Both healthcare professionals and patients must develop critical appraisal skills and use them to evaluate internet-based health information and advice and distinguish the good from the bad, wrote one researcher in the AMA Journal of Ethics. Furthermore, healthcare professionals should become involved in initiatives to improve the quality of the health information available on the internet

Dónal P. O’Mathúna, PhD, MA, associate professor at the College of Nursing at Ohio State University in Columbus and the School of Nursing and Human Sciences at Dublin City University in Ireland, argued healthcare professionals should also become involved in initiatives to improve the quality of the health information available on the internet.

Dr O’Mathúna noted that in 2012 approximately 72% of American adult internet users searched online for health information. More than three-quarters used a search engine like Google to initiate their search rather than a healthcare website like WebMD. This raises concerns about the accuracy, quality, and clarity of the information they may find, as well as their ability to effectively search for information and comprehend what they find.

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For example, a systematic review of 87 websites that provided information about pre-operative fasting — including sites from healthcare institutions — found that 55% included “at least 1 recommendation that contradicted evidence-based guidelines.” Furthermore, healthcare institution websites were more likely to have inaccurate information.

Dr O’Mathúna argued that given the variability in quality of online health information, both professionals and patients must maintain a degree of skepticism. Furthermore, he maintains that clinicians who use websites for professional education have “an ethical obligation to use their critical appraisal skills to help patients avoid false or misleading information.”

He also outlined the guiding principles of the e-Health Code of Ethics, which include candor, honesty, quality, informed consent, privacy, professionalism in online health care, responsible partnering, and accountability. He added 1 suggested ethics guideline of his own: conflicts of interest. 

Dr O’Mathúna also discussed the issue of justice — that is, equal access to online healthcare information and ensuring that such information is accessible to patients who do not speak English, as well as the issue of ways to credential health websites. He notes that the Health on the Net Foundation (HON) is a Swiss nongovernmental organization looking to improve the credibility of online health information. HONcode certification assures the user that the website contains high quality information with supportive evidence from independent sources.

Dr O’Mathúna concluded by calling for healthcare professionals to contribute to the public good by becoming involved in efforts to improve online information and ensuring that online healthcare information is accurate and accessible.


O’Mathúna DP. How should clinicians engage with online health information? AMA J Ethics. 2018;20(11):E1059-E1066.