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Tuesday, 7 December, 1999, 15:38 GMT
The future of 'e-medicine'
Computer consultations may not be private


Patients may soon be having email or video consultations with UK doctors - but what are the practical problems linked to this technology?

The arrival of "e-medicine" as an alternative to face-to-face, or even simple telephone consultations holds out potential solutions to many of the limitations of conventional medicine.

For example, if you live in a remote area, how do you avoid a lengthy journey to see a doctor for a relatively minor problem?

Medical websites offer information and advice
And how do you get medical advice on simple problems at odd hours without having to either queue all night at a casualty department, or call out a deputising doctor?

The idea of using video-links to bring doctors and their patients together is nothing new.

Some hospitals and clinics have been experimenting with "telemedicine" in which visual illnesses, such as rashes, can be beamed to a consultant in a different hospital.

But, at the moment, some argue that traditional telephone technology is more likely to result in an accurate diagnosis than an internet video link or email exchange.

Dr Grant Kelly, a Sussex GP with an interest in computer technology, said there were a number of potential pitfalls which electronic consultations would have to overcome to succeed.

Security problems

He said: "The main problem is security - nobody should be taking part in e-consultations unless they are secure and encrypted.

"At the moment, it's like standing there with a loudhailer and shouting over the rooftops."

He says that the vital "cross-questioning" of patients by doctors - which can lead to more accurate diagnoses, would be impossibly stilted by e-mail.

Most conditions can only be diagnosed face to face
And he argues that there are only a small number of conditions which are suited to video-links - some dermatological conditions, facial tics or unusual gaits - but many more which are completely unsuited.

"There is no substitute for taking a pulse, or just putting your hand on someone's chest to feel their heartbeat," says Dr Kelly.

The distance between patient and doctor is likely to lead to "over-diagnosis", in which the advisor is more likely to send a patient on to their GP or casualty department "just to be on the safe side".

It is possible to take other measurements and pass them down an internet link, but the cost of keeping trained doctors on call 24 hours a day to interpret them is currently prohibitive for the NHS.

A heart monitor, currently being marketed privately, which can send an electrocardiogram reading to an on call specialist, costs each patient 400 to buy, and 50 a month to keep the service running.

So, until the arrival of "Star Trek"- style technology, the traditional terrestial consultation is unlikely to be replaced
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See also:
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