Doctors are using the internet to search for information and email patients, but it shouldn't replace face-to-face communication, a couple of medical experts conclude. (CBC)

Online health information should be used according to doctor's orders, physicians advise.

Thursday's New England Journal of Medicine includes an article by Dr. Pamela Hartzband and Dr. Jerome Groopman of Harvard Medical School in Boston on how the internet has helped medical practice evolve.

Doctors can now communicate with patients by email or send electronic lab or radiology reports, but the internet should never replace a conversation with physicians who are in the best position to weigh information and advise patients, the pair said.

"Knowledge is said to be power and some of the past imbalance between patient and doctor may be equalized," Hartzband and Groopman wrote. "But information and knowledge do not equal wisdom, and it is too easy for non-experts to take at face value statements made confidently by voices of authority" from a computer screen.

If anything, the wealth of information on the internet will make doctors' expertise and experience more essential, concluded Hartzband, an assistant professor of medicine at Harvard, and medicine chair Groopman, who is also chief of experimental medicine at Boston's Beth Israel Deaconess Medical Center.

"The doctor, in our view, will never be optional," they wrote.

Untangling web of info

Exposure to a range of views can be helpful, such as for prostate cancer patients who are concerned about incontinence and impotence and want to weigh the risks and benefits of prostatectomy, radiation treatments and watchful waiting.

But one woman recently diagnosed with lupus told the authors, "It's hard to make out what all of this means for my case." Her condition is currently stable, yet she found herself focused on the worst possible complications of the disease after seeking out data and patients' stories on the web.

Some secure hospital web portals allow patients to remotely view their laboratory, radiology and pathology reports, but these can be a double-edged sword, the authors said.

The technology averts the need for multiple phone calls and mailing information, but the benefits need to be weighed against the potential negative effects of receiving clinical data without context.

"Patients and families may be confused by results and worried that minor abnormalities might portend serious consequences," the authors wrote.

As a tool for communicating with patients, email is a written dialogue, where replies may be delayed, phrases more stilted, and tone of voice is absent. It's also impossible to judge the effects on patients since grimaces, tears and looks of uncertainty can't be observed, the authors said in concluding that human interaction is always best.