Online doctor

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Online doctor is a term that emerged during the 2000s, used by both the media [1] and academics,[2] to describe a generation of physicians and health practitioners who deliver healthcare, including drug prescription, over the internet.[3]

Emergence of online doctoring[edit]

In the 2000s, many people came to treat the internet as a first, or at least a major, source of information and communication.[4] Health advice is now the second-most popular topic, after pornography, that people search for on the internet.[5] With the advent of broadband and videoconferencing, many individuals have turned to online doctors to receive online consultations and purchase prescription drugs. Use of this technology has many advantages for both the doctor and the patient, including cost savings, convenience,accessibility, and improved privacy and communication.[6]

In the US, a 2006 study found that searching for information on prescription or over-the-counter drugs was the fifth most popular search topic, and a 2004 study found that 4% of Americans had purchased prescription medications online.[7] A 2009 survey conducted by Geneva-based Health On the Net Foundation[8] found one-in-ten Europeans buys medicines from websites and one-third claim to use online consultation.[9] In Germany, approximately seven million people buy from mail-order pharmacies, and mail-order sales account for approximately 8–10% of total pharmaceutical sales.[10] In 2008, the Royal Pharmaceutical Society of Great Britain reported that approximately two million people in Great Britain were regularly purchasing pharmaceuticals online (both with a prescription from registered online UK doctors and without prescriptions from other websites).[11] A recent survey commissioned by Pfizer, the Medicines and Healthcare products Regulatory Agency, RPSGB, the Patients Association and HEART UK found that 15% of the British adults asked had bought a prescription-only medicine online.[12]

In developed countries, many online doctors prescribe so-called ‘lifestyle drugs’,[13] such as for weight loss, hair loss or erectile dysfunction. The RPSGB has identified the most popular products prescribed online as Prozac (an antidepressant), Viagra (for erectile dysfunction), Valium (a tranquiliser), Ritalin (a psychostimulant), Serostim (a synthetic growth hormone) and Provigil (a psychostimulant).[14] A study in the USA has also shown that antibiotics are commonly available online without prescription.[15]

Online healthcare system is being more popular in Bangladesh. Digital health care service and drugs information is now the most fashionable theme that people search on the internet. Nowadays a growing number of specialist metropolitan doctors in Bangladesh are using internet to give immediate online health tips and advice in rural areas through the internet broadband and videoconferencing system, and alternatively many doctors to give satisfactory online prescription their patient by using email and online chat through health and medical website, portal, blog and forum. As a result, a physician can play a vital role in contribution medical health care system by using online digital technology.

Potential harm[edit]

Traditionalist critics of online doctors argue that an online doctor cannot provide proper examinations or diagnosis either by email or video call.[16] Such consultations, they argue, will always be dangerous, with the potential for serious disease to be missed.[17] There are also concerns that the absence of proximity leads to treatment by unqualified doctors [18] or patients using false information to secure dangerous drugs.[19]

Proponents argue there is little difference between an e-mail consultation and the sort of telephone assessment and advice that doctors regularly make out of hours or in circumstances where doctors cannot physically examine a patient (e.g., jungle medicine).[20]

Laurence Buckman, chairman of the British Medical Association’s GPs’ committee, says that online consultations make life easier for doctors and patients when used properly. "Many GPs will be very happy with it and it could be useful. When it’s a regular patient you know well, it follows on from telephone consulting. Voice is essential, vision is desirable. The problem comes when I don’t know the patient".[21] Niall Dickson, chief executive of the General Medical Council, says: "We trust doctors to use their judgement to decide whether they should see a patient in person. Online consultations will be appropriate for some patients, whereas other patients will need a physical examination or may benefit from seeing their doctor in person".[21]

Past and future developments[edit]

The first medical consulting website in the US was WebMD,[22] founded in 1996 by Jim Clark (one of the founders of Netscape) and Pavan Nigam as Healthscape. Currently, its website carries information regarding health and health care, including a symptom checklist, pharmacy information, drug information, blogs of physicians with specific topics, and a place to store personal medical information. As of February 2011, WebMD’s network of sites reaches an average of 86.4 million visitors per month[23] and is the leading health portal in the United States.[24]

Other popular US healthcare and medical consulting sites include NIH.gov, MSN Health, Yahoo! Health, EverydayHealth, WomensHealth.gov, MayoClinic, and Doctor Vista, and many have experienced dramatic growth. (Healthline, launched in 2005, grew by 269% to 2.7 million average monthly unique visitors in Q1 2007 from 0.8 million average monthly unique visitors in Q1 2006).[25] Niche consulting sites are also popular including SeniorNet, which deals with age-related syndromes and 4collegewomen.org and GirlsHealth.gov, which target young women. Several American online doctor companies, including Teladoc, First Stop Health, American Well, WebDoc247, MeMD, and Ringadoc, provide consultations with doctors over the phone or the Internet. Prominent San Francisco-based venture capital firm Founders Fund called such services "extraordinarily fast" and predicted that they will "bring relief to thousands of people with immediate medical needs".[26]

In the UK, e-med was the first online health site to offer both a diagnosis and prescriptions to patients over the Internet. It was established in March 2000 by Dr. Julian Eden,[5][27] drawing on his experience as a doctor serving the world SCUBA and dive population. In 2011, e-med served 100,000 online patients.[28] NHS Direct is the free health advice and information service provided by the National Health Service (NHS) for residents and visitors in the UK, with advice offered 24 hours a day via telephone and web contact. Over 1.5 million patients visit the website every month.[29] More recently, a number of online doctors have emerged in the country, firms such as Dr Fox Pharmacy, DrThom, DoctorSpring and Lloyds Pharmacy offer consultation and prescriptions regularly via the Internet.

