Doctors, Internet and service to patients

From Fred Ezeh, Abuja 

Unarguably, the internet revolution and increased penetration across the world has heralded unprecedented changes in people’s lifestyles. Socioeconomic activities, politics and governance, health, security and several other areas of human endeavour have been significantly redefined by Internet and ICT infrastructure. 

Google, Wikipedia and other search engines are fast displacing clinical content of medical books, competences, professionalism, skill and experience in public and private hospital service in Nigeria, just as it has been the case in virtually all areas of human life in the 21st century.

Medical doctors and other healthcare workers, like other professionals, are increasingly visiting Internet search engines and relying heavily on the facilities for consultation and dishing out medical advisories and information.

The development has, undoubtedly, heightened fear and anxiety among clients in public and private healthcare facilities. This could, perhaps, be due to limited information on unexpected and speedy developments in the field of medicine, as well as emergence of new and strange diseases and their dynamic ways of attack, which the doctors were not exposed to in the course of training.

This has made doctors refer to Google, Wikipedia and other search engines as their friends. They see in search engines new ways of doing things, sourcing information, research or clarification on doubts regarding the certain health related issues.

Google videos, images, news and several other Internet contents that provide information are mostly visited by these doctors. They also rely on other websites that provide medical information, just as it is the case in other professions, including academia.

There are indications that young doctors, most of whom are fresh graduates and on residency training, are the greatest culprits, even though some senior and experienced consultants are not left out. They also patronize Google, Wikipedia or other search engines for information on ailments that are strange and unclear to them.

These search engines have redefined research, making information in any field of medicine available at the touch of a button on phone, laptop, desktop or any Internet-enabled device.

Doctors’ hands on Internet

As the practice, each time doctors are confronted with unfamiliar or difficult health issues, they speedily approach Google, other search engines or ‘reliable’ medical websites for information and guidance.

 In most cases, they do the search in the presence of their patients who often witness Google’s response or that of any other search engine, as well as doctor’s actions. This has greatly affected the confidence of patients in the competence and ability of doctors to attend to their health needs.

A patient, who identified herself as Thelma Effiong, said a young female doctor at one of the government-owned hospitals in the FCT (name withheld) displayed a high level of unprofessionalism in one of her visits to the hospital.

She said: “These young doctors shouldn’t be left alone because, from all indications, most of them are undergoing practical training. In my case, the young female doctor practically had to attend to me following instructions from Google and other Internet sources. I wasn’t told; I was there and witnessed what she was doing.

“I presented my case to her politely and confidently. As I was doing that, she was nodding her head, perhaps, in agreement and understanding. Thereafter, she began to ask me the symptoms I felt, and thereafter, she inputted the symptoms in the Google search bar. It was based on the search result that she gave prescriptions.”

Thelma said her husband and a few friends of hers have had similar experiences in different locations and at different times. She lamented that such reliance on Google or other Internet services could lead to wrong diagnosis and wrong prescriptions.

Doctor’s viewpoint

Dr. Titus Ibekwe, a professor of otorhinolaryngology (the study of diseases of the ear, nose, and throat) at University of Abuja Teaching Hospital, agreed that the Internet has revolutionized global information sharing in every field of endeavour, including medicine and healthcare.

He said search engines were routes to sourcing information though they contain the good, the bad and the ugly. He said the Internet could be useful as an adjunct to buffering information, and also as a source for primary health knowledge.

He, however, highlighted the dangers, “Conversely, it could be misleading too. This is why medical professionals should use these search engines as a means to an end and not otherwise. It’s useful for memory recall and cannot be a substitute for skill acquisition.

“The medical knowledge acquired over the years through training and experience via medical practice cannot be obtained over the pages of the Internet. Thus, relying 100 per cent on the information out there is extremely dangerous and could lead to quackery.

“Furthermore, untrained and uncertified individuals must not attempt self-treatment based on what they dig up from the Internet. Medical practice and human health management are more complex and beyond documentation.

“Above all, responses and reactions do occur, which are individualized, responses to stimulus that do not follow the stereotyped documentation in the Internet. This knowledge is only available to the trained and exposed doctor only. The Internet is a potpourri of information, which is most useful when used with caution. Let’s not also forget that there is often no second chance to life.”

