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310 James E. Katz, Ronald E. Rice, and Sophia K. Acordthe British Medical Association (BMA). In addition to putting patient confidentialityat risk, among the reasons she cited are that it is difficult to ascertainexactly with whom physicians are communicating and that there is nopersonal contact which is necessary for picking up crucial diagnostic clues(Pincock, 2003). (The BMJ’s discouraging views are presented atbma.org.uk/ap.nsf/Content/Consultingmodernworld.) On the other hand, theAmerican Medical Association is more moderate. While it does urge cautionand mandates follow-up in-person visits, it does see substantial benefit to e-mail communication. Indeed, it has undertaken a joint venture in this area.Private firms, for example, WebMD, also are seeking to turn small-scaleexperiments into full-fledged profit centers.Physician WebsitesHealth seekers are increasingly requesting reliable websites and recommendationsfrom their local medical practitioners. Over two-thirds of patientsconsider websites recommended by their physicians to be the most reliable, 61percent consider their physician’s website to be most reliable, and over half ofpatients trust health sites affiliated with other local medical authorities(LaurusHealth survey, cited in Pastore, 2000). One survey found that nearlytwo-thirds of consumers would change to a doctor who provided a websitewith credible content, appointment scheduling capabilities or secure communication(Pastore, 2001). However, according to another survey, only 40percent of physicians had a web page, and the majority of such sites lack thesort of depth sought by patients (Pastore, 2000). Sanchez (2002) notes that thevast majority of physician websites focus on practice enhancement tactics,rather than concrete patient service.Hence, we suggest that, just as the Internet is providing a context for reinventingor renegotiating the relationships between centralized and decentralizedsources of health information, it is doing so also for actors withintraditional small practices of “street-level” healthcare. As individuals andgroups are becoming more active, seeking out and creating their own informationand communication resources, they are increasingly, though notdramatically, turning to physicians as expert guides and interpreters of theinformation they find as well as seeking reassurance or innovative steps fromthem. While patients still think of their physician as their trusted medicalagent, they are turning to other sources, even those that question traditionalWestern medicine, and using that information as part of interactions with theirphysician.Physicians, for their part, are attempting to maintain as well as extend theirambit to include a virtual side. They do this by becoming more involved inInternet communication, drawing on the Internet for information, extending