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Medical communication can be both a dialogue between expert-to-expert or expert-to-laymen (Cordella, 2004; Bowles, 2006; Candlin, 2006; Maynard and Hudak 2008; Lutfey and Maynard 1998; Heritage 2010; Heritage and Clayman, 2010 among others). In this last exchange, the doctor treats the patient as an ‘understanding recipient of medical reasoning’ (Peräkylä 1997) and language is simplified for communicative reasons (Koch-Weser et al., 2009). Patients are assumed as having little medical knowledge, which affects their understanding of medical terms and eventually leads to poor communication and to patients’ dissatisfaction (Candlin, Bruton and Leather, 1974; Coulthard and Ashby, 1975; Todd and Fisher, 1993; Bertakis, Roter and Putman 1991). However research on data taken from online message boards proves that e-patients are comfortable users of a highly specialized medical terminology and are thus construed as health literates (Jensen, Fage-Butler, 2014). It is questioned whether this new expertise modifies the quality of doctor-patient exchanges in online question/answer format frames. It is also asked whether doctors are still ‘silent listeners’ (Ribeiro, 2002) and expert translators of personal emotions and subjective realities (Guido, 2006). In particular the study investigates if e-doctors follow the socio-relational approach or, on the contrary, they use a more direct biomedical approach and if posts maintain the asymmetrical relationship which favours the doctor (like in face-to-face ‘traditional’ exchanges) or if the approach is imposed by the literate e-patient’s question. Analysing data by means of discourse analysis, it is further questioned whether cultural differences are found in sites directed to Italian speakers and English speakers.