The Internet, virtual communities and threats to confidentiality.

OBJECTIVES: To describe the role of the Internet in building virtual communities of doctors, to identify threats to privacy and confidentiality in this use of the Internet, and to suggest ways in which this threat can be managed.
SUMMARY: The Internet is revolutionizing the medical profession. The doctor's role as medical expert is being challenged by patients who have immediate access to multiple sources of information about their diseases. Telemedicine makes use of the Internet to enable doctors to diagnose and treat patients far from their offices or hospitals. Internet list servers and chat groups gather doctors together in virtual space to exchange views on clinical and professional issues. This paper focuses on the last of these Internet applications, beginning with a description of the 'virtual community' that the list servers and chat groups constitute. It demonstrates how various Internet practices particular to virtual communities, namely registration, e-mail lists, and 'cookies', pose a threat to confidentiality. It discusses the conflicting values at stake, especially privacy and confidentiality on the one hand and openness and freedom on the other, and suggests how a balance between these can be achieved.
CONCLUSIONS: The proposed resolution of the value conflict necessitates the implementation of effective registration systems, including collection of participants' personal information, and the monitoring of submissions to the chat groups. At the same time, the privacy (anonymity) of participants is maintained, except to the monitor, and the latter can intervene to delete uncivil submissions. Participants are also protected against unauthorised use of their e-mail addresses for advertising purposes and the like.