Originally created 10/25/98

Internet may keep doctor away, but use caution



Have you e-mailed your doctor today?

The Internet may change the doctor-patient relationship in the future, but researchers say their studies suggest it is still not sound medical practice to accept the advice of strangers in cyberspace, health professionals or not.

Drs. Gunther Eysenbach and Tomas Diepgen, epidemiologists at the University Hospital in Erlangen, Germany, sent a medical query to 58 physicians or webmasters who were identified with specific medical sites on the Internet.

Half of those queried responded with specific advice, the researchers said, opening the question of whether they were practicing medicine across state lines, which is illegal in the United States. Only 59 percent gave the correct diagnosis.

There are no standards for physician responses to unsolicited mail on the Internet, the authors reported in Wednesday's special issue of the Journal of the American Medical Association, devoted to the study of cybermedicine. The issue was broken into three categories: computerized systems in clinical care; legal and ethical issues concerned with doctoring online; and using computerized resources in clinical practice.

The AMA is particularly interested in the subject because the organization oversees one of the most active medical sites on the Internet, with 1.5 million hits a week, while its journal's Web site gets about 130,000 hits a week. Additionally, many doctors within the AMA have been exploring the growing technology as a way to educate consumers, including their own patients.

In another study in the journal, Dr. Stephen Borowitz of the University of Virginia Health Science Center in Charlottesville analyzed his first three years providing e-mail consultations to his patients and others interested in pediatric issues.

Borowitz suggested the response from about 1,300 e-mails received through his site indicated that the people contacting him in cyberspace are not looking to him to act as a doctor, but rather as an educator.

Because of either time issues or simple embarrassment, he said, many of the people using his Web site are seeking more complete explanations of their problem than those afforded by their personal physicians. And most, he said, do not seek a specific diagnosis.

"It is an incomplete communication," Borowitz said. "There is no face-to-face contact and a lot of information is not given during the interaction."

Borowitz says that since he began answering questions on the Web almost four years ago, he averages about 2 or 3 consults a day. He has received queries from 39 states and 38 countries, he said.

In his analysis, he said he found that two of the most common questions concerned constipation and bed-wetting, noting, "Parents seemed happy to receive a response that was helpful. I never tell parents what to do, and most parents seem to recognize the limitations of this service."