A man dies and goes to Heaven. When he arrives he sees that there is a long line to the Pearly Gates. After some time he hears a commotion behind him and turns to see a man in a long white coat with a stethoscope in the pocket cutting past everone. He strides right through the gates without a pause and past everyone who had been waiting forever. When the man gets to St. Peter he says, “Say, who was that guy who cut past everybody and walked right through?” St. Peter replied, “Oh. That’s God. Sometimes he likes to think he’s a doctor.”(1).
There was a time when only doctors and nurses had access to the medical information necessary to make a diagnosis and decide on the treatment that was needed. The World Wide Web has changed all of this and now anyone can have access to an almost inconceivable amount of information, both accurate and poor quality. According to the Office for National Statistics, eight out of ten Brits use the web regularly (2). It is interesting to consider the ways that this can impact on health. That, together with a shameless plug for our new Health Protection and Screening website (3) is the subject of today’s blog.
It’s very easy to “Google” a few search terms and come up with a wide range of material, some legitimate and peer-reviewed, some of dubious provenance and quality. With unfettered access to all kinds of health information, we need to help people to make sense of it all. I’m reminded of “J.” the narrator in Jerome K Jerome’s Three Men in a Boat who went to the British Museum one day to read up the treatment for hay fever. In an unthinking moment, he idly turned the pages of the book and discovered that (apart from Housemaid’s Knee) he suffered from every complaint listed (4). The scare stories erroneously linking MMR to autism happened in the early days of the web and certainly before today’s almost universal access, yet various anti-vaccine websites still managed to stir up public opposition to the vaccine despite any credible evidence. How much worse might this be now?
But what about the positive ways in which the web can affect health? Using the web as a means of interacting, and even as a tool for delivering healthcare has exciting possibilities. Peer support forums, often run as self help groups – with or without the support of charities – are common. These are perhaps most beneficial for stigmatising or embarrassing conditions where the relative anonymity of the internet can be an advantage. People with rare conditions can also benefit from the global reach of the web. Online consultations with GPs now take place using email, and increasingly with Skype/FaceTime etc. In a rural area, telemedicine can help an isolated GP to get a quick dermatological opinion about an unusual rash. In Scotland we have many national Managed Clinical Networks and teleconferencing over the web can sometimes save hours of travelling for some more productive use of the time.
The web has enabled a shift in the balance of power between health professionals and the public. More than a decade ago, there were reports (5) of patients bringing printouts of websites into their consultations with health professionals and today this is commonplace. Interestingly in that survey, the patients reported far more benefit in bringing in material from the web than did the health professionals.
The wider public health can also be affected by the web. An internet-enabled society means that more of us can “home work”. Whilst this may reduce traffic pollution, congestion and potentially accidents, it can also lead to isolation and perhaps a reduction in physical exercise. When whole communities come together on the web it can build social capital. Inevitably when talking about public health, we must consider inequity. The term “digital divide” has been coined to describe the gap in web access that exists between the “have nets and the have nots”. As we grapple with ever decreasing budgets and more printed health information is replaced with web pages (with all the benefits that this brings) we may, paradoxically, be making it much harder for the very people we are trying to reach to actually get access to information about breast screening, immunisation and how to stop smoking.
As healthcare professionals we have to adapt our practice to embrace the world wide web. It provides exciting opportunities to improve quality of care and access to services, particularly in a rural area such as ours. It is true that not everyone has access to a computer, and that in some remote areas internet speeds are still very slow, but in time that will improve.
By its nature, the health related material on the web can’t be controlled so we have to provide easy access to high quality health information. Many charities such Marie Curie, Meningitis UK and Diabetes UK do a great job. The NHS too has some websites of which it can be justifiably proud – NHS Inform is a good example. Now for my shameless plug. Just before Christmas we launched our new Health Protection and Screening website. It provides some original content, such as our policies and newsletters, but much of it consists of links to other material on the web – there’s some great stuff out there if you know where to find it. So far, we’ve had about two and a half thousand hits – a reasonable start. Please have a look – just remember Gavin and Stacey’s Uncle Bryn’s (6) sage advice to put w-w-w (whisky with water) in front of absolutely everything – www.dghps.org.
Nigel Calvert is a Consultant in Public Health Medicine at NHS Dumfries and Galloway