Patients lament

Expectedly, the development is fast eroding public confidence in the ability and competence of doctors to save life or issue accurate advisory on health issues.

Like Thelma Effiong, a Reverend Sister with one of the Catholic schools in Abuja, said she had to leave Wuse General Hospital in the middle of consultation when she realized that the doctor attending to her was practically relying on Google for information on the case presented.

 She said: “Things have degenerated in our public service system, especially the health care system. People’s lives are being used to play Kalo kalo at several hospitals by doctors. Doctors and other critical healthcare workers arm themselves with Google to get information on what to tell their patients.

“It’s not peculiar to doctors in public hospitals; those in private hospitals do so too, but it’s high in public hospitals because of young resident doctors who are left alone to attend to patients without input from senior consultants. It’s a pathetic situation and experiences that I have had and heard in these hospitals. I don’t know if it’s professionally right for a doctor to regularly and openly consult Google or other search engines for information to attend to patients.”

Another patient, Kasimu Khalifa, in his submission, said; “There are lots of young doctors in public hospitals in Abuja, especially at the National Hospital and some other FCT-owned hospitals. Ideally, these young doctors are supposed to be attached to a senior consultants for practical knowledge. But most of the consultants are often unavailable in the hospitals because of divided attention. Most run private hospitals and they spend most of their time there.”

NMA, MDCAN, MDCN, NARD react 

Nigerian Medical Association (NMA), National Association of Resident Doctors (NARD), Medical and Dental Consultants’ Association of Nigeria (MDCAN) as well as Medical and Dental Council of Nigeria (MDCN) reacted differently to the development.

For NMA president, Prof. Innocent Ujah, doctors are not relying on Google or other search engines for consultation and should not be accused of such things.

“I refused to accept that fact because I have not seen nor have I heard about it. I also don’t believe that a doctor will rely on Google to make prescriptions.

“However, you must know that doctors are always studying and researching for improved knowledge based on their field of expertise. Besides, many patients, in most cases, visit Google for prior information on their ailments before visiting the hospital.

“Doctors are always studying and updating their knowledge, seeking second opinions on several health-related issues. So, I completely disagree with your position. But if I am furnished with empirical evidence, I will take action on that.”

President, MDCAN, Kenneth Ozoilo, in his submission, said the use of Internet facilities in the 21st century for research and information could not be ruled out, but should be well filtered and done with caution.

“I intend to disagree that the practice of using Google or other search engines for consultation is rampant among doctors. For me, a survey must be conducted to ascertain the true situation of things, instead of basing conclusions on empirical observations of a few people.”

He said accessing information on the Internet was not bad even though it had  consequences: “Internet is very vast and the quality of information harvested is dependent on the reliability of the website visited.”

“We always advocate that a researcher must be guided in searching for information on the Internet. It’s unwise for a doctor to rely entirely on the Internet to replace clinical acumen. The major brain work/decision is done by the doctor based on available information and symptoms presented.

“A doctor cannot rely on the Internet to formulate clinical diagnosis. It’s something that can only be done through clinical judgment based on a patient’s health history, physical signs being manifested by the patient or laboratory results.

“Years ago, doctors were advised to go about with a medical handbook, which contained details of commonly used drugs for ailments. It helped the doctors to have accurate information on ailments, instead of ‘guess work,’ which could be disastrous. There are several digital copies of those materials now, which were aided by technology,” he said.

 Registrar, MDCN, Dr. Tajudeen Sanusi, explained that the council was doing something about the issue. He said, “We are working on the regulation that will control the use of the Internet for medical consultation, because we don’t want to put the health of the people in jeopardy.

“The regulation, when completed, will ensure that anyone using the Internet for medical services, otherwise known as telemedicine, is duly registered with MDCN so we can hold such a person responsible for any professional misconduct or harm done to a patient.”

He said a committee on the regulation had been set up and it was working assiduously to complete the task. He added that the Nigerian Communication Commission has been contacted for assistance.

Meanwhile, NARD president, Dr. Uyilawa Okhuaihesuyi, admitted that doctors visit the Internet for information and research. He mentioned that such websites include Pub Med and Sci Hub, which often provide additional information on any unclear areas of medical service.

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