It is a sunny day and I am feeling fine, yet the doctor has just told me I
have flu. This is worrying. It is particularly worrying in the light of the
fact that I have just informed the doctor that I have no symptoms at all.
Yes, the GP I consulted at onlineclinic.co.uk did not have a great deal of
information with which to work. The only question I was asked about my
symptoms was: “Do you feel as though you may have symptoms of influenza?” To
which I responded: “No.”
After answering a series of unrelated background questions – did I have
asthma; was I pregnant? – I was asked whether there was anything he should
know about my condition. No, I said, there was not. An hour later, I had my
diagnosis. “Taking into account the information you have provided, I can
diagnose that you are suffering from the symptoms of influenza.”
Shortly afterwards I was offered the opportunity to buy Tamiflu, the antiflu
drug, at £111 for one week’s supply, or £299 for three. This is way above
the cost price of the drug. If I were prescribed it by my doctor, it would
cost £16.36 for five days’ treatment and the guidelines under which he must
work would allow him to give it to me only during an epidemic in which I’d
been in contact with an infected person.
When asked to comment, onlineclinic.co.uk didn’t seem to think their doctor
had made a misdiagnosis. Although they didn’t comment on my lack symptoms,
they did say that having Tamiflu was a sensible precaution against flu, and
did not constitute prescribing the drug without a good reason.
However, both the British Medical Association (BMA), which represents doctors,
and the Government’s Medicines and Healthcare products Regulatory Agency
(MHRA) have expressed concern about internet medical services, revolving
around doctors who provide advice, diagnosis and prescription online.
Online doctors, like all doctors, are regulated by the General Medical Council
(GMC), which discourages online consultations. The GMC says in its
guidelines that online diagnosis may seriously compromise the standard of
care received by the patient if he or she is not known to the doctor, if no
examination can be carried out and if there is little or no provision for
follow-up and monitoring.
And the real problems come when doctors start prescribing as a result of an
online or phone diagnosis. Online medical services that also offer
prescribing and pharmacy services are regulated by the MHRA, which says that
it is at present investigating no fewer than 76 online companies for
prescribing drugs without there first being a proper consultation with a
doctor – either online or in person. It has successfully prosecuted four in
the past 12 months.
My own attempts to obtain medical advice on the internet brought a mixed
response. On several sites, I simply failed to get a reply. As I had not
paid upfront, I had lost nothing. But with one online service,
talktoadoctor.co.uk, I found myself discussing my “symptoms” via e-mail with
a real doctor, Michael Cohen, after paying £19.95 for answers to three
questions on a single subject.
I told him I was worried because I had tingling in my fingers – a problem that
might have been indicative of multiple sclerosis. Dr Cohen asked me for
further details – which fingers were tingling, and on which hand – and then
said that while he could not make a specific diagnosis, my problem sounded
as if it was down to poor posture or computer usage. I added that I was
suffering from occasional blurred vision, which also could be a sign of MS.
Dr Cohen suggested this could be connected with diabetes and said I should see
my doctor. “It all depends on how long the blurred vision lasts and it may
be worth you having a glucose level check,” he said.
The BMA’s spokesman on computing in general practice, Dr Paul Cundy, said he
believed that Dr Cohen had behaved properly and professionally. But he
expressed reservations about the existence of such online medical services,
and said he did not believe that such a short exchange could lead to a
diagnosis.
When I spoke to talktoadoctor.co.uk’s managing director, Dr Doniert
Macfarlane, he agreed with much of what Dr Cundy had said. He added that as
MS is such a serious illness, many doctors would avoid mentioning it until
it had been confirmed by tests. The website did not offer a diagnosis
service and many of these brief consultations ended with the suggestion that
the patient should see a doctor, he admitted. So why had I just spent £20?
“We are very much there as a support service,” he said. “Often people have
been given a diagnosis or sent for tests, and there hasn’t been enough time
within a conventional consultation to talk about the wider implications.”
Talktoadoctor.co.uk does not offer medical treatment. But some sites do. One
company, Surgery Express, said that it sent patients to India for
operations. So what checks would be made into my medical condition, I
wondered? I filled in an online form saying I was concerned about my weight
and would like to travel to India for a gastric banding operation that would
stop me from eating too much. I gave my correct, healthy, height and weight,
and immediately received a quotation for £5,280 for a six-day trip plus the
operation. The GMC told me it would regulate the doctors’ actions only if
they were actually working here. Dr Cundy told me that it would be dangerous
to perform this surgery on a healthy person, and that it should be carried
out only after other less dangerous treatments had failed. There should also
be a psychological assessment, he added.He said the BMA was opposed to these
online services in most cases. “The question I always ask is: ‘Why are
people doing this?’ The reason is this way they can deal with several
thousands of patients simultaneously – that is to say, there’s money
involved. We are very wary of this,” he said. His message, and that from the
Patients’ Association, is that we should all exercise caution before using
these online services. Katherine Murphy, director of communications for the
Patients’ Association, said it was all too easy to buy medicines or seek
diagnosis online, and too difficult at times to access GP services. “Our
advice would be to be very careful,” she said. “If you have something you’re
concerned about, it’s far better if you can speak to your doctor.”
Worth logging on to . . .
Dr Martyn Lobley and Body&Soul’s Medical Editor Simon Crompton
recommend the top five health websites:
PATIENT UK www.patient.co.uk
NHS DIRECT www.nhsdirect.nhs.uk
; www.nhs24.com for Scotland; www.nhsdirect.wales.nhs.uk
for Wales
NET DOCTOR www.netdoctor.co.uk
BBC www.bbc.co.uk/health/conditions
BEST TREATMENTS www.besttreatments.co.uk
(This site charges a subscription fee but gives a wealth of information.)
