When Terri Nelson learned she had a large fibroid tumor in her uterus, she went online.
There is nothing new in that, of course. The intrepid and the adept were going to the Web for health information as long ago as the 1980s, well before Google and other search engines made it accessible to a wider audience.
These days, that is pretty much everyone. At least three-quarters of all Internet users look for health information online, according to the Pew Internet and American Life Project; of those with a high-speed connection, 1 in 9 do health research on a typical day. And 75 percent of online patients with a chronic problem told the researchers that "their last health search affected a decision about how to treat an illness or condition," according to a Pew Report released last month, "The Engaged E-Patient Population."
Reliance on the Internet is so prevalent, said the report's author, Susannah Fox, the associate director at Pew, that "Google is the de facto second opinion" for patients seeking further information after a diagnosis.
But paging Dr. Google can lead patients to miss a rich lode of online resources that may not yield to a simple search. Sometimes just adding a word makes all the difference. Searching for the name of a certain cancer will bring up the Wikipedia entry and several information sites from major hospitals, drug companies and other providers. Add the word "community" to that search, Ms. Fox said, and "it's like falling into an alternate universe," filled with sites that connect patients.
As a result, said Dr. Ted Eytan, medical director for delivery systems operations improvement at the Permanente Federation, "patients aren't learning from Web sites — they're learning from each other." The shift is nothing less than "the democratization of health care," he went on, adding, "Now you can become a national expert in your bedroom."
These expanded capabilities allow people to share information easily, upending the top-down path of information between doctors and patients. Today, said Clay Shirky, an expert in the evolving online world, patients are "full-fledged actors in the system."
And they have plenty of company. Benjamin Heywood, the president of PatientsLikeMe.com, a site that allows patients to track and document their conditions and compare notes with other patients, says that with a growing online population, it becomes possible to research highly specific conditions — say, being a 50-year-old with multiple sclerosis who has leg spasms and is taking a certain combination of drugs.
"We are really about measuring value in the real world," he said.
There are so many sites today and the landscape is changing so rapidly that it would take an encyclopedia rather than a newspaper to list them. But they can be grouped into five broad, often overlapping, categories.
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