Patients looking for information on the Internet and seeking teleadvice - Motivation, expectations, and misconceptions as expressed in e-mails sent to physicians

Objectives: To analyze the motivation, expectations, and misconceptions of patients seeking teleadvice or medical information on the Internet. To expl ore the possible economics and problems of direct physician-to-patient tele advice via electronic mails (e-mail). Design: Exploratory survey of 209 unsolicited e-mails mostly sent to physic ians by individuals seeking teleadvice, Setting: University dermatology hospital with a major Web site on the World Wide Web. Patients: Two hundred nine patients and information-seeking individuals, ma inly with dermatologic problems. Main Outcome Measures: Previous contacts with live physicians, disease dura tion, level of frustration expressed in the e-mails, and type of informatio n sought. Results: Many dermatologic patients who request teleadvice have a chronic d isease (81%) and seek a second opinion. Seventeen percent express frustrati on about previous encounters with live physicians. Forty percent of all e-m ails could have been answered by a librarian, 28% of all e-mails were suita ble to be answered by a physician via e-mail alone, and in 27% of the cases any kind of consultation would not have been possible without seeing the p atient. In at least 5 instances patients attempt self-diagnosis. Conclusions: We found examples for the beneficial effects of the provision of medical information on the World Wide Web but also evidence suggesting t hat patients are trying to use information on the Internet as a supplement for physicians and that teleadvice might be over-used by chronically ill an d frustrated patients looking desperately for additional information. Telem edicine via email could substitute a physician visit or telephone call in s ome cases, but many principal problems must be solved beforehand.