Objectives: This review aims to explore the relationship between patient empowerment and the physician-patient relationship in the context of the clinical encounter. Difficulties and opportunities presented by patients' use of the Internet are presented from the perspectives of both patients and health care providers. The review explores roles for librarians in facilitating communication and informed decision-making in the clinical consultation.
Methods: Medline was searched using the MeSH terms Physician-Patient Relations, Internet /utilization, Power (Psychology) and Information Services. Scholars Portal was searched using the keywords Internet, Empowerment, and Consumer Health Information.
Main Findings: Studies on how the Internet affects patients' experience of empowerment within the clinical encounter have shown mixed outcomes. While patients' desire to use the Internet for health information is increasing, some patients are reluctant to discuss this information in the clinical encounter for fear of challenging the physician's authority. Some physicians express frustration in dealing with patients who search for information online, while others describe the Internet as beneficial.
Conclusions: While searching the Internet is often personally empowering for patients, this sense of empowerment does not necessarily translate into self-efficacy in interactions with health care providers. Whether health information found on the Internet is empowering for patients in clinical consultations appears to depend on the power relations between patients and practitioners, how patients use the information they retrieve, as well as on physicians' affective responses to these patients. Librarians have a role to play in educating health care consumers and mediating the exchange of information between practitioner and patient.
Keywords: physician-patient relationship, Internet, empowerment, health information, health care consumer
There has been considerable discussion of the role of the Internet in facilitating public access to health information. Policy documents from Health Canada's Office of Health and the Information Highway and the Department of Health in the UK suggest that patients who are more informed will experience a greater sense of agency and empowerment and will be better able to manage their health. The increasing availability of online medical information has been the result of growing efforts to cut costs of health care by advocating disease prevention and self-management of chronic conditions (Eysenbach 1714). Sources of health information on the Internet include government portals, association websites, privately-sponsored health information supported by direct-to-consumer advertising, and consumer-produced sites such as personal websites, blogs, and online discussion forums. The growth of these accessible and inexpensive online sources of information, compounded by shortages of general practitioners and time constraints experienced by patients during medical consultations, have led to patients' increased reliance on the Internet for information and advice on medical topics (Anderson, Rainey, and Eysenbach 69-72).
Health care consumers' use of the Internet for health information has grown substantially in the past few years. Eighty percent of American Internet users, or some 113 million adults, have searched for information online in 2005 (Fox), an increase from 62% of Internet users, or 73 million Americans, in 2002 (Fox and Rainie). In one study, between 7% and 32% of those using the Internet for health reported that using the Internet affected a decision about health or health care (Baker et al. 2403). Internet users with chronic diseases are more likely than users with acute illnesses to use the Internet to access health-related information (Bansil et al.).
It has become increasingly common for patients to bring information found on the Internet to their visits with health care professionals. …