Web Relationships Between Physicians and Individuals Seeking Information on Hepatopancreatobiliary Diseases

Abstract

The Internet has led to widespread Web consulting, the proportions of which are not yet known; there is not yet agreement on its management. Design: We verified the typology and needs of people and patients of a single-language population inquiring about a homogeneous group of diseases treated in tertiary reference centers and their reason for writing. Data were extracted and coded from e-mail messages received over 27 months by a noninstitutional Web site devoted to surgically treatable hepatopancreatobiliary diseases. Consultation activity was verified by the number of answers and subsequent messages. Main Outcome Measures: One thousand fortyseven users sent 1788 messages to one of the Web site addresses; 1179 (94.6%) of them inquired about clinical problems. Data were collected on the demographics of senders and patients, the nature of the clinical problem, and the reasons for the messages. Results: A mean of 2.1 messages per day were received. Queries were sent by patients in 260 instances (22.1%) and by others in 750 (63.6%). Two hundred thirty-seven (20.1%) e-mails had medical enclosures. The presence of a malignant disease was reported in 705 messages (59.8%). Description of previously undertaken therapy was present in 613 cases (52.0%). An answer was given to 1177 first messages (94.4%) and a follow-up message was received from 401 users (34.1%). Second messages were characterized by a shorter time to receive an answer (mean, 2.5±3.6 days vs 3.5±5.3 days). Each user sent a mean number of 1.4±0.7 messages (range, 1-8). Conclusions: Web consulting is a powerful tool for patients and health professionals that emerged owing to physician communication problems. Nevertheless, the Internet is still pushing physicians toward a reconsideration of the principles of medical ethics and a reevaluation of rules and regulations to deal with these new communication methods.

Interest in the Use of Computerized Patient Portals: Role of the Provider–Patient Relationship

“…27 , 28 Participants appeared more willing to branch out to alternative methods of computer-based communication, such as the patient portal, if they had a dissatisfying relationship with their provider. 29 …”

An ask‐the‐expert service on a rheumatology web site: Who were the users and what did they look for?

“…Therefore, group‐specific interests have to be taken into account, and the provided information content must be consistent throughout groups (6, 9). The relatively high proportion of questions asked of the online expert panel by proxies also raise ethical, privacy, patient security, and legal concerns not occurring to the same extent in face‐to‐face health care, which have to be considered and solved like those discussed for e‐communication in general (9, 11, 16, 19, 20).…”

“…Similar to published data from other medical expert services and e‐mail consultations, many inquirers asked common questions on (rheumatic) symptoms/diseases, diagnostic procedures, and medication/treatment (1, 2, 5, 17, 21, 22). These standard issues are either not completely met in regular health care or they arise after face‐to‐face appointments (2, 9, 17, 19, 22). Since patients and/or relatives obviously use more than one source of information, physicians should explicitly address and critically comment on the retrieved (online) information during face‐ to‐face visits in order to avoid confusion and/or misconception.…”

“…Nevertheless, the web site provider has to decide whether he is interested in giving this kind of information when adding an ask‐the‐expert service to the array of e‐communication options (30). In addition to the published advantages, disadvantages, and barriers of e‐communication, Figure 1 summarizes the pros and cons of an ask‐the‐expert service (6, 8, 19, 31–33).…”