In Australia HealthDirect is the free health advice and information service provided by the government with advice offered 24 hours a day via telephone. Medicare began funding online consultations for specialists on 1 July 2011 which has seen a slow but steady increase in volumes. Companies like GP2U Telehealth have forged alliances with pharmacy chains like Terry White Chemists and Priceline Pharmacies to facilitate online consultations and real time medication delivery.

New advances in digital information technology mean that in future online doctors and healthcare websites may offer advanced scanning and diagnostic services over the internet. The Nuffield Council on Bioethics identifies such services as direct-to-consumer body imaging (such as CT and MRI scans) and personal genetic profiling for individual susceptibility to disease.[30] Professor Sir Bruce Keogh, the medical director of the UK NHS, is drawing up plans to introduce online consultations via Skype and has said IT will "completely change the way [doctors] deliver medicine".[21]

See also[edit]

References[edit]

  1. ^ Are online doctors the best medicine?, USA Today, 20 November 2010
  2. ^ Medical profiling and online medicine: the ethics of ‘personalisedhealthcare’ in a consumer age Report, Nuffield Council on Bioethics, October 2010
  3. ^ The Internet Doctor- the future of health care, Doctor Vista, 16 September 2011
  4. ^ Nuffield p.VIII
  5. ^ a b House call - No appointments, no waiting, speedy diagnosis and prescription - online doctors are flourishing. But are they safe?, The Guardian, 4 June 2000
  6. ^ Buying Drugs Online: It’s Convenient and Private, But Beware of ‘Rogue Sites’Food and Drug Administration, U.S. Department of Agriculture, 2001
  7. ^ Online health search S. Fox, 2006. Prescription drugs online S. Fox, 2004
  8. ^ [1]
  9. ^ Online Patient Safety Climate Survey: Tool Development and Lessons Learned, Lynne M. Connelly and Judy L. Powers, U.S. National Library of Medicine National Institutes of Health
  10. ^ Mail-order trade in medicines in Europe: a guide for legislators to protect consumers, NJ Seeberg-Elverfeldt European Journal of Health Law 16: 351–66, 2009
  11. ^ Millions risk health buying drugs online Royal Pharmaceutical Society of Great Britain, 2008
  12. ^ Get Real, Get a Prescription’ campaign Royal Pharmaceutical Society of Great Britain, 2009
  13. ^ Medicalisation: The role of e-pharmacies in iatrogenic harm, N. Glover-Thomas and J. Fanning, Medical Law Review 18(1): 28–55, 2010
  14. ^ RPSGB p.12
  15. ^ Availability of antibiotics for purchase without a prescription on the internet, AG Mainous , CJ Everett , RE Post, VA Diaz and WJ Hueston, Annals of Family Medicine 7(5): 431–5, 2009
  16. ^ Consulting Online Financial Times, 1 September 2000
  17. ^ Are Online Doctors The Best Medicine?, USA Today quoting Roland Goertz of the American Academy of Family Physicians, 20 November 2010
  18. ^ USA Today
  19. ^ Online doctor put patients at risk, hearing told The Guardian, 3 February 2007
  20. ^ The doctor will see you now . . . over the internetThe Times quoting Professor Sir Bruce Keogh, NHS Medical Director, 29 August 2011
  21. ^ a b c The Times
  22. ^ Corporate History History of WebMD
  23. ^ History of WebMD
  24. ^ comScore Media Metrix rating Web 3.0 & Online Health, comScore Media Metrix rating 2011
  25. ^ comScore Media Metrix
  26. ^ [2] TechCrunch, retrieved 22 June 2012
  27. ^ GP treats patients 'over the internet' BBC,23 July 2000
  28. ^ British websites are pushing boundaries of online medicine 'USA Today', 8 July 2011
  29. ^ History of NHS Direct NHS Direct, retrieved 14 January 2009
  30. ^ Nuffield p.22

External links[edit]

  • NHS Direct The UK government's medical advice and treatment portal
  • FDA Federal Drug Administration's guidelines to consumers dealing with online

24/7 Online Doctor

doctors and pharmacists

  • FSMB Federation of State Medical Boards, body of the state medical boards that regulate online doctors in the US
  • CQC Quality Care Commission Board, body that regulates online doctors in the UK
  • SMIDR Find Indian Doctors Information Online
  • iCliniq Medical advice and treatment portal
  • Doctor Vista Doctor's second opinion