Medicine and the Internet Era: The Landscape and the Challenges

by Yathu Maheswaran | Features Editor

In most areas of our lives the internet is a welcome presence, and life without it – unimaginable!

The realms of business, science and medicine have each enjoyed a revolution of greater information accessibility and new platforms for interaction and education, all owing thanks to the internet. But the expansion in knowledge and capabilities has far outstripped the ability to regulate the role it plays in each of these fields. Existing guidelines and ethics are rendered obsolete by the rate at which internet-based technologies are advancing (1). In many fields this is an issue, but none more so than medicine and healthcare. This new internet driven arena, has us debating the ethics of virtual consultations, the role of Facebook and Google+ in the doctor-patient relationship or the legalities of online pharmacies (2). Thus, while the role of the internet in modern medical practice continues to grow, it is important that we consider the challenges it raises for future clinicians.

 

With great power comes great responsibility

From the latest news, to data about health products, sharing information has never been easier. This is a double-edged sword. For with the great power of informing, comes the greater risk of misinforming.

The rapid spread of misinformation is a genuine concern, affecting many professions. It seems that sensationalism and reporting stone cold facts do not always align. As far as health journalism is concerned, this can be very dangerous. For example, articles about the miraculous curative powers of specific supplements over existing well evidenced treatments appear almost cyclically, and they have the power to promote health ideas that could be harmful to patients in the long run (2,3).

In January 2017, The Independent reported on its investigation into problems in health reporting. The newspaper in 2016 found that of the 20 most shared news articles on Facebook with the word “cancer” in the headline, more than half of them reported claims that had been discredited by health authorities (3). Admittedly, Facebook is not a news service, but it is a convenient means by which people can share and discuss news items from other sources (2,4). The idea that people can be widely sharing and discussing information that is wrong/potentially harmful is terrifying. The article went on to say that across many social media platforms, misinformation can be shared more widely than evidence-based reports from reputable news organisations (3).  The challenge for those working in healthcare comes when ideas about health are influenced by such articles, and when these ideas come to the fore during medical consultations. Misinformation becomes a barrier to the clinician’s goal of promoting good health through presenting the facts.

Figure 1: The internet has revolutionised the sharing of information and ideas in numerous fields - none more so than in Medicine

Image 1: The internet has revolutionised the sharing of information and ideas in numerous fields – none more so than in Medicine.

The war between sensationalism, misinformation and accuracy rages in print media as well, but the internet is a significant contributor. It has also provided platforms for people to set up their own websites to sell various health products and to make health claims that are not rooted in evidence (5). Many of these health products which fall under the umbrella term of “alternative medicine” are researched online by patients who self-manage their chronic conditions. Alarmingly, patients do not necessarily disclose their research to their healthcare team – and if they did, how could this be recorded (4)? The result is patients and healthcare workers having discussions seemingly based on two different sets of facts – a recipe for disaster. Much like patients who are misinformed by certain health articles in the news, they can also be at risk from poorly evidenced alternative therapy information, and unknowingly take risks with their health. When health products are promoted on company websites, it is hard to differentiate promotional information and content about health problems themselves. This is not intended to berate alternative medicine, but merely the dubious ways it can be presented online, and the potential harm incurred.

Medical professionals have always been the gatekeepers of good health, readily rebuking myths in the face of well evidenced facts. The ease with which we can now access information online is unprecedented and the war between facts and fake news is set to be the defining one of our time. It has never been more important for online content to be reviewed by experts so that the public know what sources they can trust. Public health practitioners should continue to have a greater role in the design, distribution and evaluation of web-based health information. Additionally, health professionals have a duty to highlight online content which is harmful or misleading.  Some patients already show an awareness of the credibility of sources, but the battle is not over yet (6,7).

 

Online Drug Stores

Online pharmacies have emerged, which have allowed patients to purchase prescription medications after completing a brief questionnaire, which are reviewed by doctors. This is different to reputable pharmacies providing online services (5,8).

The main concerns here are that these websites have very little verification of patient identities and medical histories, and no assurance of their clinician’s qualifications (5). How can one prescribe medications to someone without an accurate medical history, or without knowing who the patient is? Alarmingly, some websites reviewed patient’s questionnaires within seconds, whilst others have a laissez-faire approach to opioid painkiller sales(5). The appeal of these sites is as undeniable as the risks. Poorly documented drug interactions, inadequate advice and no guarantee of receiving the actual medication are all concerns for medical practitioners.

