The first UK study of how GPs respond to print-out-wielding patients shows that they feel anxious and threatened.

But GPs pull themselves together and use cognitive and behavioural techniques to deal with their negative responses.

One GP admitted to ‘a heartbeat moment' when faced with a patient quoting from the internet.

‘Internet-informed patients proved challenging to GPs,' Dr Sanjiv Ahluwalia, a north London GP and lead researcher, wrote in the February issue of the British Journal of General Practice.

The shift in the balance of power in the consultation means that GPs have reshaped their role ‘from gatekeepers of secondary care services to facilitators of information interpretation and decision making', Dr Ahluwalia said.

GPs expressed ‘a general sense of anxiety' when faced with a patient bringing internet information.

But an existing good rapport with the patient protected GPs against internet-related stress.

‘The importance for doctors of feeling valued by patients was apparent, as was the effect of the prior doctor-patient relationship,' Dr Ahluwalia said.

GPs were frightened of losing control of the consultation.

‘I am threatened by the possibility that they have read something that I don't actually know and understand,' one GP said.

But they pulled themselves together, playing for time to allow their anxiety to dissipate by asking open questions and deliberately adopting open body language.

They got over their fear of being seen as ignorant by deliberately admitting their ignorance and showing respect for patients' information.

GPs used bad consultations as learning experiences and found that with time they became more comfortable and their initial anxiety subsided.