How good is ‘internet medicine’?


When I mention ‘internet medicine’, do not confuse this with ‘internet pharmacies’. Internet pharmacies are the ones that offer you cheap willy stiffeners, while in my view, internet medicine is medical advice and information.

These days, with internet access freely available, it is very common for a patient to tell me they had “looked it up on the internet, and stopped taking it, because it was so dangerous.” And this is the problem – you know your doctor and can ask him questions, but do you know the person who uploads “information” to the web?

We are however, in a consumer oriented age. In the western world, advice is no longer taken at face value. “Take these tablets three times a day until finished” is not acceptable these days unless there is a patient information (PI) leaflet inside, and the patient has been advised that if his toe nails drop off he should stop taking the medication immediately and consult his litigation lawyer post haste.

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These PI sheets are a two edged sword in my view. Whilst it is important that the patient knows what they are taking, and why, listing every known side effect is somewhat off-putting, and can actually be counter-productive by making the patient stop the medication because they are afraid that something disastrous might happen to them. If the number of people who have taken the medication is squillions, while the number of catastrophic side effects can be counted on the fingers of one hand, what is the likelihood of getting an adverse effect? Not high. Put another way, did you know that one of the side effects of aspirin can be death, and yet aspirin is still one of the safest and best drugs on the planet.

So what do you really need to know to be an informed consumer? The first item is to know why you have been prescribed any particular medication and what it is supposed to do for you. Is the pink tablet the painkiller or the antibiotic, for example? The next important item is to know how often and when the medication should be taken. Before or after meals? At night or in the morning? These instructions can have enormous bearing upon the absorption of the medication. And on the likelihood of your getting a reaction or unwanted side effect, and on how long it will take you to get better.

The next important issue is that of reactions and side effects. You need to know the most likely side effects. If 20 percent of the folk who take this tablet get nausea, you need to be informed. If, however, less than 0.1 percent get a rash, then this is not such an important issue. I have always taught medical students that they should present the main issues only, but cover the rest by saying that if the patient has anything untoward happen to them which they think could be related to the medication, then stop taking the tablet and consult the doctor again.

Another important issue for the patient consumer is inter-actions. Some medications can affect the way the oral contraceptive pill does its job, for example. The informed consumer needs to know this! The wise doctor will tell you. The even wiser consumer will ask! Especially if you are on any medications at all, and that is including herbal medicines.

The patient will also have asked the internet, but will read a large number of the sites available and come up with a consensus, which can be discussed with your doctor.

The other aspect of your treatment that should be known by you is how long it should be before you begin to feel better. If you know it is going to be six weeks, then you know not to start fretting after one week. If it is supposed to be one week and you’re still in trouble three weeks later, then you will know to return for another consultation.

So be a wise consumer. If you are unsure, then ascertain what the tablets are for, when and how to take them, the most common side effects and inter-actions.