Traditional provider-patient relationships can be characterized with a gatekeeper model in which the provider role is keeper of medical knowledge and major decision-maker. Internet access by many persons makes possible a shift that expands power and control of health information, which is no longer just accessible to a privileged few. Although congruent with emerging social norms, patient participation in health care remains controversial. Some provider or physician groups historically relied on dominant societal ideologies to promote resolution of this challenge while maintaining their own power. Through use of a critical social theory analysis, we examine provider-patient relationships by reviewing the political, economic, and social perspectives within a historical context and identify ideologies, assumptions, and supporting structures that contribute to the existing situation. In addition, we analyze constraints on Internet use that affect oppressed groups and offer ideas to eliminate oppressive ideology and foster social change. Future initiatives that support change are discussed. © 2002 Mosby, Inc. All rights reserved.
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