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Wednesday, 26 July, 2000, 11:33 GMT 12:33 UK
Are web doctors dangerous?
If you had the choice would you rather have a consultation with your doctor face-to-face, or cut out the waiting room and talk to them on the internet?
A GP in the UK has decided to offer his medical services on the web - he can give both a diagnosis and prescriptions to patients without them having to enter his surgery.
However the British Medical Association warns that patients should not seek medical advice on the internet because there are no regulations to protect them against bogus doctors.
There are also concerns that the system could be open to abuse in prescribing drugs, or that mistakes could be made in diagnosis.
This debate is now closed. Read a selection of your comments below.
Wow this is stupid. There is a point
to have a relationship with your GP.
He or she will have some understanding
of your medical history and can base
a diagnosis on this. A doctor cannot
properly work without this information.
The feedback on the recommendations has been very good. In Finland the Ministry of Health has registered the first Virtual Hospital as an official health care service provider on the Internet. The service is supervised by the Ministry and the qualifications of all doctors are checked before they enter the service. Some sickness funds reimburse the service already.
For electronic prescriptions there are also new instruction published by Finnish Ministry of Health. Prescriptions can be written electronically to patients, if the need of treatment can be confirmed. In some cases it is not needed for the customer to visit physician. E.g. if one is travelling to Indonesia and needs vaccinations, the prescription for a vaccination can be written based on Internet consultation.
Also if there is an existing patient-physician relationship renewal of drugs is possible in many cases. The key issue here is that the physician and patient are identified. In addition, the pharmaceuticals have to be delivered through pharmacies to ensure that e.g. a grand child is not using grand mother usernames to order sleeping pills.
As a medical doctor myself, I feel that the Finnish open attitude to new developments is correct. In fact the only way to tackle bogus and harmful medical services on the net is to set up better professional ones and teach citizens to use them.
Peter Zettinig, Finland
Everyone seems convinced that minor problems can be sorted out over the Internet. But how can you decide which is a minor problem without a visit, since sometimes minor symptoms can hide a serious illness?
This can't be much worse than sitting in front of an overworked, stressed GP who obviously has no time or sympathy left to give. Now what is unsafe?
Superb. The UK has once again beaten the world in the medical arena. No other country can claim to be so ridiculous that a nerd with a PC and a hacking manual can prescribe his own drugs. Outstanding. Right up TB's street.
For most minor complaints this is great. No doubt the price will be less than a regular visit.
After all what is the first thing a doctor asks? "What's wrong with you?"
I am therefore alarmed that a UK based site is offering this prescription service - it is worrying enough to have international sites where at least there is a chance customs will intercept the packages. I am seeking to discover whether others share my concern and to establish an action group if there is sufficient interest.
Richard Long, UK
Having worked at a helpdesk I know from personal experience how difficult it is to
form a mental picture of the situation on the other side of the line.
Nick S, UK
For diagnosis of the unknown I would rather see and be seen. For reassurance and follow up, I cannot believe that a doctor separated by wires and modem is any less effective than one who knows me and sees me.
Web medicine is a step in the right direction provided its limitations are realised. One can, at best, give an opinion but providing treatment may be a little dangerous. It can be argued that a large number of conditions are self-limiting and therefore require a little reassurance. The web can be an excellent support.
I think there is nothing wrong with a consultation over the net. If it is a serious problem, any responsible doctor will advise the patient to see a doctor in person. If is a minor illness, the doctor can advise the patient over the net, saving time for both doctor and patient.
It will not be very a very accurate diagnosis. Face to face contact is healthy.
The Net is a good source for research and ideas, but even as a knowledge base I am sceptical. Any moron can make claims and post it. This really is bad medicine.
I think it's possible for doctor to make diagnosis over the internet .The equipment for remote medical diagnosis are already exist such as video camera. The problem now is
there is no regulation for such kind of action.
It's not hard to imagine the near future - consultation by webcam, auscultation, vital signs, pulse oximetry can all be conveyed electronically. Sampling of body fluids is a bit of a hurdle but that too can be achieved.
I think as in all new endeavours, consumers will need to be on guard and the profession must prepare for change.
Stephen B, US
A patient's illness is cured 80% by the trust he/she has in the doctor. A net doctor may find it hard to get the trust but if he has it then he will be as good as any other doctor.
If you have a minor trouble it might be possible to solve by telephone or net discussion. Any serious doctor cannot risk giving a diagnosis in any risky or suspicious case without seeing the patient. That I believe is self explanatory to all patients too.
Dangerous quackery. All good medical decisions are made by a patient and their doctor communicating and negotiating. Complete communication is more than verbal. Any good doctor is sensitive to their patients' voice and body language, and so is able to help when "things are not all they seem" - which is at least a third of a GP's consultations. Stripping all of this out in email will leave consultations very poor indeed.
P Morrison, USA/UK
I'm already appalled by the lack of attention I get when I visit my GP and he writes out a prescription for antibiotics after a 5 minute chat. This is just going to make things worse. I can have my suspicions about what's up with me, but I'm not qualified to say... What's going to happen when the first web doctor prescribes the wrong drugs just because the web patient didn't explain their symptoms correctly? And what about hypochondriacs and drug users? Is this going to be a free ride for them?
It's difficult enough verifying the credentials of physicians and visiting, chatting or consulting with web doctors, I dare say, is impossible.
How does one verify the "doctor's" credentials? How does one verify his or her medical track record? And, even more important, how does one ensure privacy on the Superhighway when talking to a complete stranger? Why would anyone put himself or herself in the position of allowing a stranger into your inner-most upfront and personal world?
Only a fool would do so!!
Most comments about the competency of alternative medical services delivery systems can be attributed more to the greed of the medical establishment than to any faux concern they may voice about public health.
I think that a database of medical conditions that people can consult would offload many trivial questions. Although, then again it may mask some of the more serious conditions that may need urgent medical attention. You're damned if you do and you're damned if you don't!!
Internet consulting is about providing information and opinion - not about prescribing drugs to unknown patients.
Roger Thomas, Wales (Cymru)
It seems that many people complain about their doctors not taking interest in them when they do finally get an appointment, so a web doctor can hardly be less personal then that can they?
It is an honour for a person to be a doctor.
As a doctor I am dealing with human beings at stages of weakness in their lives. How on earth would a doctor practise good medicine electronically? He can follow up his patients electronically but certainly he cannot use the Internet in the initial evaluation.
Web doctors are like any other doctors. All of them can be dangerous but most are satisfactory. People have elevated doctors entirely too much in their minds. They are nothing more than human beings who have to deal with personal problems and life like everyone else
Willy Davidson, UK
I believe it depends on the doctor who sits to the other side of the net. He might be a conscientious one and tell you he can't provide a full diagnosis without seeing the body. But he may also deliver you some invaluable advice for you to decide what to do further. I welcome the progress in this case.
If he is a recognised doctor what's the problem. It's no different to NHS direct and probably a lot more personal. Some patients also need anonymity.
I would prefer to see a doctor face-to-face but, given the "government" has yet to pass laws snooping on doctors' surgeries the audit trail of an email is useful if there is any dispute over the suitability of the proposed treatment.
There are pros and cons to this. As someone who lives in the country, I have to say that getting a suitable appointment is difficult and then managing to make your way to the surgery in the next town is a nightmare. Provided that concerns about abuse or misdiagnosis can be addressed I think this is a good idea.
Paul Charters, England
21 Jul 00 | Health
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27 May 00 | Health
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