Most patients still prefer 'aah' to click

By MARTIN JOHNSTON Health reporter

You can buy anything from artichokes to airline tickets with the click of a computer mouse these days. But when it comes to internet medicine, most patients still prefer to visit the local doctor.

The internet was meant to change the face of healthcare, with consultations through a computer keyboard and mailorder drugs bought from online chemists.

The revolution may still be around the corner, but the hype has yet to convince most patients that sending electronic messages to an internet-based clinic is better than saying "aah" to a GP.

New Plymouth-based Doctor Global, launched in April 1999, claims it was the world's first website to offer online medical consultations.

Since then its doctors - it has 32 on offer, based in Australia and New Zealand - have given only 1200 consultations through the website. Nearly a third of its registered patients are in the United States.

It is still the only New Zealand-based site offering online consultations, although an Auckland-based doctor sold prescription drugs, including anti-impotence pill Viagra, on the internet before closing the site and being investigated by the Ministry of Health.

Up to 40 pharmacies are online in New Zealand, but only one has achieved accreditation from the Pharmaceutical Society.

An Auckland pharmacist has been charged with professional misconduct over internet sales of prescription drugs overseas without prescriptions.

Doctor Global's practitioners set their own patient charges, which are up to $50. Having your personal health records stored online, a new service, costs $50 a year.

Prospective patients choose a a doctor and a clinic, such as general, heart or sexual health, then answer online questions about their general health and specific problem.

The doctor sends the "likely diagnosis" or advice to the patient's personalised section of the website and an e-mail is sent to tell the patient it is available.

Doctor Global's medical director, Dr John Gillies, a paediatrician and Wellington Medical School lecturer, said the site had not flourished, "for the simple reason we haven't marketed it.

"Nobody knows it's there. When we do ... it will take off."

The site had not been widely promoted because health records, a major new section, had been under development, he said.

There are plans to supplement it with a service in which any doctors can conduct online consultations with their own patients through the Doctor Global site.

But the site has scaled back its claims. At first, it trumpeted that internet medicine could "replace and assist current medical consultations." Now it says Doctor Global "does not replace the traditional role of the health professional."

The Medical Council, concerned about the "inherent risks" of patients receiving medical advice without a physical examination, last year issued guidelines to control internet medicine.

They said doctors should prescribe drugs only for patients who had personally visited them or another doctor who could verify the patient's identity. Prescribing solely by email was not permitted.

Dr Gillies said Doctor Global patients rarely received a diagnosis. "We give second opinions most often."

And no more than a likely diagnosis was offered since, Dr Gillies said:

"We can't be absolute, because we haven't done a physical examination on the person and if you came to me with a sore throat there's probably 60 or 80 possible causes. The easiest way to find out which one it could be would be to have a look."

But he maintains that by carefully taking a patient's history, a diagnosis can be made in up to 85 per cent of cases without a physical examination.

"A physical exam will be probably be used if you have them face-to-face to confirm what you already know."

The College of General Practitioners criticised Doctor Global when it was set up and strongly supports the Medical Council's guidelines.

College chairman Dr Ralph Wiles said that because of the need for physical examinations, the college could see only a limited role for internet consultations.

Pharmaceutical Society chief executive Jim Thomson said accreditation meant greater safety to consumers, but it was difficult for internet pharmacies to ensure their service remained ethical.

Their biggest problem was to be satisfied that information given by internet customers about themselves, such as their age, was accurate.