By H. Jay Wisnicki, MDMany ophthalmologists view the Internet as a tool to broaden their practices by offering on-line eye-care advice. However, it is important
to remember that using the Internet does not exonerate the physician from good ethical requirements. In fact, the broad base of the Web encourages a stricter adherence to solid ethical qualities.
Health information has the unique property of being able to help as well as harm the patient. Good solid information, dispensed accurately
and properly, can enhance a person's health. That same information, dispensed in a shoddy manner, can do serious harm.
It is important that patients can look to their Internet information sources as reliable and accurate. Patients must be certain that the content's quality is high and that their own information is kept private.
Online health-care providers have a responsibility to disclose to patients the constraints of online diagnosis and treatment recommendations. Obviously, you cannot prescribe medications online, nor
can you be certain of a patient's condition without a proper examination. However, you can narrow the possibilities down and give the patient a good starting point.
There are other factors that enter into dispensing medicine on the Internet. Physicians must disclose any outside factors that could influence the site's content, such as advertising, co-op shares, etc. In
addition, patients must be made aware that there are risks associated with sharing health information online. Internet users are often concerned about the privacy of their credit card
information, but they should be equally concerned that their health information is secure.
It is incumbent upon the health-care provider to ensure that patient privacy is safeguarded.
Health-care providers must be wary about who sees patient information and guard Internet information as closely as patient records. After all, they are one and the same.
In addition, when you gather patient information over the Internet, you must be sure the patient understands who sees that information, what it is being used for, and how it is being used. Too often,
patients don't understand that their health-care information is as valuable to them as their financial information. You must ensure that their information is secure.
You must let users know if information is being collected for any purpose. If you have an outside vendor running your site, ask what information is being gathered and by whom, what uses that
information will have, and any possibilities that the information will be sent to third parties. Insist the vendor disclose this information on the site or not use gathered information. Your obligation is to the
patient, not the vendor.
Disclose interests
As an information provider, you also have an obligation to disclose any factors that could influence
your information. Stock analysts must disclose if they have a vested interest in a company they are reporting on and the same should hold true in health care. If you receive financial benefits from one
type of procedure or referral, tell your patients.
When you make a recommendation, the patient sees it as an endorsement. Be willing to stand
behind your advice. Unfortunately, with online consultations, it is impossible to read facial expressions to see fully if the patient understands what you are saying.
Your Web site should state clearly who owns it, what its purpose is, and how to contact the owner and/or person responsible for the site's content. Ideally, you should have a feedback section where
users can e-mail you by clicking in one specific area. Questions you receive about site content should be addressed in a quick, professional manner. Remember, the Internet is for quick
correspondence. Establish a turnaround time for answering questions and stick to it.
If you carry advertising on your site, you must differentiate it from educational content. Do not
assume patients can tell the difference.
If you are providing general health information, such as from a trade journal or a study, get
permission and then attribute the source. Cite any publications, including date and version number if necessary. If you link to other sites, remember, you are endorsing the content on them. Check them
often to ensure you still want to do that.
Let your users evaluate your site. You may think you have the greatest site in the world, but your
patients may think otherwise. Take their views into consideration. You do not have to use all their suggestions, but often the users will have ideas you or your webmaster never thought about.
Your patients have a right to know your credentials. Have a page on your site that outlines them. You hang your medical school diploma on your office wall, why not advertise your education and
experience on your Web site?
Remember, when you provide information over the Internet, you are just extending your office walls.
Your main goal must remain to serve patients' needs while protecting their confidentiality. Medical ethics do not go away with the addition of a modem. Instead, they are more critical since the patient
and doctor often will never meet face to face.
A Web site and online consultation can be a lucrative method for getting your name out, visiting with
patients, and building a larger practice. However, make sure that despite the change in medium, your message remains the same: "I am a high-quality health-care provider who puts my patients first."
