Will online consulting spell the end of hours in unhealthy waiting rooms? MICHAEL FOREMAN reports.
While nobody denies that Internet medicine has arrived, not everyone - including a large section of the medical profession - agrees that this is a good thing.
New Zealanders can now obtain almost any medicine, including prescription
drugs such as Viagra or Xenical, online from local sources and at least one practice, New Plymouth-based Doctor Global, is offering full digital consultations.
Launched just over a year ago, Doctor Global's 23 doctors provide online prescriptions and medical advice on topics including general health, nutrition, sexual problems, allergies and depression.
"It's a whole new way of transferring information and it's going to impact on everyone over the next 10 to 20 years," says chief executive Dr Tom Mulholland. "I've just got on to it early."
He believes that prescribing medicine over the Net can often be quicker and more convenient for patients.
"Why should you have to sit and wait in a waiting room full of sick people and get coughed over when you only want a box of something?"
But research shows that many doctors disagree.
A poll of GPs by the trade newspaper New Zealand Doctor last March found that 83 per cent oppose any kind of "e-prescribing" to patients they have never examined.
Only 13 per cent of doctors thought the practice was acceptable for a limited range of drugs.
Last week, the Medical Council issued guidelines for doctors practising medicine over the Internet, which included a stipulation that no doctor should prescribe medication unless the patient has had a face-to-face consultation with the said doctor or another medical practitioner.
"Internet medicine is here but the issues around it need to be addressed," says Dr Philip Rushmer, a board member of the Medical Association.
"Our view is that nothing should take the place of the one-to-one, face-to-face consultation."
Dr Rushmer believes that digital consultations are incomplete and that patients should be thoroughly examined in person, with their full medical condition and history checked, including contra-indications for other medicines they might be taking.
But Dr Mulholland says online consultations compare favourably with doctors giving advice over the phone, which has been practised since the invention of the telephone.
"Patients ring up in the night and say their kids are sick. The doctor says do this or do that - it happens every day. The difference is, with the Internet you have a transcript of what has been said."
Dr Chris Simpson, of the Men's Health Clinic in Auckland, who prescribes and dispenses the impotency drug Viagra and weight-loss drug Xenical online (at www. menshealthclinic.co.nz), says his site provides a vital service for those too embarrassed to see their GPs.
"Of course the optimum is the face-to-face consultation. It cannot be beaten, but some patients just don't want it," he says.
"A lot of my people are terrified of admitting that they are suffering from it [erectile dysfunction] in the first place.
"They certainly don't want to go and discuss it with their GPs, and they don't want the knowing grin of the girl in the pharmacy," Dr Simpson says.
As well as concerns over online prescriptions, the Internet's role as a source of medical information worries some doctors.
Leading-edge medical reports from sites such as the British Medical Journal's eBMJ (at www. bmj.com) are only a few mouse clicks away - as are a host of charlatan and ill-informed sites.
The Medical Association's Dr Rushmer says it is becoming normal for patients to arrive for consultations armed with reams of printout they have gleaned from the Internet on their condition.
"It's hard for patients to know whether the information is current and whether it's pertinent to their condition. These things are best discussed with their doctor."
But Shirley Wass, national coordinator of Parent to Parent, an organisation that helps families and children affected by disabilities and health impairments, says patients are sometimes better equipped than doctors to gather that information.
Ms Wass says the Internet has made it much easier for Parent to Parent (p2pnational@compuserve.com), which acts as a clearing-house for information relating to more than 1800 disorders, to keep abreast of medical developments.
She says the Internet is most useful when dealing with rare diseases and syndromes.
"Sometimes a condition is so rare that it may crop up only once in an average doctor's career."
Ms Wass says a parent who has a passionate interest in the condition is going to obtain information on it far quicker than a doctor who is seeing many people during the day and does not have the luxury of concentrating on one area.
"In some instances they could well end up being better-informed than their doctors.
"I don't see that as a bad thing," she says. "It's part of the partnership with your medical practitioner."
However, there are pitfalls.
"Just keying in the name of a disease [into a search engine] can bring up an awful lot of sites," says Ms Wass.
"We look for sites written by those who have some standing in the medical community.
"The Net can be a trap for some people who just take what they find."
ANYTHING THAT AILS YOU
Feeling poorly? There's a wealth of health resources on the Net.
Cyberchondriacs can search for herbs, drugs and vitamins at Lycos' WebMD [http://webmd.lycos.com].
The patient and provider services of Virtual Hospital
[www.vh.org], Switzerland's Health on the Net [www.hon.ch] for advances in the new field of telemedicine and www.nzhealth.co.nz for local wellness.
StartingPage is a vastly comprehensive collection of healthy links at www.startingpage.com/html/health.html.
Will online consulting spell the end of hours in unhealthy waiting rooms? MICHAEL FOREMAN reports.
While nobody denies that Internet medicine has arrived, not everyone - including a large section of the medical profession - agrees that this is a good thing.
New Zealanders can now obtain almost any medicine, including prescription
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