How the internet is accessed by and influences surgical patient's decision makingThe internet shapes and influences many facets of society. Healthcare has been slow to utilize internet for healthcare delivery and education. 1,2 The COVID-19 pandemic has forced a rapid acceleration of internet-based healthcare, but there is limited research assessing internet accessibility and the influence this has on patient health decision making.The abundance of health information on the internet enables patients to play active roles in patient-cantered care, providing immediate patient information in culturally and linguistically diverse ways.Curation of all health information available on the internet is impossible. Patients often use heuristics to judge the quality of a website rather than the quality of the evidence presented. 3 On the other end, websites with evidence-based content can be too complex to be understood by the target audience's literacy level. [3][4][5] It is increasingly important for surgeons to understand the online habits of their patients and how these habits influence their patient's decision making. The COVID-19 pandemic has accelerated the usage and implementation of internet-based healthcare globally.We conducted a cohort-controlled study comparing internet access and health-related search habits of private and public patients in a large Metropolitan centre in 2012 and repeated the study design 2019. Low risks ethics approval was obtained (QA2018.16). In 2019, 200 patients from a tertiary metropolitan orthopaedic outpatient clinic and 202 patients from a private surgical clinic were recruited. A 37-question survey was administered in English, with the aid of interpreters when necessary. The results of these questions were compared to those of a survey completed in 2012. 6 The chi2 test was used to compare proportions. A two-sided T-test was used to compare means between the 2012 and 2019 results. P-values <0.05 were considered significant.Participant age range was between 17 and 88 years. 94.2% of patients in 2019 reported internet access (n = 379), increased from 79% in 2012 (P < 0.05) (Fig. 1.). The patients over 60, increased their internet access by 44%. Public and private patients have statistically the same internet access in 2019, 91% and 95% respectively (P = 0.7094).Amongst all study patients, education level influenced internet access the most. Internet access amongst people with a primary school education or no formal education was 69% and 99% with university or higher education. In 2019, 64.8% of all patients used the internet to search their medical condition and treatment options.