Wired on Friday: When you need a good doctor, lawyer or plumber, who do you turn to for advice? Increasingly, people are turning to the net for tips on hiring professionals.
But once you snag your home help or your GP by Googling for reviews, does the internet still have a part to play, or are ongoing professional relationships still a matter of personal contact?
Out here in San Francisco, the idea that you could pull a decent accountant from Craig's List, or your cleaner from Yelp.com, isn't too much of a surprise. Beyond that, though, the commitment to the more intimate communication possibilities of the net thins out.
Even in the heart of Silicon Valley, there are still vocations that resist the allure of e-mail, even when their customers say they would like to use the net.
Perhaps the most obvious gap is in medical advice. This year the Center for Studying Health System Change in Washington DC revealed that only around 20 per cent of physicians in small practices used e-mail, despite a growing interest among patients for consultations that don't require a trip to the doctor's surgery.
Conservatism among doctors is part of the problem, but as a new generation of tech-savvy doctors enters the workforce, more practical issues emerge surrounding e-mail communication with patients. Privacy is one: in the US, the federal government has recommended that only secure e-mail be used, and it's not clear that in Europe, doctors would even be able to discuss medical conditions on public e-mail. Secure e-mail is possible, but the use of encryption or visiting special security-hardened mail sites removes most of the convenient advantages to communicating by mail.
Perhaps a more realistic issue is that of payment. A few short words by mail may not seem much for a patient, but coping with a sizeable backlog of queries is not something that any overworked GP would look forward to.
In the US, health companies are looking at the possibility of charging for online consultations, or offering it as a value-added service.
Whether it's in a private health system like the US or publicly supported medicine as in the majority of the rest of the developed world, online communication may well be more cost-effective than office appointments.
Doctors, for obvious reasons, are uncomfortable with treating patients without seeing their symptoms. But a semi-automated system of follow-up checks and reminders would help to shore up that part of modern medicine that desperately needs some technological back-up: bedside manner.
It seems strange to imagine that a soulless computer network might help bring doctors and patients together, but those people I know whose doctors use e-mail swear by it.
A quick rote message from a doctor asking whether the drugs are working, or asking patients to rate their new pain level, or even pointing to follow-up websites after a consultation make the process of receiving treatment seem more than a three-minute visit and a prescription.
E-mail and instant messaging have an intimacy that printed letters and even follow-up phone calls by receptionists lack. A friend, recovering from a kidney-stone operation, was touched when her GP e-mailed from her personal mail account to see how the operation had gone. A quick e-mail from my wife to her GP to ask if her prescription could be renewed saved a surgery visit or a long and involved phone call; another e-mail asking a simple question about a drugs interaction with alcohol prompted a reply that saved time on both sides.
Beyond these simplest of net uses in patient-doctor interactions lies a far wider future.
Ten years ago, the operators of an MRI brain scan were surprised when I asked to take home a copy of the digital data they used to analyse my brain image with.
In 2003, after my daughter's image emerged on the ultrasound screen, we were given a digital CD with a QuickTime movie of our child's in-utero movements to take home with us. A friend last week obtained a vast image file of a full-body X-ray for him to keep.
Right now these are all geek bonuses. E-mail interaction with your doctor doesn't take you that far from a phone call or a consultation. Having a Zip file of data to take away from a medical procedure is exciting for technology buffs, but hardly a life-improving experience for anyone else.
But at least it draws patients into the already high-tech process of medicine, a side that we're usually (literally) screened from for fear of intimidating us.
One of the problems of modern medicine is that doctors can use technology to help them make sense of a blinding number of possibilities and confusing diagnoses - but patients have no such guidance. Irritating though it must be for doctors to hear half-truths and random symptoms plucked from a Google search when they speak to their customers, it's the best most of us can do when faced with the data overload of the medical world.
If doctors want better-informed patients, they need to do a better job of informing us.
But if modern medicine is constantly aspiring to become more human, it might start by being a bit more humanly honest about how high-tech it has become, and set about sharing the benefits of that with us all, medical professionals and patients alike. Technology can bring us together as well as set us apart.
