By MICHAEL PETRO

It used to be that a clinician or family physician would have the first and last words on a patient's health.

That's not the case anymore.

Patients are walking into doctors' offices armed with more medical information than ever.

Much of it comes from medical websites such as WebMD. There's not much that can't be found online these days, including simple health tips and in-depth reference material about everything from decoding prescriptions to choosing a hospital.

As a result, many patients no longer visit their doctor seeking knowledge; rather, they want affirmation of a self-diagnosis.

Potential for lawsuits?

Could patients armed with unverifiable information and self-diagnoses present legal risks for their doctors or put their own health in danger? Is there pressure on physicians to practice defensive medicine and avoid malpractice lawsuits by not indulging patients' research-drawn conclusions?

Members of the legal and medical communities in Western New York say they don't think so.

Doctors wouldn't put themselves or their patients at risk by making a determination without running the the expected due diligence. Also, there's a belief that those who go online for medical information see websites as another tool to learn about their health; they're not a substitute for medical advice.

"I think you'll find that patients come in with a lot of information," said Dennis Horrigan, CEO and president of the Catholic Independent Practice Association. "You may find a great variety of reactions from patients because of it, and I'm sure a lot of doctors' experiences have been different as a result. Are patients coming in with a better understanding of illnesses? Yes. That's going to happen with all of the resources that are available to them."

No impact on patient care

Attorney Kathleen Reilly of Damon Morey LLP said more-educated patients haven't changed the way doctors do their jobs. While there is possibility of a lawsuit if, say, a doctor deviated from proper procedures and research in diagnosis and treatment because a patient leads the doctor in that direction, Reilly said she has never seen it happen. Also, although many doctors represented by Damon Morey say they take the time to listen to the patient, they won't perform unnecessary tests or alter their practice because of what is discussed.

"Nothing changes. You just have a more savvy patient base," Reilly said. "The doctor has a responsibility to go through all of the proper steps. A patient may have made a self-diagnosis, but it's up to the doctor to go through all of their usual obligations."

Dealing with overzealous patients isn't anything new, according to attorney Eric Naegely, who specializes in health care at Damon Morey. Even before easy accessibility of medical news and information, they were out there.

"Doctors are educated and intelligent people. I don't think they'd just defer to a patient to quiet them," Naegely said. "Sometimes that may mean having to tell patients that this is the right thing and not that. I have enough confidence in the medical profession that, above all, they'll use their expertise."

As far as liability, the Damon Morey attorneys said it would be difficult to build a case for a lawsuit proving malice from the published content on a website. The individual sites post a disclaimer that it is not a substitute for medical advice and a physician should be consulted regarding a medical condition. And Naegely said a doctor-patient relationship must be established for there to be grounds for any action in a court of law - not likely in these types of interactive environments.

"As long as the content is reasonable and has some sort of medical backing," he added. "If you really look at the sites, they're careful and don't really ever get too specific."

In fact, doctors rate the risk as so minimal that many advise their patients after an office visit to use the computer to expand their knowledge on a particular health subject.

Horrigan, meanwhile, said he asked seven doctors within CIPA - a partnership between Catholic Health Systems and associated physicians - which websites they like and the most popular was WebMD. It describes itself as the leading source for trustworthy and timely health news and information. Pediatricians and specialists tend to steer patients to websites that represent their niche.

Proactive education

To further patient education, CIPA utilizes Emmi, an interactive, web-based, patient education program that clarifies complex medical information and promotes behavioral change. Emmi also is a tool that can be used by employers in an employee health program, according to Horrigan. He said CIPA strives to ensure that doctors are reinforcing positive behaviors for their patients.

"Some patients might go to a website and it helps them through whatever they're going through," he said. "Others might need the human interaction and support. Doctors have a different discussion based on a patient's needs."

Proceed with caution

There is a growing realization among medical professionals that websites have become starting points for many people in need of treatment, as well as those simply looking for everyday information when it comes to their family's health and welfare.

Karen Colmerauer of Hamburg is a prime example. While admittedly not web-savvy, she said she finds it helpful to peruse health and medical websites for information about a variety of things. For example, she routinely looks for info about vitamins that may help when her arthritis flares up. If her mother or grandmother aren't feeling well, she might turn to the Internet to research their symptoms and determine what is ailing them.

"I would never use it in place of a doctor. And if I ever really had a concern, I would call the doctor first, but I do find it informative and helpful," said Colmerauer, a teacher's aide at Hamburg High School. "If they ever get too wordy or use too much medical-ese, I steer away from it and go someplace where it's easier to understand."

Michael Petro is a freelance journalist from West Seneca.