When the pain in her knee from an old running injury continued even after surgery, Sarah McCluan turned to the Internet for help.

"I don't use it to diagnose myself, but I do go to the Internet for basic information," said McCluan, who downloaded some knee strengthening exercises that she is following.

McCluan, 37, of Hopewell is among a growing number of wired adults searching the Internet for medical information.

Eight in 10 Internet users look online for information about health topics — researching specific diseases and treatments, alternative medicine, health insurance, doctors, hospitals and ways to stay healthy, according to the Pew Internet & American Life Project, which tracks the social impact of the Internet.

"You can monitor clinical trials online, access journal articles ... but there's also a lot of spin, advocacy and old information," said Lee Rainie, director of the Washington-based research group.

Sixty percent of these e-patients, as they're called, said they or someone they know were helped by following medical advice or health information found on the Internet. That's up from 31 percent in 2006, Pew researchers said. The Internet ranks third behind health professionals and family members as a source for medical advice, the researchers said.

But the "e" stands for more than electronic; it means "equipped, enabled, empowered and engaged," said Susannah Fox, associate director of digital strategy at Pew.

That has forced some changes at doctors' offices, said physicians, many of whom are spending more time interacting with patients.

"They very often come in with a print-out. ... They have questions," said Marc Itskowitz, an internist at Allegheny General Hospital. "We have to respond to what they're looking for on the Internet."

Consumers clearly are ready for this type of change in their health care, Fox said.

"While Washington debates health care reform, while doctors try to figure out if they're going to get paid for this, consumers have gone ahead and are using the Internet to search for information about health," she said.

The American Medical Association would not comment on the topic.

But G. Daniel Martich, professor of critical care medicine at the University of Pittsburgh's School of Medicine and chief medical information officer at the University of Pittsburgh Medical Center, said medical students he teaches are learning to work with e-patients in a course called "The Basic Science of Care."

"We are actively pursuing e-visits," he said.

It's not just for young students. Those embracing the "e" concept include at least one doctor older than 70 who has "taken to this," Martich said.

Although there are no specific courses dealing with e-patients at the University of Pennsylvania School of Medicine, "the concept has been integrated throughout our medical education curriculum," said spokeswoman Kim Guenther.

Younger patients are more likely to research health issues online and follow up with their doctors. Internet users ages 18 to 29 make up the largest group of people seeking health information, the Pew study found. Those ages 30 to 49 were second.

There is a clear generational divide when it comes to using online health information, the Pew research shows. Older adults are more likely to have seen a doctor in the past year; younger people may not have, Fox said.

Joan Cooper, 83, of Squirrel Hill wouldn't think of taking information she found on the Internet to her doctor.

"Politically, that's not a good thing," said Cooper, a retired academic research librarian whose special interest was medicine. She occasionally sends e-mail articles she finds online to her geriatrician.

Studies show patients who e-mail doctors can cut down on office visits, and insurers are beginning to reimburse doctors for online visits with patients.

Although such e-visits could help cut costs, it could be time-consuming for smaller practices, and no one has developed clear guidelines on payments, said Dr. Bernard Bernacki, chairman of family medicine at UPMC Shadyside and one of a growing number of physicians with their own Web sites.

Doctors warn patients to use caution with information they find online.

Itskowitz, 37, said he often points out incorrect information that patients downloaded from the Internet. "I tell them to stick to reliable Web sites," he said.

The amount of health information available can exasperate doctors, Cooper said. Search engines will produce a glut, including commercial and home remedy information.

"You need to go to reliable sources," she said. The National Library of Medicine has a user-friendly database called PubMed, Cooper said.

The Journal of Participatory Medicine, which debuted in October, is publishing online peer-reviewed articles on shared decision-making in health care. The inaugural issue included articles from patients, health care providers, payers and others.

The 72-page Healthcare Survival Guide, which provides cost-saving options for the suddenly unemployed and others, has been offered online by its authors for a limited period.

In this perpetually connected world, look for this trend to keep growing on both sides, experts said.

"By 2012, all physicians will walk around with a stethoscope and a smart mobile device," said Monique Levy, senior director of research at Manhattan Research, a global pharmaceutical and health care market research and services firm.

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