On the Net, Be Wary Of What  Dr. Orders

By Jamie Talan. STAFF WRITER


    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 advice to accept the counsel of strangers in cyberspace, health
professionals or not.
    Gunther Eysenbach and Tomas Diepgen, epidemiologists at the
University Hospital in Erlangen, Germany, sent a medical query to 58
physicians or Web masters who were identified with medical sites.
    Half of those queried responded, the researchers said. Of those, 59
percent gave the correct diagnosis, opening the question of whether they
were practicing medicine across state lines, which is illegal in the
United States. Others who responded either supplied general information
or suggested that the respondent see a doctor in person.
    There are no standards for physician responses to unsolicited mail
on the Internet, the authors reported in today's special issue of the
Journal of the American Medical Association, devoted to the study of
cybermedicine. The issue addressed two  categories: the use of
computerized systems in clinical care, and legal and ethical issues
concerned with doctoring online.
     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 Web site gets
about 130,000 hits a week. Additionally, many doctors within the AMA
have been exploring the technology as a way to educate consumers and
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 of providing e-mail consultations to patients and
others interested in pediatric issues.
    Borowitz said the overall response from about 1,300 e-mails received
through his site suggested the people contacting him 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.
    Borowitz says that since he began answering questions on the Web
almost four years ago, he averages two or three consultations a day. He
says he has received queries from 39 states and 38 countries.
    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."
    Dr. Tom Ferguson, an expert on Internet health and medicine, said
the issues surrounding online care are important for the future. "Just
as the most caring, competent and sensitive physician of today would be
hard-pressed to build a successful practice without a telephone," he
said, "those who choose not to communicate electronically with patients
may soon find themselves at a similar disadvantage."
    But Alissa Spielberg, a lawyer at Harvard Medical School in Boston,
says  doctors should move carefully.  In the AMA journal, Spielberg
explores the ethical and legal dimensions of e-mail use in cyberspace.
    "E-mail in the medical context not only generates liability concerns
but also raises serious questions about privacy, confidentiality,
authenticity of authorship, and patient consent," she wrote.


Copyright 1998, Newsday Inc. 

On the Net, Be Wary Of What Dr. Orders., 10-21-1998, pp A19.