Many patients are now turning to the internet to buy prescription medications online. This can be risky as these medications should only be taken under supervision of a health professional

Image 2: Many patients are now turning to the internet to buy prescription medications online. This can be risky as these medications should only be taken under supervision of a health professional

Patients’ willingness to be involved actively in their healthcare is commendable, but it is possible that they are being put at risk by retailers avoiding pharmaceutical safeguards. The MHRA has issued badges of approval for some sites, but is this enough(5)? Knowledge of these sites as an alternative source of medications is important for healthcare providers and is another example of how the health landscape is changing.

 

Social Medicine

It comes as no surprise that social media usage by doctors, nurses and medical students has risen dramatically. A growing number of patients are now seeking out social media platforms for health information, to network with people with similar conditions and to play a more active role in healthcare decisions (2).  The potential for social media to patients and clinicians is enormous: promoting public health; improve communication with patients; driving awareness with culturally relevant health messages and support networks. But there has been considerable discussion about the perils of social media in medicine too (9).

Past headlines have been quick to admonish medical students or nurses for the opinions or incriminating photos that have been posted on social media (2).  Healthcare workers have a growing need to be aware of the content associated with their online profiles, and with that, awareness of ever changing privacy settings. Medical associations have published information on the ethical use of social media and the need to maintain confidentiality. This is a big leap forward, but it is very telling of the scale of the problem (10)– one that reaches into all walks of professional life.

The landscape is changing. Social Media platforms allow us to select who can view posts online, and to group contacts together – imagine doctors and nurses being able to post health advice aimed at a certain part of their patient demographic, grouped together on Facebook or Twitter (2). In some rural communities, some social media adopters have found it to be an effective tool in practice. Public platforms such as Twitter that allow unreciprocated posts to be made to large numbers of people, have allowed important public health notices to be distributed (11). Nevertheless, many would agree that it is still too high risk an environment for more personal consultations between physicians and patients online, with much potential for the blurring of professional and private boundaries and reputational damage (2,10). Furthermore, the very nature of social media is that people can see what others are doing – a concept that is a stark contrast to confidentiality and preserving patient dignity.

If we are to realise the full potential of social media in medicine, we will need to be better versed in the ethics and redefine our guidelines to ensure that practice is safe.

 

Consulting. Virtually. Anywhere.

Online consultations by video are no longer a fantasy. It has been argued that traditional outpatient consultations are not enough to meet the demands of increasing chronic illness, ageing populations and growing confidence in self-management (12).

There is a growing evidence base favouring the use of programs such as Skype in consultations, with patients, at times, preferring this to face-to-face consultations (12,13).  Patients have reported feeling more comfortable speaking to the camera than speaking to their GP (12)

How close are we to common place video consultations?

Image 3: How close are we to common place video consultations?

Whilst video consultation can help issues such as accessing health services from remote locations and lowering clinic running costs, technical details such as the quality of the video and audio visual synchronicity are barriers to progress (12). But is skype is sufficient to assess a patient and is this safe? If video consultations are to become more frequent in the future, our consultation skills and vocabulary will change to accommodate this. There is more to the doctor-patient relationship than simply a conversation. Privacy, the clinic environment and facilities at hand are all factors to consider.

Video consultations will also create disparities in access – favouring younger, computer literate people rather than those who are older with chronic illnesses. For clinicians to practice safely using new technologies, a greater level of computer literacy will be demanded of them – but which service will be responsible for ensuring this?  It will be the challenge of future medics to decide how best to use video-consultation, if at all and to manage the technical, safety and communication challenges that accompany it.

As the countless benefits of the internet and web-based technologies come to fruition, we find ourselves thrust into a new arena with fresh challenges and a rapidly changing health landscape – be it managing the fluctuant boundaries between professional and private life or battling misinformation. The rise of lightly regulate online pharmacies, or news and research biases to which multiple books and articles have been dedicated, have emerged. These challenges exist now and it is important to recognise how the internet will shape medical practice, how the responsibilities of medical professionals are changing to reflect this and how we can ensure that we can continue to serve our patients, safely and thoroughly.

 

 

Bibliography:

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