ARTICLE: Telemedical Technology
Consumers increasingly access information once reserved exclusively for the medical establishment
By Lee Hart Weber, community director, eHealthForum: October 2008
From its mainstream debut in 1992, the internet has profoundly impacted patient access to health information. Increasingly, people are seeking answers to their medical questions, checking out their symptoms, and self-diagnosing…online. With 1 billion people online, 100 million unique websites[1] and countless health related pages to choose from, the internet plays a central role in creating an informed patient population.
A Growing Demand
It’s estimated today that more than 220 million people in the United States use the internet. What’s more, the web usage from this demographic increased at a rate of about 115.7 per cent from 2000-2007 [2] and continues to balloon. In fact, 30.1 per cent of the continent’s population has yet to log in…meaning that we’ll be seeing more and more people join the e-revolution in the next decade.
Online Patients and Autonomy
Access to medical information is a valuable resource for those wanting to know more about a particular condition and enhance autonomy as a patient[3]. But just how are patients using the internet to answer medical questions?
Increasingly, people are taking charge of researching health issues via online community forums and “Ask a Doctor Online” services. Even web based search engines such as Google are becoming the latest tools in clinical medicine, as patients dig up relevant health-related content.
Surveys suggest that online information directly influences users’ decision-making and interactions with medical professionals[4]. In fact, the modern patient is presenting an internet diagnosis and treatment plan to their doctor. Trouble is, sometimes the information a patient finds is inaccurate or highly biased. So, how does a consumer sort the good from the bad info?
Healthcare consumers should be skeptical in their approach to internet health research. “You’re only as good as the sources of your information” is a wonderful motto for the 21st century. To make it easier to discern between sites, certifying boards such as Health on the Net help verify medical websites’ authenticity. Consumers can trust the Health on the Net emblem, or HONcode, which is the industry’s stamp of approval.
Researching ailments or treatment programs online, before visiting the surgery, can enhance the consultation experience for both doctor and patient. Investigating in advance helps people to prepare for their visit to the doctor. For example, provoking more in-depth questions to ask and highlighting extra information that could be useful to share during the session.
J. Sybil Biermann, M.D. and orthopedic surgeon, says: “The patients who have done extensive searches are often well informed and you can spend less time on the basics and more time on the finer points” of treatment.”[5] People who create open, collaborative relationships with health care providers can synthesize individual findings with their doctor’s experience. Moreover, people who question the relevance and applicability of internet research findings to a treatment plan are more likely to be more fully and correctly informed. In sum, the web and the establishment may compliment one another. Judiciously used, the web can help people help themselves.
The Online Health Community: Bond and Belong
“The history of humanity is the history of being part of a group, having a group mentality,” says Professor Rebecca Grinter of Georgia Tech’s College of Computing.[6] “The internet makes a whole other set of those groups possible [that] don’t have to be physically proximate,” she said. In other words, people need and use groups. Interestingly, in the electronic age, cyberspace users are doing just this. They find one another and establish communities naturally, with health concerns in common.
So, what does an online health community look like?
Mail lists, discussion groups, and health forums help an individual patient connect with hundreds of others experiencing or researching similar medical symptoms. Sites such as eHealth Forum.com and networking groups on Yahoo or MySpace, for example, often bridge the gap between clinical and practical need in health care. Online health communities offer compassion and advice. Further, online communities are places to share practical and non-clinical information. “There are relatively few face-to-face support groups for lung cancer,” says. Karen Parles, a woman who developed localized lung cancer in mid-life. Her online health community,” is available 24 hours a day, 7 days a week, and there is no commute or session time parameter. Because of the sheer numbers of patients online, I was able to find others just like myself, and I no longer felt like the only 38-year-old nonsmoker on the planet with lung cancer.”
Social health networks are crucial to helping people feel supported; social networks are a place to bond and belong. “You can ask other patients specific questions about your treatment or your diagnosis, questions that would take a lot of time to research on the open internet,” says Parles. Further, shared information and experiences can provide patients a feeling of being more in control over their disease: “The information I learn on the internet enables me to ask different questions, to affect the agenda and to feel involved in my care.”
Furthermore, trend in internet-based consultation is growing. Ask A Doctor services are appreciated for their convenience and flexibility. Most patients get answers to their medical questions within hours or days, in the comfort of the home, without making a physically present appointment. Plus, the mode of communication enables patients the ability to reflect on a written answer without having to hurry. It can also help minimize doctor patent barriers such as inhibitions, especially when discussing more personal ailments that could otherwise be dangerously ignored. What’s more, Ask a Doctor answers can be read more than once by the online medical consultant.
However, this medium has begun huge debate about ethics within the medical establishment. Some individuals, and special interest groups, cite patient security and doctor responsibility as potential gaps for breaches in medical ethics. They claim that nothing can replace face-to-face consultation and care. Yet most North Americans are not satisfied by the “in-house” treatment they receive. Even more, most Ask a Doctor services attempt to educate rather than diagnose. Plus, tools are being created to move medical care deeper into e-health. Doctors already answer patient questions in emails for example. And internet-based systems are being developed to collect a patient’s medical history that tailors medical information according to patient response.
So can internet-based consultation truly complement traditional health care?
As long as some basic requirements are met and the restrictions of “Ask a Doctor” services acknowledged, then yes. First, informed consent requires fair and honest labeling. Health professionals must also maintain patient confidentiality. And, finally, doctors online must define internal e-procedures. As Gunther Eysenbach of the University of Heidelberg’s Department Of Clinical Social Medicine states, “Different media are appropriate at each point on the continuum between dispensing general health information and handling patient problems that would require the practice of medicine to solve. For example, email is a sufficiently capable medium for giving out general health information, while diagnosis and treatment usually requires at least advanced telemedical technology.”[7]
The Doctor-Patient Relationship Revised
Such revolutionary social change must, then, impact social establishment …but how? and to what extent? The UK’s Clincial Medicine has stated the internet provides an unparalleled opportunity to revolutionize medical education to include: bedside decision-making, patient records and communication between professionals and patients[8]. And the American Medical Association recognizes that access to medical information, “has the potential to speed the transformation of the patient-physician relationship from that of physician authority ministering advice and treatment … to that of shared decision making between patient and physician.”[9] But will physicians be willing to share in this new medical experience with patients? Or will their access to information (and thereby power) be challenged or threatened? Will physicians employ disciplinary strategies that reinforce traditional patient roles and alienate patients who use the internet? Or will doctors manage patient understanding by balancing personal experience with clinical trial? More findings will unravel as eHealth information and trends toward patient autonomy develop.
