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Guidelines may be needed regarding online physician-patient interactions
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 Richard L. Lindstrom |
The impact of the Internet on our daily lives and the practice of medicine in the past decade is nothing short of amazing. As a 63-year-old ophthalmologist, adaptation to the impact of this truly disruptive technology on my daily life, including my practice of medicine, has been enormous.
I sit writing this commentary in a private home on the slopes of Snowmass, Aspen, Colo., attending a Minnesota Medical Foundation board meeting. I will be able to complete my commentary and meet my deadline from this isolated location with ease. While here, I have communicated with my administrative assistant repeatedly, remained connected with colleagues throughout the world, gained and offered insight on difficult patient management issues with ophthalmologists globally, interacted confidentially with my partners and fellow on some difficult patient management issues at Minnesota Eye Consultants, been attacked by groups that condemn and oppose the very procedures that I advocate and perform for my patients, and been contacted by patients I have never met asking for medical advice. Truly an amazing experience, all in a 2-hour session in the morning while gazing out at the snowcapped mountains and sitting comfortably in front of a fire.
One troubling aspect of this morning’s Internet session is the attacks on my person and the procedures, such as LASIK, I have come to appreciate as offering great advantage to my patients. We have all learned that even entire countries can be damaged by concerted Internet attacks, and we ophthalmologists are certainly vulnerable here as well. I have learned that there are professionals who can be helpful to any victim of such attacks and encourage anyone who experiences this, in my opinion, inappropriate tactic to contact his or her professional societies for help and advice.
The second troubling aspect is the increasing number of patients who are searching the Internet and contacting me directly after finding my name in assorted publications, writing about issues that affect their or their loved ones’ health. I am comfortable communicating on the Internet privately one on one with my current patients or with colleagues about anonymous cases in which help is needed, as we do on various blogs. Direct, pointed requests for medical advice from patients I have never seen, such as which IOL shall I have implanted in my or my mother’s eye, are another matter. The physician-patient relationship/contract/covenant is classically created by a patient who requests a physician’s care, a face-to-face interaction in which a history is taken, an examination is completed including direct “laying on of hands” followed by a discussion of therapeutic options, risks and benefits. A treatment plan is then formulated, and follow-up care is arranged.
This physician-patient relationship just cannot be consummated over the Internet. Unfortunately, many patients do not understand this fact and are upset and put off when they cannot receive immediate feedback as they are accustomed to when surfing the Internet regarding other issues, such as which hairspray holds well in the wind. I find myself simply giving a general answer, such as there are many different IOLs that can be implanted after cataract removal, and recommending they see their local eye doctor or seek reliable information sources, such as the American Society of Cataract and Refractive Surgery and American Academy of Ophthalmology websites, for guidance.
However, it is clear that this response does not satisfy most, with many feeling I am just trying to generate fees for myself or my colleagues by not answering their questions as they wish them answered, and I am concerned my general response often directs them to information sources that are much less reliable. Still, I find it impossible to practice medicine over the Internet.
This is an area that needs careful evaluation and discourse by all affected stakeholders, including physicians, ethicists and representatives of the lay public. In the interim, before a clear consensus is established and guidelines are available, physicians must establish their own approach and follow their conscience. For me, recommending a specific course of treatment is just not possible without a face-to-face interaction and examination of the patient.