From Patient Burdens to User Agency: Designing for Real-Time Protection Support in Online Health Consultations

Abstract: Online medical consultation platforms, while convenient, are undermined by significant privacy risks that erode user trust. We first conducted in-depth semi-structured interviews with 12 users to understand their perceptions of security and privacy landscapes on online medical consultation platforms, as well as their practices, challenges and expectation. Our analysis reveals a critical disconnect between users' desires for anonymity and control, and platform realities that offload the responsibility of ``privacy labor''. To bridge this gap, we present SafeShare, an interaction technique that leverages localized LLM to redact consultations in real-time. SafeShare balances utility and privacy through selectively anonymize private information. A technical evaluation of SafeShare's core PII detection module on 3 dataset demonstrates high efficacy, achieving 89.64\% accuracy with Qwen3-4B on IMCS21 dataset.