The doctor will e-mail you now

Imagine consulting your GP online from the comfort of your home. Private patients can already do this. And the NHS may not be far behind, reports Hugh Wilson

While many of us no longer think twice about doing our banking online, most of us accept a familiar ritual when it comes to our dealings with the doctor: wait for an appointment, queue in the surgery, and grab five frantic minutes with the harassed GP.

While many of us no longer think twice about doing our banking online, most of us accept a familiar ritual when it comes to our dealings with the doctor: wait for an appointment, queue in the surgery, and grab five frantic minutes with the harassed GP.

But according to recent US research, a majority of patients would be happy to consult with GPs electronically. In one survey, 80 per cent of respondents said they would like to be able to send medical questions to their doctors by e-mail, and 69 per cent said they'd be happy to receive test results in the same way.

In the US, they increasingly can - if they have health insurance. A number of large insurance companies have started to pay doctors for electronic consultations. The insurers' aim is to reduce costs, but doctors seem to like the innovation. "Patients love this stuff; I love this stuff; the staff love this stuff," gushed one New Hampshire GP.

British patients are still some way from routine e-mail consultation with GPs, but most experts think it's just a matter of time. A recent report in the British Medical Journal, for example, concluded that "making e-mail communication more readily accepted as a part of routine medical practice should be a key objective of the NHS".

Aziz Sheikh, professor of primary-care research and development at the University of Edinburgh and one of the authors of the report, believes that e-mail consultations are inevitable - eventually. "The pace of adoption, initially at least, is likely to be relatively slow in comparison with many other service industries," he says. "Conversely, if we can get our act together and train health professionals to make the most of these opportunities, we could become international leaders."

Unfortunately, there's little evidence of that happening yet, at least in the NHS. Instead, a number of private practices have moved in to fill the gap. E-med has been up and running since 2000, and now has 100,000 members. It has a physical address in London and can offer consultation over the phone, but most of its work is done by e-mail. "Speed is the big advantage of e-mail consultation," says E-med's Dr Julian Eden.

It's not the only advantage. Electronic consultation can cut surgery waiting times, reduce the costs of missed appointments and improve communication between doctor and patient. It provides a written record of the consultation for both parties. In the US, surveys have shown that e-mail, by reducing the number of daily office visits, gives doctors more time to spend with patients who need to be seen in the surgery.

There are similar benefits for patients, who don't have to miss work for the sake of a niggly cough or a new prescription. "It's often difficult to get an appointment with my local GP and there is usually a wait once I do get there," says Juliet Simpson, who now uses e-mail health services. "I'm self-employed and my whole business comes to a standstill, even if I have a relatively simple illness. [With e-mail] I can get things sorted out without taking time out of my schedule."

And Simpson points out another advantage of e-mail: you can consult your own doctor from halfway around the world. Distance consulting also has clear benefits for disabled people, and those who live in isolated communities.

But e-mail consultation offers more than just convenience, say its fans. Many patients are more forthcoming about their problems and symptoms from the comfort of their own computer. At E-med, Dr Eden has seen this for himself. "Patients can be much more forthcoming, especially, for example, men with depression. In a face-to-face consultation, there are a lot of hidden agendas, the patient wanting the doctor to pluck symptoms from their hidden psyche. But by mail, they come straight out with the facts."

Some psychology, homeopathy and counselling services are also using e-mail and Instant Messaging. Psychology online.co.uk is a dedicated electronic counselling site, where chartered psychologists use a chat-room system to have real-time conversations with distant clients. It is, says Sue Wright, who founded the site, a useful tool.

"We are both chartered psychologists with the NHS, and felt that because of the long waiting lists we ought to think of ways that we could get good-quality psychological help to the people that need it, using an alternative method of delivery. Some people prefer online therapy because they don't feel as inhibited as they might do in a face-to-face session."

Butthe lack of a physical examination and the possibility of missing a potentially serious symptom worry many GPs. Professor Sheikh believes, however, that, these fears are misplaced. "Diagnoses are made largely on the basis of the clinical history," he says. "But clinical examination is clearly needed on some occasions, and where this is thought necessary the clinician would, of course, suggest a face-to-face encounter. The key thing to realise here is that this is not a substitute for traditional modes of consulting: it simply offers greater flexibility."

Though concerns persist over security and privacy, those who are prepared to bank online would probably be prepared to send properly secured and encrypted medical information over the internet. In fact, the biggest concern is not for the people who use electronic consultation, but for those who can't afford to. E-med charges £20 for membership, and £15 after each completed consultation. Psychologyonline.co.uk charges £60 for a 55-minute appointment. These prices might be competitive compared to traditional private treatments, but it's still far from cheap.

And NHS patients may be queuing in crowded surgeries for a while yet. Electronic consultation sounds like an idea whose time has come, but Sheikh admits, "There is no clear strategic implementation throughout the NHS at the moment." He believes that a number of factors are holding it back, from a lack of strategic vision to a lack of appropriate training. Nevertheless, as more and more of us turn to the internet to avoid queues in banks, shops and ticket offices, the clamour for online doctor's appointments can only increase.

The online surgery

* What is the problem?

I have a burning pain when I pass water.

* How long have you had it for?

Three days.

* Have you had it before?

Yes I have, my doctor said it was cystitis, and treated me with antibiotics, but I am going on holiday tomorrow, and can't get an appointment to see him.

* What cured it before?

Antibiotics, one beginning with T!

* Have you tried any other treatment?

Not yet, just lots of cranberry juice, which doesn't seem to be helping.

* Are you on any other medication?

Just the Pill.

* What do you think the problem is?

A bladder infection. My doc checked me for diabetes before and said it wasn't the cause.

* What do you hope e-med can do for you?

Can you get me some antibiotics today as I have to be at the airport very early tomorrow?

* No problem. What you had before was called Trimethoprim. You need to take it twice a day for three days at least, five to be safe. Prevention is better than cure, so if you are prone to cystitis, the following may help to prevent attacks:

- Wear cotton underwear, and stockings instead of tights.

- Avoid wearing tight underwear or jeans.

- Use a water-soluble lubricant during intercourse and empty your bladder as soon as possible after intercourse.

- Take a shower rather than a bath. If you have a bath, don't use perfumed bubble bath.

- Try changing your washing powder.

- Cut down on coffee, tea and alcohol.

- Sit properly on the lavatory. Hovering over the seat can prevent your bladder from emptying.

- You need to drink plenty of fluids, especially if you are going to a hot climate.

That should cure it, but if there are any problems feel free to e-mail us from abroad. I have called the prescription in to your pharmacy so you can pick it up right away.