients' experiences with Internet health material?", a Mann-Whitney test showed no significant difference between respondents answering the positively- and negatively-framed versions of the questionnaire (U = 63815,
Demographic data on the participants was available (with data missing on 2 doctors): gender (624 men, 107 women), year of qualification (median 1985, inter-quartile range 1979-1992), region (London 78, South East 91, South West 63, West Midlands 60, Eastern 50, Trent 54, North West 90, Northern and Yorkshire 71, Scotland 86, Wales 26, Northern Ireland 24, other 38; other was ignored in analyses by region) and specialty (general practice 375, medical 144, surgical 84, psychiatry 40, anesthetics and intensive therapy units 35, accident and emergency 17, radiology 15, other 21).
Gender and year of qualification of respondents were checked and found to be similar to the general Medix membership. Compared to all GMC registrants, Medix has a lower proportion of female members (who make up 30% of GMC registrants, where gender is known) and a higher proportion of members who qualified between 1970 and 1999. Medix members match (UK resident) GMC registrants on proportions split by the first letter of their postcode.
Asked to estimate the percentage of their patients accessing Internet health material during the last month (
Proportion of patients estimated to have accessed Internet health material in the last month - responses to question shown
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<1% | 143 | 22% |
1%-2% | 191 | 30% |
3%-5% | 195 | 30% |
6%-10% | 83 | 13% |
>10% | 36 | 6% |
Unsure | 82 | |
Non-response | 3 |
Participants were asked what they think of the general quality of health information on the Internet. Responses were: 89,
Asked on the same scale about the general quality of financial information on the Internet, many more (272) responded
Asked whether patients had experienced problems or benefits from using the Internet, many doctors answered
Proportion of patients estimated to have had health problems or benefits from Internet use - responses to questions shown
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Yes | 92 | 44% (37%-50%) | Yes | 160 | 85% (80%-90%) |
No | 119 | 56% | No | 28 | 15% |
Not sure | 158 | Not sure | 180 | ||
Non-response | 0 | 3 |
Perceived health problems or benefits for patients from Internet use - responses to questions shown
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Ordering dangerous or ineffective drugs or other health products | 45 | 12% | 9-16% |
Getting misleading second opinions from (purported) practitioners | 63 | 17% | 13%-21% |
Getting misleading risk estimates | 46 | 13% | 9%-16% |
Getting misleading advice from patient support sites | 68 | 18% | 15%-23% |
Seeking appropriate medical help later | 20 | 5% | 3%-8% |
Becoming misinformed about their condition | 94 | 26% | 21%-30% |
Spending a pathological amount of time on the Internet - "Internet addiction" | 41 | 11% | 8%-15% |
Other | 29 | 8% | 5%-11% |
Perceived physical harm or benefit to patients from internet use - responses to questions shown
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No | 176 | 92% | No | 65 | 61% |
Slight injury or pain | 4 | 2% | Slight benefit | 23 | 22% |
Mild injury or pain | 6 | 3% | Mild benefit | 14 | 13% |
Serious injury | 5 | 3% | Dramatic benefit | 5 | 5% |
Not sure | 175 | Not sure | 256 | ||
Non-response | 3 | Non-response | 1 |
There was again considerable uncertainty in responses to the questions on physical harm or benefit arising from Internet use, more so for the question about physical benefits (
Perceived health problems or benefits for doctors and the health service from internet use - responses to questions shown
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Patients are less able to cope with their symptoms or disease | 38 | 10% | 7%-14% |
Longer consultations | 236 | 64% | 59%-69% |
Patients are less confident about self-care | 34 | 9% | 6%-13% |
Patients not seeking medical help when it was needed | 23 | 6% | 4%-9% |
Patients are coming in later for necessary investigation or treatment | 9 | 2% | 1%-5% |
More unnecessary investigations | 162 | 44% | 39%-49% |
More unnecessary treatments | 81 | 22% | 18%-27% |
Other | 50 | 14% | 10%-17% |
Participants were asked to describe overall their patients' experiences with Internet health material. The responses were: 5,
Asked about problems for themselves and for the health service (
Respondents could give free-text responses under the Other heading for the questions on specific problems or benefits. They were also able to comment on the questionnaire as a whole. Certain themes emerged. Respondents recognized the value of the Internet in providing information, which could lead to more productive consultations. However, these also tended to be longer, a luxury not always available. Problems were often not with the information per se, but for the patient (and the clinician) to be able to sift through and evaluate the information.
