Websites need to be regularly updated so that users are not misled or misinformed, and patient confidentiality must be maintained at all times, says Dr Gerard Panting


The internet is a fantastic source of information. No matter what you want to know about, if you google for it you will probably have more information than you can cope with. The real question, however, is how much faith can you put in it? For most people that probably boils down to how much they trust the organisation behind the website—the Royal Colleges being held in higher esteem and generally regarded as more authoritative than the online encyclopaedia Wikipedia, for example.

However, any website that is not regularly updated will soon come to contain redundant information and will be in danger of misleading its readers.

General practice websites

Many general practices now have their own websites, with information on surgery hours, members of staff, how to order repeat prescriptions or find out the results of blood tests, and a host of other housekeeping details. In addition, some have advice on common illnesses and how to manage them, and here lies the potential cause for concern.

It should be made clear that general medical content on the website is just that, and is no substitute for a one-to-one consultation. Information must be accurate, kept up-to-date, and have an appropriate safety net in place.

For example, many illnesses can be confused with influenza in their early stages, and although people who are normally fit and healthy can usually treat themselves at home, patients potentially at risk of more serious complications should be advised to seek advice from the surgery during surgery hours, or from an ‘out of hours’ service in an emergency. Those who might be harbouring more serious illnesses masquerading as influenza also require further advice. This should include considering symptoms and signs that require immediate reappraisal, as well as instructing individuals who have recently returned from areas where malaria infection is endemic to seek advice straightaway.

Quality of information

Providing reckless advice, perhaps designed to dissuade patients from bothering their doctor, will inevitably draw criticism, but could provision of poor advice on a website result in legal action? In extreme cases, where inclusion of information is reckless, or if it has been allowed to become hopelessly out-of-date, it is certainly possible that the General Medical Council (GMC) would investigate complaints and find the responsible practitioners at fault.

General practitioners owe a duty of care to their patients and it is, in theory at least, possible for patients who have come to harm as a result of acting on inaccurate information to claim that their injury was a result of negligence by the practice. Pursuing such a claim would be far from straightforward, but not impossible, so it is important to stress the advice on keeping a website.

This is to:

  • make information general
  • keep it up-to-date
  • encourage patients with significant co-morbidities, whose illnesses are in any way unusual or not progressing as expected, to contact the surgery for further advice at the earliest opportunity.

E-consultations

Some doctors offer advice via the internet to patients, sometimes in remote places, which brings with it a fresh crop of complications. With improvements in video and voice links, communications can be clear and even offer the opportunity of a crude visual examination of a rash or other superficial lesion, but communication may be limited to email exchange, perhaps not even in real time. Whatever the circumstances, the doctor providing advice has to take into account the limitations of e-consultations, ensure the patient is aware of those limitations, and err on the side of caution. But if there is no other help at hand, a judgement must be made on how best to protect the patient’s interests.

Prescribing via the internet and repeat prescriptions

Practices that allow their patients to request repeat prescriptions via the website need to be aware of the GMC’s guidance in Good Medical Practice, which requires doctors to conduct an adequate assessment of their patient’s condition by taking a history, paying attention to relevant clinical symptoms and signs, and, where necessary, undertaking a clinical examination.1 Further information about prescribing remotely can be found in the GMC publication Good practice in prescribing.2

The GMC website reports a number of cases where doctors have prescribed drugs over the internet and found themselves in trouble. In one case, a doctor offered drugs for the treatment of impotence and obesity for sale via a website to the general public, upon completion of a questionnaire. The GMC ‘fitness to practice’ panel found that the questions did not provide sufficient information for the doctor to assess the patient’s condition adequately, and there were no means of monitoring progress or reassessing the diagnosis. The doctor’s registration was suspended for 12 months and he was banned from prescribing over the internet for a further 12 months after reinstatement. Other restrictions were also placed on his practice.

Internet confidentiality

Another problem area is the potential for breach of confidence, which can occur in at least two ways. These are:

  • by a failure to appreciate that transmission of information via websites may not be secure and may be vulnerable to inadvertent disclosure or prying individuals
  • by the use of pictures of patients on the website.

General advice

The GMC issued guidelines in 2004 on confidentiality. General advice is as follows:3

  • When you are responsible for personal information about patients you must make sure that it is effectively protected against improper disclosure at all times
  • Many improper disclosures are unintentional. You should not discuss patients where you can be overheard or leave patients’ records, either on paper or on screen, where they can be seen by other patients, unauthorised health care staff or the public. You should take all reasonable steps to ensure that your consultations with patients are private.’

If electronic means are used to transmit confidential information, patients should be warned that communication via email or a website may not be totally secure. Practices may also want to consider what categories of information are too sensitive to transmit by standard electronic means.

Case reports and photographs

The GMC also issued advice on publication of case reports and photographs. It says that:3

  • ‘It is very difficult to anonymise case studies fully, especially if they are of interest because they deal with a rare condition, or the detailed history of a patient with mental illness. Similar problems apply to many photographs
  • For this reason, you must obtain express consent from patients before publishing personal information about them as individuals in media to which the public has access, for example in journals or text books, whether or not you believe the patient can be identified. Express consent must therefore be sought to the publication of, for example, case-histories about, or photographs of, patients
  • You must do your best to ensure that no patient is identifiable from such material.’

Advice on providing information

Finally, there is further advice from the GMC on providing information on your services. It is worth bearing in mind the following:1

  • If you publish information about your medical services, you must make sure the information is factual and verifiable
  • You must not make unjustifiable claims about the quality or outcomes of your services in any information you provide to patients. It must not offer guarantees of cures, nor exploit patients’ vulnerability or lack of medical knowledge
  • You must not put pressure on people to use a service, for example by arousing ill-founded fears for their future health.’

Conclusion

The internet offers great opportunities but also creates further scope for doctors to get into trouble if the basic requirements of good medical practice are compromised or bypassed.

 

  1. General Medical Council. Good Medical Practice, 2nd edition. London: GMC, 2006. www.gmc-uk.org/guidance/good_medical_practice/index.asp
  2. General Medical Council. Good Practice in Prescribing Medicines. London: GMC, 2006. www.gmc-uk.org/guidance/current/library/prescriptions_faqs.asp
  3. General Medical Council. Confidentiality: Protecting and providing information. London: GMC, 2004. www.gmc-uk.org/guidance/current/library/confidentiality.aspG