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which patients assume increasing responsibility for their own care As testimony to its impact, a recent poll [300] has shown that more than 98 million US adults have sought healthcare information online and 75% and those who have access to the Internet use it to find health-related information This explosive growth brings threats as well as opportunities, and many clinicians are unprepared both technically and mentally for the new patient power and the ethical and legal dilemmas that the new paradigm produces For example, physicians now find that they need to provide online services [301] such as web sites, direct email communication, and questionhnswer sessions to help interpret the information that patients acquire They are also concerned about the amount of time they need to spend with patients to explain the shear mass of data and the way in which the Internet is reducing the asymmetry of the patient-doctor relationship.

Love is more than sex. I have more patients complaining about lack of closeness or lack of verbal communication than about lack of sexual skills or opportunity. Fortunately, however, partners with Parkinson s disease have usually retained their loyal spouses and have a life-time of devotion to sustain one another. . . . Talking, fondling, hugging, touching, and shared sensual experiences of many kinds can continue to enrich a couple, no matter how disappointing the decline in sexual activity may be. For better or worse still includes a lot of better you just have to look a little harder for it.

An oft-expressed threat is the uncertain origin and quality of information offered in a frequently anarchic and unregulated environment [302] (see Section 642) Another perceived threat that remains high on the agenda of concern is the privacy and confidentiality of personal information Patients (as well as web site developers!) have shown themselves sceptical [303] of claims that information is secure and immune to attack Patient trust is a key issue and once it is lost it is difficult to recover However, the convenience of electronic communication means that despite the many ethical concerns of clinicians, medical advice, email diagnosing [304] and prescribing [305] will become increasingly common, as will the automatic monitoring of conditions and the transmission of test results.

While services will be tailored more to individual needs and customised care becomes the norm, the web will also be used to host treatment regimes such as disease management programmes and care protocols and the depersonalisation of these activities could result in the loss of vital contextual clues and a reduction in the quality of care A further move in the direction of impersonal care is the tendency of physicians to form groups so that the group is online rather than an individual Government must be aware of and respond to these pressures by educating the public and providing a legal framework in which unethical and irresponsible practice can be exposed and the offenders punished This framework should involve healthcare professionals and industry, and should encourage them to construct ethical codes [306, 3071 and act in a self-regulatory manner to minimise malpractice and maximise patient benefits (see Sections 52.

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1 and the rest of Section 64) 642 Ethical Guidelines for Patient Information Informed users quite naturally expect clinical information on the Internet to be of high quality ie accurate, timely and based on evidence That is they expect the content of a web site to be governed by the same principles as.

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6. If the system switches on and off without warning or the power seems flaky, check the following: