"I have been doing my own research on the internet," she starts as I eye the sheaf of colour-coded papers in a folder. "I think I should be on a tablet that starts with A - here, I can't say it properly." The first sheet slides across the desk to me.

"Anthracycline - it's not a tablet but intravenous chemotherapy."

"Why are you not giving it to me?"

I remind myself that she has always been an intense patient, from the day I broke the news that her abdominal pain was not due to food poisoning but advanced cancer. She underwent a lot of diagnostic tests at the time and interrogated every result in detail. Treatment options for her type of cancer are limited and guided particularly by an oncologist's instincts. "They say there are many things you can do, you just have to look harder.""They" refers to Google, a swiftly adopted companion in her journey. Patiently, I had explained that I had treated others in her situation and would now treat her to the best of my ability.

I initially invited her questions, believing that empowered patients handle treatment better. Sometimes the questions were exacting. Just how much sputum production was safe? Should the celery be raw or steamed? Once, there was a piece of tissue, neatly folded and saved in a Ziploc bag - "Can you record the exact dimensions of this blood clot from my nose for future reference?" All harmless questions, I consoled myself. And if they reassured her, it was worth it.

Unfortunately, the chemotherapy has stopped working lately and although I had foreshadowed this, she is puzzled.

"This isn't right." Understanding that for some patients such expressions reflect anger, grief or resignation, I don't press the point too much, instead inviting her to discuss future options.

"So why am I not on this great new anthra chemo?"

"It's actually an old drug. Do you remember my concern that your heart wouldn't withstand it?"

"My cardiologist says my heart's as good as it gets."

"Which means your heart failure is presently stable."

"But what if this chemo really works?"

"I wish it were the case, but it's also unsafe to prescribe something that could cause serious heart damage."

She purses her lips. "Facebook has these amazing stories about it curing breast cancer."

"You don't have breast cancer."


Willing myself to digress, I ask, "How are your sugars doing?" She is a lifelong diabetic.

"Your last chemo upset my diabetes."

Before I can continue, she enthuses, "Anyway, I am taking these incredible juices from Canada. They are showing amazing results in cancer."

"How many juices do you drink?"

"Eight glasses a day."

"Do you think they might cause your high sugars?"

"No, they are just anti-cancer." Her expression will brook no argument. As I wonder what to say next, she says, "Anyway, the internet says that I should have this gene test." Another piece of paper slides across my desk.

"I've heard of it, it's experimental."

"I want to have it."

"It's not useful or available at present." Returning the paper to her, I add gently, "I know you really want something to work but we are better off discussing reasonable options."

She pretends not to hear. "I'll courier the blood to Europe but I need you to write me a pathology slip. Wait, I can tell you exactly what needs to go on it." As she rifles through her folder, I tell myself wryly that the issue is no longer whether I will alienate her but how much. Adjusting her glasses, she reads, "And I also need a total body scan, and this last unpronounceable thing, some enzyme to see how my body is going overall." Oblivious that her last claim doesn't even make sense, she asks, "Can you do that?" I take a moment to compose my thoughts. Quashing the temptation to tell her bluntly that I don't order tests that scammers demand, I force myself to do what I teach my residents - step into the patient's shoes.

"I can imagine this must be hard."

"You have no idea."

"You're right, I probably don't. But I still want to help."

"I don't need help, I want a cure."

I meet her gaze. "Unfortunately, I don't think anyone can cure you, but we can work towards improving your quality of life."

Her expression melts for a brief second before she says resolutely, "There are so many blogs about the most incredible cancer treatments offered by real professionals. They have no side effects and cure cancer - what's wrong with wanting that?"

Again we discuss her needs and my recommendations. Although it seems like forever getting to it, we eventually arrive at her sole concern.

"So will you order these tests?"

"I think you've already had all the tests you need."

"So you are not going to help me?"

"I will, but in ways we both agree are reasonable."

Her annoyance is clear. "You don't have to buy my beliefs to do what I ask. Doctors are meant to help patients."

I am intrigued by her line of thought. "Can you see why going along with what you have read on the internet might be acting against my own principles?"

At this she bursts into exasperated tears. "But this is my disease and just maybe, the internet knows better!" She storms out of the room, pledging to find another more "co-operative" doctor.

Her accusations leave a sting as much as her tears dismay me. No doctor aspires to mislead or mistreat patients. And patients often need to be their own advocates to receive appropriate medical care. But what used to be a conversation between doctor and patient has increasingly turned into a duel between the omniscient internet and the considered doctor. The commonest objection many patients register is, "The internet doesn't think so."

It didn't take the internet the nearly 15 years it took me to become a specialist. What is downloaded from the internet in seconds has taken me years to learn and finesse. The internet provides information but not perspective. It provides the same information to the tottering old lady, the middle-aged businessman, the expectant mother, and the self-confessed "clueless" adolescent. The job of tailoring the information to patients falls to doctors. The old lady must be saved from fatal toxicities and the broken businessman will need psychiatric assistance to make it through chemotherapy. The expectant mother must be guided towards the safe delivery of her baby and the adolescent will need a frank discussion about fertility preservation. This is not a job that the internet shoulders; indeed, it's one that needs the eyes and ears of a skilled doctor.

Some call this vital element of healthcare, the "end-of-the-bedogram", the gut instinct of the doctor who sums up your condition from the bedside. Take away this crucial instinct and a lot more will be lost.

Like all doctors, I seek help from the internet. It is impossible to keep abreast of the hundreds of new publications any other way. But my training gives me the ability to sift through information; my experience allows me to understand what "a promising result" or a "groundbreaking discovery" really signifies for the individual patient seated before me.

Internet recommendations about disease management are often generic and sterile; applied without professional oversight they can prove downright dangerous. Patients are puzzled by doctors who remind them that a blood test or a CT scan is never "just a test" but carries implications. Asking for this test or that medication is not like choosing between two cereals on sale. My last patient nearly lost her life due to an anaphylactic reaction to the CT contrast. Some years ago, I watched a young man die from a severe bacterial infection of a heart valve gained through the site of an intravenous drip. Every year doctors and patients rue adverse and avoidable medical events.

The memory having stored many such regrettable events, what sounds like hesitation on my part is often deliberation - is this the right drug for the right patient? What could go wrong if I acted in this way? How does this treatment match with the patient's wishes? These are not questions that concern the internet, which is why the more difficult the decisions, the breezier its confidence.

When faced with a doctor who disagrees with the internet printout, patients often argue, "How can you be sure?" This is an unwinnable argument. No, I can't be absolutely sure, but the internet can be even less so. Ultimately, it boils down to trust. Do you have enough faith in your doctor to make the right decisions? Many seriously ill patients suffer doubt about their medical care. I have too, and I think it's only natural. Does the doctor know enough about me? Is she well read? Does he know when to ask for help? But to journey through an entire illness second-guessing the doctor is not just unfair to the doctor but detrimental to the patient because the patient never feels satisfied, the doctor never feels capable, and eventually, there is disengagement. Good medicine is not a dispassionate commercial dealing; it is a transaction of trust.

"But my doctor is clueless," another internet-informed patient recently huffed as he asked me to test his PSA, a hotly debated screening test, for the second time in a month. Aside from his hubris, I wanted to point out that he lives in a country whose health outcomes are the envy of the world. Childhood mortality is low and life expectancy is high. Major diseases are managed comprehensively if not perfectly. If you no longer suffer from an ulcer that gnaws at your stomach; if your chemotherapy-ravaged blood counts have been saved by a growth factor; if you have a child born through IVF; or if you are the latest recipient of the cervical cancer vaccine, you are the beneficiary of Australian medical expertise. A country's healthcare system cannot consistently feature near the top of international charts if the people it employs are "clueless". Of course, there are inequities: doctors are found professionally wanting, some are accused of personal misconduct, and there is room for improvement, but the way forward is not to treat healthcare like a casual transaction, where the doctor delivers the remedy the patient demands.

The era of medical paternalism is over in rich countries and modern patients seek much more empowerment, as they should. Nothing pleases me more than a patient who says, "I want to understand what's happening to me." It signals to me that the patient and I will share the responsibility for decision-making. It reassures me that when things work out, we will share the relief but if they don't, we will move forward as one. Not only is it a satisfying way of practising medicine, it also just seems right.

Someone new to my clinic once asked me, "What makes a good patient?" When I reflect on all of my seriously ill patients, I can define the ones who extract the most therapeutic benefit from our relationship. These patients are actively engaged in their treatment. They aren't afraid to ask questions or report unacceptable toxicities. They take the time to think through their wishes, separating the miraculous from the desirable to the achievable. They air their doubts and are upfront about what the neighbour, the gardener and their friend's friend advises them should be done about their cancer. Realising that they can't remember everything, they write down their most important concerns for me. When they read yet another breathless report about a cure for cancer, they openly ask me for my opinion. In other words, they tell me their viewpoint and rightly expect me to absorb it.

But equally importantly, this is what savvy patients don't do. They don't tell me which precise drug to select, how much to reduce the dose by and what to make of the new spot on the liver or the lung. They don't tell me which scan to order or how to interpret the latest blood test. They don't compare my recommendations to that on a random blog. When I provide counsel, they believe that I am looking after their best interest. They ask questions but are cognisant of the boundaries of their expertise.

Instead of assuming that I and my colleagues are "clueless", they graciously allow that doctors are also fallible and, in accepting so, make space for the occasional hiccup in a long journey. It would be doing these patients a disservice if you thought them to be passive. To the contrary, what sets them apart is their ability to engage meaningfully and reasonably with the doctor while never relinquishing their sense of control. And, unsurprisingly, because they invest their faith in me, I treat this gesture with the utmost respect and care that it deserves. It makes me think harder, sweat more and be better.

Consumerism and the urge to satisfy every appetite now with the object of one's choice, whether one is right or wrong, has spilled over into healthcare. Imagine being a doctor who is badgered by a patient to order an unnecessary test or prescribe a futile drug "just to be sure". A patient recently asked a GP, "If I just have a virus and you won't give me antibiotics, do I still have to pay for the consult?" If this kind of rancour affected your self-confidence or cost you business, wouldn't it be easier to succumb to the pressure from uninformed patients?

I recently talked to some dejected colleagues who were harangued by a patient to recall the weekend surgeon at the threat of a lawsuit. We reflected that when it was our turn, we hoped to let go of enough reins to allow our doctor to help us. Remarkably, we all agreed that anything less would be harmful. What no one could say was how to get this message across to the growing number of individuals who believe that the internet allows them to be both doctor and patient.

Web MD? Speaking to a professional is the best way to get good advice, but if you like to do research first, start by going to the right places:

General well-being, Better Health Channel, betterhealth.vic.gov.au

Cancer management, Cancer Council Australia, cancer.org.au

Paediatric conditions, Royal Children's Hospital Clinical Guidelines, rch.org.au/clinicalguide

Women's health, Royal Women's Hospital, thewomens.org.au/clinicalpractical guidelines