Telephone and Internet Medical Advice

I posted a blog on this subject before, but it is time to re-visit this controversial and touchy subject. Before I begin, I want you to guess what color shirt I am wearing right now (not the same one in the picture)? Did you guess? Trying to guess what color shirt I am wearing is about the same as someone posting and asking me to determine the nature of their rash.

Suppose you saw a medical provider today because of a mysterious rash. He has never met you before and does not know your history. Before examining you, he places a big paper sack on his head, or puts on a blindfold. He will need to place his hands behind his back (so he could not touch that rash) and just listen to your story; no matter how brief or medically incomplete. He is prohibited from carrying on a live, one-on-one, real-time conversation. He cannot hear your voice for subtle clues of anxiety, fear, or other emotions. He cannot see you raise an eyebrow, look puzzled, or angry. Yes, he can ask you a few questions, but he will not get the answer for a day or so. This, folks, is the Internet when it comes to diagnosing. We have no ability to use all of the five senses bestowed to us by God.

I had a posting earlier in the week from Anonymous (probably not his/her real name) that was frustrated because I do not diagnose and treat people on the ENT board. In this person's opinion, if I can't do that, then what good are the boards? What purpose do the boards serve?

Long before the advent of the Internet, we had the telephone. People would call their medical providers at all times, including the middle of the night, asking questions that we cannot answer. Fortunately, medical providers were able to carry on a dialogue - a two-way conversation with a patient that they actually knew. We knew their medical history, but we still could not Reach Out and Touch Someone. For a medical provider, the key, essential component of a medical encounter is that face-to-face interaction and the ability to touch...to examine. Even when telephones progress to interactive, live video, we still will not have that tactile, unique, hands-on opportunity.

Medical providers are taught to examine patients, and this requires touching, feeling, and poking around in places that may be painful, or even embarrassing. If you see your medical provider for a painful wrist, you can be certain that he or she is going to have it touched...or squeezed...or moved around, even if it hurts. Why? No, not sadism! This is how complex information is obtained in order to formulate a working diagnosis. It would be nice if fingers had x-ray capabilities, but they do not. If it is determined, based on the examination, that an x-ray is needed, then your medical provider orders it so we can add to the information pool. Even with an x-ray or diagnostic laboratory tests, a diagnosis may remain elusive, so your medical provider refers you to a specialist, and the dance begins again - more touching, more probing, more medical history. At some point (hopefully), a diagnosis is determined and appropriate treatment can be initiated. Sometimes, even with all of those tests, touching, probing, disrobing, consultations, and talking, a diagnosis is never found. It happens all of the time. This is the world of medicine.

I have always felt that it is better to educate than medicate. Education lasts much longer and has fewer side-effects. The main function of the message boards is to provide an educational forum for an open discussion. Basically, readers of the board are privileged to snooping in on a medical encounter. You are able to read what others post and see how I respond. In essence, you are sitting in a virtual examination room. Of course, no true examinations take place in this room. And, unlike the rules of medical confidentiality, you get to read what is happening. As a matter of fact, you get to participate. This is not unlike having an intimate medical encounter in the waiting room, where other patients can throw in their two cents.

Another of our functions as a WebMD Health Expert is to maintain order. If someone on an open board posts a dangerous suggestion, I certainly need to intervene. If someone is posting symptoms that could indicate a serious, or even life-threatening medical event, I have to say something. There is nothing more anxiety-provoking for a medical provider than to read a story about someone's severe headache, sudden loss of vision/hearing, who has one--sided numbness, and to discover that this person chose to post a question instead of calling 911.

Unfortunately, the boards are not conducted in real time. If the person is fortunate to catch me online at the time of the posting, they do get a rapid response. Most of the time, there can be a delay of a day or more for various reasons. Lately, I have been dealing with the Worst Internet Service ever that has prevented me from getting on line. Additionally, Health Experts on not online 24/7, unlike a group of Indian tech support people in a huge boiler room in Bombay waiting to help you. In most cases, the Health Expert is one person; a person that sleeps at night, uses the bathroom, works during the day in an active practice, and has a family life of sorts.

I have been answering postings for over eight years now; thousands of them. I suspect I have helped many people, because they have been grateful enough to post a thank you. I have not been able to help everyone, but I take pride in the fact that I try to answer EVERY posting, even though I am not required to do so.

For the people that I have helped, I am honored. To be able to help someone navigate the confusing world of medicine; to point someone in the right direction, or to hold a frightened, cyber-hand, if only for a few moments is a privilege. This is why I do it.

For the people that I have NOT helped, I ask for your kind understanding. The Internet poses significant barriers that cannot be overcome, even if you don't have health insurance or financial resources to see a medical provider. Health Experts would love to reach out and examine you. We would love to be able to provide a diagnosis, or an inexpensive, over-the-counter treatment plan, but more often than never, this cannot happen. We would love to be your medical provider, but we are not.

We are but one person with a big heart, apparently with extra time on our hands, and a desire to participate in one of the most innovative (and free) health web sites on this planet. All that we ask is for you to help us, too.

Yes, the picture is me. I am sitting at my desk in my clinic office. It is lunch time and I am posting between bites of food and patient calls. My calendar says 2004; I have not had time to change it (just kidding, this is an older picture). WebMD is on my screen, as it is most days. My hair is white; my fingers are tired; and my back is sore, and yet, I am happy because my Internet is working. Life is good.

Related Topics:

• Internet-Savvy Patients
• Emailed Health Warnings: Hoax or Fact?

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