Correspondence

Cybermedicine

N Engl J Med 1998; 339:638-639August 27, 1998

Article

To the Editor:

Readers of the Journal should be aware that, in Massachusetts and perhaps other states, some physicians are providing diagnostic and treatment services over the Internet, without having seen or examined patients. This practice involves providing patients with prescribed medication after the patient completes a questionnaire and an on-line, physician-generated “conference” regarding symptoms and medical history. Ostensibly, the provision of this service is rationalized as a way of improving access to medical care and counteracting the lack of physicians in underserved areas, and as a simple convenience to patients. Curiously, one on-line service claims to provide “real time, online, confidential emergency medical care and advice,” but it is implied that the service would be most helpful to those “experiencing symptoms of an apparently minor medical illness for which you would like some medical advice and/or initial treatment.”1 The same service recommends that its users “obtain timely medical follow up with a physician, in person,” and affirms that “we are not a substitute in any way for conventional medical care.” It does not appear to require follow-up by the doctors providing the on-line service itself.

Although I do not wish to impugn the motives of the physicians who are involved in such “cybermedicine,” I do want to express my deep concern about both the medicolegal implications and the clinical wisdom of this service. Although a detailed questionnaire may suffice in straightforward cases of, say, ear infections, such tools are no substitute for a physical examination, face-to-face with a patient.2 In my own field of psychiatry, it is not uncommon for someone to sound quite reasonable on the phone as he or she requests an “urgent” prescription for benzodiazepine. When the person is actually seen and examined, however, the clinician may observe needle tracks, signs of self-injurious behavior, or other signs that the person is a poor candidate for such drugs. Or consider the person reporting insomnia and requesting a “simple prescription” for a hypnotic drug. An Internet conference cannot rule out the possibility of a primary sleep disorder, such as obstructive sleep apnea, which would be worsened by conventional hypnotic drugs.

In medically underserved areas, telemedicine — in which the physician can at least see the patient electronically — shows promise, though many questions regarding the quality of care with telemedicine have been raised.3 But cybermedicine over the Internet is another matter, and it represents a trend all physicians should view with concern.

Ronald Pies, M.D.
297 Bedford St., Lexington, MA 02420

3 References

1. 1

   Virtual housecall overview: CyberDocs. (https://www.cyberdocs.com/housecall.htm).
   

2. 2

   Simon RI. Concise guide to clinical psychiatry and the law. Washington, D.C.: American Psychiatric Press, 1988:51.
   

3. 3

   Del Junco R, Cordray J. Telemedicine prospects and perils: weighing the potentials. Fed Bull J Medical Licensure Discipline 1996;83:18-22
   

Citing Articles (4)

Citing Articles

1. 1

   H.A.P. Archbold, A.R. Guha, S. Shyamsundar, S.J. McBride, P. Charlwood, R. Wray. (2005) The use of multi-media messaging in the referral of musculoskeletal limb injuries to a tertiary trauma unit using: a 1-month evaluation. Injury 36:4, 560-566
   CrossRef

2. 2

   Kirsti A. Dyer, Cole D. Thompson. (2000) Internet Use for Web-Education on the Overlooked Areas of Grief and Loss. CyberPsychology & Behavior 3:2, 255-270
   CrossRef

3. 3

   J VARON, P MARIK. (1999) CRITICAL CARE AND THE WORLD WIDE WEB. Critical Care Clinics 15:3, 593-604
   CrossRef

4. 4

   Gunther Eysenbach, Thomas L Diepgen. (1998) Evaluation of cyberdocs. The Lancet 352:9139, 1526
   CrossRef