A man walks into a hospital urology department for a consultation on prostate cancer screening. The man, an executive type, makes it clear that he will only meet with the department chairman.

After 30 minutes, he emerges from the chairman’s office; it is clear that the meeting has not gone well. It turns out that the man is upset the institution does not offer the advanced screening tools described in the Internet printouts the man is carrying in a large file folder. Apparently the man could not accept that the “digital” in “digital rectal examination” refers to a finger, not a high-end computer-based medical device.

Some might say this true story—related by Lars M. Ellison, MD, a surgeon specializing in laparoscopic renal and prostate surgery at Penobscot Bay Urology in Rockport, Maine—illustrates the contention that a little knowledge gleaned from the Internet is a dangerous thing. Today’s Internet-savvy patient often arrives at the doctor’s office armed with a lot of information—information that can easily be misleading or misinterpreted.

The margin for misinterpretation notwithstanding, physicians seem to be pleased that patients are taking their health into their own hands by consulting online resources to supplement the information they receive from their providers.


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“What I have observed is that those patients who take the time to do their own research prior to coming to the office are far better informed than they were even five years ago,” Dr. Ellison said. “They have access to a number of websites, both independent and affiliated with premier medical centers, which give them up-to-date data.”

Dr. Ellison witnessed the “digital exam” mix-up during his residency, approximately 10 years ago, so he is aware of the pitfalls associated with patient self-education. But as he and urologic oncology resident Nicholas Hellenthal, MD, concluded in their review, “How Patients Make Treatment Choices” (Nat Clin Pract Urol. 2008;5:426-433), “The democratization of medical information by the Internet has made the patient a much better informed consumer, and thus a more active participant in his or her own care.”

Indeed, Internet-informed individuals now appear to make up the majority of the general patient population. According to the July 2009 results of a Harris Poll, by 2007 71% of adults reported going online to look for health information. That translates to 160 million patients.

The question is, does this new baseline of knowledge help the appointment move faster, because the basics do not have to be explained, or does it lengthen the amount of time urologists and nephrologists spend with their patients because the patients have so much more information to question and discuss?

“The Internet has not changed the quantity, but has definitely affected the quality, of time I spend with patients,” related Stephen Z. Fadem, MD, a Houston-based nephrologist who founded and maintains the 13-year-old kidney news and patient-information site www.Nephron.com. “Patients who are exposed to information beforehand have better questions and have a deeper and more sound understanding of what the issues are. They are more likely to take their medications and comply with their diet if they understand the basis for doing so.”

As a member of cyberNephrology and the International Society of Nephrology Informatics Commission, Dr. Fadem has had a front row seat to the evolution of the WorldWideWeb’s role in health care. “We have Internet [access] in each of our exam rooms, and I often show patients which web resources will be most meaningful,” he says. “As far as I’m concerned, it is part of the experience of practicing medicine today.”

Dr. Fadem has directly reaped the rewards of his cyber-efforts. “One of my patients began quoting information that he had downloaded online before meeting with me,” he recounted. “The patient was very informed—I am almost certain he either worked for NASA or was in the software business,” In other words, he knew his way around the Internet and could discern reliable information from more questionable material.

Upon asking the man to show him the downloaded information, Dr. Fadem was surprised and pleased to find that it came from the site he built himself, nephron.com. “Needless to say, it made my day.”

Competitive edge

The Internet can be as important a marketing tool for physicians as it is an educational tool for patients—perhaps even more so when it comes to the subspecialty of male infertility treatment.

“In terms of the demographics for infertility, you are catering to a very educated, sophisticated group of people most times, and fee-for-service business,” points out Ajay K. Nangia, MD, Associate Professor of Urology at the University of Kansas Medical Center in Kansas City. “By far, realistically, the Internet is a business tool for advertising [rather than just a service for patients], but you want it to have integrity.”

Many of Dr. Nangia’s patients find him through their online research. “A very large proportion of my practice is self-referrals that have come from the Internet or word of mouth. All I can do is try, as a specialist, to be above the other non-specialist sites in this world of competition. And the only way you can do that is to play the game and get your name out there at the front end of the [online search] list.”

Dr. Nangia, who has helped the urology department chairman turn www.kumedurology.com into a one-stop shop for patients since his arrival at the university two years ago, uses a two-pronged approach to get his name out to people scanning the Internet for help with infertility:

  • The website provides patients with accurate information, videos, and diagrams as well as links to other trusted online resources such as the American Society for Reproductive Medicine (www.asrm.org), the American Urological Association (www.auanet.org), and even another medical center’s site: Cornell University Weill Medical College’s Center for Male Reproductive Medicine and Microsurgery (www.maleinfertility.org).
  • He uses the advertising services of search engines to be sure his information appears when people search for certain key words. (Typing “male infertility Kansas City” into Google returns the university’s urology website as the first hit.)

“Medicine is a competition for patient care in this country, whether we like it or not, but it should not be and so the Internet can be a means to search for the most appropriate care. The Internet allows us to act as an advocate for the patient in this world of overwhelming information access,” Dr. Nangia declared.

“You have to play the game to help patients and let them go through your website and link to the other places they need, such as sites for more detailed information, and advocacy and support groups. You want to be honest, and you want to show people who are looking for the next level of services that you’re a specialist in that field. To achieve that, you have to invest in website optimization and sometimes you have to be on one of those web links you pay for such as a sponsored site that puts you at the top of search engine page for certain key words and you pay for every hit to your website.”