The Web-Enabled Patient

The past decade has witnessed major changes in the concepts of health and disease and in the respective role and responsibility of doctors and patients in health maintenance and disease management. These changes were triggered by cost-containment imperatives. Although constraining by nature, these imperatives are also enabling. The original incentive to engage people in taking larger responsibility in their own care was economic. The strategy used to foster commitment to better health was increasing people’s health awareness and making them confident they could modify their behavior, and in so doing reduce their risk for preventable diseases such as cardiovascular diseases (primary prevention) or detect diseases at earlier stages such as cancers (secondary prevention). Only recently, the concept of encouraging people to participate in their own care has been extended to patients with chronic diseases. Here, the objective is to make the patient able to practice self-care in the management of his/her disease, and the incentive is still to reduce the demand for and cost of care. Health promotion, disease prevention and disease self-management all rest on education: systematic education about diseases and risks, practical information on how to adopt appropriate behaviors, and training in self-care skills along with the message that people have the capability to change their behavior and acquire the necessary skills. These changes brought about by economic concerns can be seen as constraining, since they require active self-monitoring and self-discipline. However, as they rely heavily on health information and the development of self-confidence, their unintended consequences, enhanced by the current technology developments, are patient empowerment and a change in the doctor-patient relationship.