Untangling the Web--the impact of Internet use on health care and the physician-patient relationship.

Objective: The use of Web (i.e. Internet)-derived health information within the health care encounter is rapidly increasing. In this article, an extensive review of the complex effects and sometimes contradictory roles of the Web in regard to health care delivery and the physician-patient relationship is presented.

Methods: A review of relevant literature was conducted, with key points integrated into a physician guide for effective interaction with Web-activated patients.

Results: An emerging consumerist model with "triangulation" of patient-Web-physician can be expected to significantly impact dynamics of the physician-patient relationship. Potential advantages of Web-acquired information include helping patients make informed health care choices (with potential to decrease health care disparities), shared decision-making with a collaborative, teamwork approach, more efficient use of clinical time, augmenting of physician-provided information, online support groups, and/or access to patients' own health information. Alternatively, factors such as misinformation due to highly variable quality of Web information, possible exacerbation of socioeconomic health disparities, and shifting of conventional notions of the physician-patient relationship ("traditional" medical authority) present their own set of challenges for the health care provider.

Conclusion: A tangible guide to the integration of patients' use of the Web within a medical practice is thus offered with recommended communication skills.

Practice Implications: The "net-friendly" clinician can be effective by engendering a genuine partnership with patients, thus contributing to quality health care.