Particular problems raised were patients' desire for new, generally-unavailable treatments: a cult of the new, engendered by our technophile society? Many other problems focused on alternative therapies. Respondents commented about how patients can put too much faith in the Internet and that this can undermine faith in the doctor, although it could also back up the doctor and improve confidence, a result seen in other research [
The Internet has no geographical boundaries, but it does have linguistic ones and US sites dominate the English-speaking Internet. UK patients, unused to the nature of the US health care system, may be especially vulnerable to the direct advertising of health care services. Concern was expressed in our survey that, unlike US patients, UK patients may be less likely to bear in mind commercial biases in information presented. Other problems concerning the unsuitability of advice written from within the US context were also reported.
Two particular diseases were mentioned often in connection with problems: multiple sclerosis and chronic fatigue syndrome. It is not surprising that chronic, debilitating diseases with limited treatment options, often affecting a young population, should be highlighted. The Internet's value when dealing with rare diseases was also highlighted. The ability of the Internet to bring together, from all around the world, patients with rare diseases and experts on rare diseases is significant [
In terms of serious health problems from using the Internet, 3 actual deaths were described: an accidental overdose of Viagra ordered over the Internet, and 2 delayed presentations of cancers after the patients had tried remedies found on the Internet. A fourth comment was ambiguous about whether a fatality occurred from a purposeful overdose performed based on information on how to do it from the Internet, a concern raised previously [
Overall, our survey paints a fairly-rosy picture of patient Internet use, although it is notable that respondents are only aware of a surprisingly-small proportion of their patients using the Internet for health material. Many more benefits than problems for patients were reported. Information, advice, and social support were frequently-identified benefits of the Internet for the patient, although becoming misinformed was also the most commonly-reported problem for patients. Reports of problems and benefits for the doctor and the health service were more mixed. Confirming past research [
Debate rages about the frequency of adverse effects from Internet use [
A survey of primary care staff in Glasgow [
Clearly, both benefits and problems exist with patients' use of the Internet. It is reassuring that these doctors see more benefits for patients, but that is not a reason to be complacent about the problems. Poor-quality information matters less if patients can effectively judge it so. High-quality information is less useful if patients are overwhelmed with its volume. The relationship between the quality of information on the Internet and patient experiences is not straightforward. There is plenty of scope for more detailed research in this area.
Many respondents felt unable to answer some of the questions. Of 732 respondents, 82 said they were unsure how many of their patients had been accessing Internet health information, while 89 said they did not know what the quality of health information on the Internet is like. While current research may help with the latter, with the former we note that patient Internet use can be obscure.
JW conceived the study, which was designed by JW and HP. The data was analyzed by HP, who also wrote the first draft. Both authors contributed to writing the paper.
HP was supported on an Engineering and Physical Sciences Research Council project grant. JW was supported by the Higher Education Funding Council for England, Engineering and Physical Sciences Research Council, National Health Service Research & Development, and a grant from the British United Provident Association to set up the UCL Knowledge Management Centre.
Medix had no role in the writing of the paper (beyond providing details of the survey methodology). Thanks to Prof. Mike Smith and Medix for data collection; and to Helen King for comments.
JW holds a small fraction of the equity of Medix.
General Medical Council
Questionnaire that asked about possible benefits of the Internet:
Questionnaire that asked about possible harms of the Internet: