This study had several limitations. Though statistically sound, the sample size of 45 people was small and should likely be expanded in further investigations to allow for analysis of demographics and socioeconomic factors. The study focused only on the text content of websites and purposely removed the influences of the other potential content mentioned previously. While a biography serves as an introduction, further research is needed to determine how initial perceptions affect future perceptions throughout the course of the patient-physician relationship. The small number of Internet biographies used cannot represent the vast array of information that could be displayed in numerous ways, but was necessary given the length of time donated by each uncompensated subject (1-2 hours). To minimize complexity, we purposefully ignored websites in the middle, somewhere in the continuum between self-promoting and non-self-promoting. Instead we selected websites that would be stark in their self-promotion to allow for the assessment of our hypothesis. Finally, this study was not designed to address economic implications of promotional advertising. The goal of much advertising is to generate revenue, and in the case of orthopedic surgery, one goal is likely attracting more patients, but this effect is beyond the scope of the current study. Given the elective nature of many orthopedic surgery procedures, the effect of promotional websites on a person’s decision to have surgery or not is an important topic for future study.
Taken together, the data suggests a profound influence of the content of the Internet website in the impressions made on different groups of people. These facts, although profound in their influence and unregulated by the medical profession, present both great opportunities and liabilities. The opportunities arise from the professional community to help guide what surgeons do to generate interest on the Internet. The liabilities arise on consideration of the consequences of self-promotion in the setting of real world surgical complications.
