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Thursday, September 24, 1998 Published at 13:42 GMT 14:42 UK


Cyber clinics 'could cut waiting lists'

Could the internet be used to cut waiting lists

A rheumatologist is claiming success for a programme that allows him to diagnose patients over the internet.

Dr Badal Pal told a British Society of Rheumatologists conference this week that a pilot study of his programme showed it could cut waiting lists.

Dr Pal, who works at Withington Hospital in Manchester, got two junior doctors to help 207 patients fill in a detailed questionnaire on the internet.

He then diagnosed their condition. He said the questionnaire, which would normally be filled out in the presence of the patient's GP, worked like an initial consultation.

Patients were also seen face-to-face. In around 86% of cases, the diagnosis was the same.

There has been some controversy in the USA about internet diagnosis, with private doctors offering advice over the internet.

There are fears that doctors may misdiagnose because they are not able to ask patients all the questions they need to make an accurate analysis of their condition.

However, Dr Pal says initial consultations have a similar failure rate to that found in his pilot study and often require further meetings and investigation.

He added that people for whom the internet diagnosis did not work could return to their GP and have a face-to-face consultation and further investigations.

Waiting lists

Dr Pal denied the programme could mean some patients would not get the treatment they needed.

"We would not do it if it were unsafe," he said.

"The diagnosis should be taken as initial or interim advice. Waiting lists in rheumatology can be over six months long.

If patients fill in the questionnaire, they can be receiving treatment while they are waiting," he said.

He added that many patients sought specialist attention when they needed more general advice.

He thinks the internet programme could cut out the need for face-to-face meetings with 50% of patients and leave him more time to see more urgent cases.

However, he added that the questionnaire might not be suitable for all conditions.

Patient history

With rheumatology, he said 75% of the information on which diagnosis was based referred to patient history.

[ image: GPs could fill in forms instead of referring patients to hospital]
GPs could fill in forms instead of referring patients to hospital
The 70-point questionnaire asked all the patient history questions that would be asked at a face-to-face consultation.

Dr Pal says the questionnaire takes around 12 minutes for GPs to fill in and a few minutes for him to analyse.

He was hoping to get funding for a peripatetic nurse to help GPs in the Manchester area fill in the questionnaires.

He is also looking at the possibility of patients filling in their own forms and thinks specialists could weed out any hypochondriacs who try to trick the system.


Dr Pal says he believes the service is "quite new" and is cheaper than telemedicine, the computer link-up system promoted in the government's new information technology strategy.

He added that telemedicine machines, which connect GP surgeries with hospital specialists, often suffered technical failures.

The internet programme also freed specialists up to make their diagnoses when they wanted as they were not tied to a link-up timetable.

Dr Pal's study has caused some interest among GPs and he is to give details of it to a meeting of the American College of Rheumatology later this year.

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