Potential
The dream: Patients locate your web site when they do an internet  search for their condition. Physicians, insurance adjusters, therapists, lawyers and other sources of referrals do the same. They find your site, like what they see, and call your office for an appointment rather than calling your competitor. The only cost to you is the effort of putting up a web page.

Current Reality
Web pages are a very inefficient way of advertising for a hand surgery practice unless coupled with conventional media (print, television, radio) advertising.  There are several reasons for this:

1. The internet is huge and is overloaded with lay terms which relate to the hand. The words hand, thumb, arm, finger, palm and others are each used extensively not only in nonmedical context, but are frequently used buzzwords in Internet and computer related publications. Such search terms embedded in a hand surgery web site will be retrieved by search engines, but buried beneath a mountain of results of other sites with similar terms.
2. The current popularity of repetitive strain diagnoses in lay literature and the unregulated nonmedical industry which feeds into this has resulted in a large number of sites loaded with medical catch phrases of "carpal tunnel syndrome", "hand injury", "hand surgery", and so on. This further dilutes the search engine visibility of a single hand surgery web site.
3. The patient base of most hand surgery practices is the local regional community, but the Internet is decentralized. Unless some other form of local advertising provides a link to the practice web site, it may not catch the eye of potential patients within the catchment area of the practice. Potential solutions include listing the Web site address on business cards, print brochures, correspondence or conventional media advertising.  This still requires that the potential patient take that extra step of looking up the web site specifically rather than having it presented as a result of a search. Internet based physician directories have unknown usefulness.
4. Even when an upper level search engine visibility is achieved, patients do not always make the connection to the practice unless it is aggressively advertised on the web site. For example, during office visits, I have had a number of patients bring in printouts they have made from my web site, not realizing that I was the author of the information that they brought! This is because I have not advertised my practice web sites (24, 16, 11) in my community, and because my patient information site (23) does not showcase the details and location of my practice.