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Internet Medicine: Beyond Hype.

Like much else to do with technology, Internet medicine has been both hyped and feared. After answering dermatology questions daily for almost 2 years on an Internet site, I can present some tentative impressions about the role of this burgeoning medium.

On the hype side, the Internet is supposed to bring expert medical advice to patients who cannot get it either because their condition is rare and difficult or because they can't access or afford a doctor.

On the other side, fearmongers claim that the Web will scare uncritical folk with mounds of undigested information of doubtful relevance, which will encourage them to drive their personal doctors crazy.

My experience so far justifies neither the hype nor the fear. It suggests instead that Internet medicine will play a useful but modest supportive role to traditional methods of providing health care and information.

Those who hype Internet medicine proclaim there is new expertise for the inaccessible. Well, not really.

First of all, most of the questions patients that ask are not about exotica but the banalities of everyday clinical life: rashes, viruses, minor anatomical variations which cause anxiety, and so on. In short, online questions are very similar to the ones patients ask us in the office.

In fact, many times the Internet patient has already posited his question in the office. Examples: "My doctor gave me minocycline. Is that a good medicine?" or "I'm going to the doctor next week, but I'm worried and wonder what you think."

Why would people query an anonymous cyberdoc if they've seen or plan to see a live one? Although it is tempting to suspect the live doctors of having a rushed manner or poor communication skills, I think the truth is more complex.

In fact, most patients do not want to badger their personal physicians with questions. Rather than trouble the doctor with nagging concerns, many people find it less threatening to quiz someone they don't know.

This dynamic is even more relevant when the question itself is embarrassing. Patients are very reluctant to pull down their pants--literally or metaphorically--in front of the doctor. When they do so, most apologize as though the location of their ailment is somehow their fault.

For every patient who is brave enough to present their embarrassing ailment, there are an unknown number of others too shy or ashamed to bare their bums or their anxieties. For these individuals, the anonymous Internet is ideal.

Those who fear Internet medicine argue that it provides new fodder for the neurotic. This sentiment, too, is not quite accurate. Sure, one meets the folks convinced they have an STD who have searched every herpes site on the net. Yet even these will for the most part respond to sensible advice and reassurance, when relevant.

I do not have the impression that those who pose questions on medical Web sites are less sober and sensible than the average office patient. Once again, there are exceptions, but one finds them no less in the office than online.

Although my experience may not be typical, I would suggest that the typical Web inquirer is an ordinary patient with a common condition, who needs a little more hand-holding than fits comfortably into an office encounter.

Like much else that is technologic, the role of the Internet is thus useful, if not exactly life transforming.

In fanciful moments, I imagine treating people online with a good digital image and a text or voice file to provide history. There are certainly studies to suggest that we can do a decent job of diagnosing and treating acne, rashes, and fungal infections by such means. Issues of licensing, malpractice, and reimbursement, however, make our doing so unlikely, except perhaps in faraway places or for diseases with strange-sounding names.

DR. ALAN ROCKOFF practices dermatology in Brookline, Mass.
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Publication:Family Practice News
Geographic Code:1USA
Date:Sep 1, 2001
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