It also suggests that the medium will transform health care, with doctors and patients having less and less face to face contact.

And with the advent of videoconferencing and greater bandwidth - allowing more information to travel along telephone lines faster - patients will be able to benefit from specialist services not available locally.

However, both doctors and patients will need to revise their attitudes to each other and learn new skills for the advances to be successful.

Growing knowledge

Writing in the British Medical Journal (BMJ), Alejandro Jadad of McMaster University in Ontario said that thanks to the Internet, patients had access to as much medical information as doctors.

Other services provide easy-to-understand patient leaflets

Moreover, they were sharing their knowledge - meaning that, more than ever before, patients and not doctors were responsible for the spread of clinical facts.

"Even children can provide information to their peers, their parents, clinicians and policymakers," he said.

"Some people even offer to do research on behalf of other patients for fees that surpass those charged by clinicians for consultations."

Power shift

This was leading to a change in the balance of power between doctors and patients.

"It is evident that clinicians are finding themselves upstaged by and ill prepared to cope with patients who bring along information downloaded from the Internet," he said.

"We need to devote more resources to studying the implications of the Internet for the the role of patients and the clinicians and to ensure the clinician-patient relationship is strengthened rather than undermined."

The article was one of many looking at changes in the doctor-patient relationship appearing in a special edition of the BMJ that claimed to mark "the end of paternalism in the NHS".

Quality controls

Angela Coulter, executive director of policy and development at the King's Fund and guest editor of the journal, agreed the Internet was changing the doctor-patient relationship.

"A number of patients come in waving things they've picked up from the Internet," she told BBC News Online.

"This is both a good and a bad thing - good because patients should be informed but bad because there's a lot of unreliable information out there."

But she did not share Mr Jadad's concern that the balance of power might shift too far, with patients upstaging doctors in their own surgeries.

"The balance of power needs to slip, because there's a paternalism in the NHS and patients are treated like children. They're not - they're grown ups."