On 01/25/98 01:19:32, John D Dalton <[log in to unmask]> wrote:
> For those of us who are unwilling to disclose the personal data
> requested, it would be helpful if you could post the text.
Apologies for those who don't like long posts ;-)
Here is the text:
Ahmad
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Keep on taking the URLs
More people are tapping into high-quality medical information on the
Internet. Can doctors keep up and how will it effect the usual
relationship with their patients? Tom Standage reports Scalpel...
scissors... N64? A LITTLE knowledge, goes the old saying, is a dangerous
thing. But while most of us possess little more than a modicum of
medical knowledge, for those with access to the Internet there is now a
vast amount of raw medical information within easy reach. In fact, we
may have easier access to it than our own GPs.
Typical of the high-quality information now flooding online is Medline,
a database of more than nine million references to articles published in
nearly 4,000 medical journals, maintained by the US National Library of
Medicine and now available to anyone who wants it on the Web. Quacks
and scares notwithstanding, the availability of high-quality sources
like Medline means the Internet is increasingly seen as a valuable and
trustworthy source of medical information. Specialist medical advice
sites aimed at consumers are also springing up.
But while this is all good news for patients, it's a mixed blessing for
those in the front line of healthcare: community GPs, who are starting
to encounter patients who consult the Internet before they consult their
doctor. "The worry is that the patient may self-diagnose a particular
condition, which may be an incorrect diagnosis, and they may get
terribly concerned about something which isn't a real medical problem,
and get the wrong end of the stick," says Dr Tessa Richards, associate
editor of the British Medical Journal. "The difficulty for a lot of
doctors is that they don't have the sort of access to information which
a lot of patients have." One GP who has already come across Internet-using
patients is Dr Ahmad Risk, who is also chairman of the British
Healthcare Internet Association, a body that promotes the use of the
Internet in healthcare. "Yes, it has happened, and it will increase," he
says. "I encourage it - anything that empowers the patient is good. The
downside is that we may be faced with increased demands for not yet
established treatments, or treatments for which there isn't a public
policy. But it's good, in the sense that doctors are not going to be the
knowledge monopolists that they used to be." Dr David Murfin, another GP
and a spokesman for the Royal College of General Practitioners, agrees.
"This has definitely happened to me," he says. "A very well-informed
son of a patient came in with a considerable amount of knowledge about a
very rare condition - he'd just gone to his computer." This is, he
suggests, symptomatic of an emerging trend in healthcare.
"We are at a turning point where consumerism is getting very powerful in
medicine," says Murfin. "There is a great demand for more information -
it's just a question of whether too much information can be a bad thing.
Consumer assocations say barely ever, but for the beleaguered GP it can
be a little difficult." Patients who access Medline, he says, often
suggest treatments that are unsuitable, and GPs then need to go into
quite a lot of detail to explain why. "I think that on the whole, I am
pro patient information, but I think one can understand GPs feeling that
this is just a bit of a burden." One advantage, however, is that
patients who have taken the trouble to look things up on the Internet
are likely to respond better to treatment, because they have taken an
active involvement in their care. "Informed patients make better
patients," says Bob Gann, of the Centre for Health Information Quality,
an NHS-funded project to improve quality of information available to
patients.
But it's not just access to information that is changing the medical
landscape. Increasingly, pharmaceutical companies are marketing
prescription drugs directly to consumers, in the hope that they will
then ask their doctors to prescribe them. It's all part of what might be
called the gradual Americanisation of healthcare.
"The US consumer is traditionally more vigorous about finding out
information," says Paul Harman of HealthGate, a company which publishes
medical information on the Internet. "In America you tend to go to your
doctor and say 'I've got this, treat me with that'. In Britain you tend
to say 'I've got this, what do you recommend I do?'. So there's a
cultural difference." HealthGate is responding to growing consumer
demand for medical information by launching new sites aimed directly at
consumers later this year; its existing site combines professional
sources such as Medline with additional material to help non-specialist
users make sense of it.
All of which could take some getting used to. "The doctor has got to
re-adjust to a different doctor-patient relationship," says Richards.
"If somebody's very well-informed and questioning, you have to go more
into a partnership - you can't adopt an old-fashioned paternalistic
approach." This will ultimately be the legacy of consumer access to
medical information. "What people are now talking about is shared
decision making," says Dr Angela Coulter of the King's Fund, an
independent health charity. But, she admits, "some doctors see it as a
great threat, because it overturns the paternalism which is the
traditional way of doing things." And not all patients are keen, either.
"One of the difficulties is that some patients really don't want
information - they want the doctor to decide," she says.
However, research has shown that the proportion of patients who would
rather leave all decision-making to the doctor is decreasing; patients
are set to play a greater role in their care. "We are starting," says
Gann "to see the balance tip." 29 November 1997: Cancer help on the Web 27
June 1997: Beware the Internet's first aid, say doctors 20 May 1997: WHO
looks into Internet medicine sales
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Dr Ahmad Risk
http://www.cybermedic.org
Chairman British Healthcare Internet Association <http://www.bhia.org>
Director Internet Healthcare Coalition - USA <http://www.ihc.net>
Home: +44 1273 724866/748198
Work: +44(1737)240022 Fax: +44 1737 244660
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