Medicine and the Internet

A healthy relationship?
General Practitioner, Paris*

Online consultation: This Berlin-designed pacemaker relays cardiological data on a daily basis to doctors monitoring the patient via the Internet and can send an SMS text warning when a patient’s heart is in critical condition. ©Reuters/Arnd Wiegmann

The advent of the Internet has revolutionised the compilation, assessment and distribution of information relating to healthcare. This has modified the traditional doctor-patient relationship in a number of significant ways.

Fifty years ago, knowledge relating to matters of health and disease was largely the “intellectual property” of the medical profession. During consultation, doctors divulged little information to their patients and patients rarely questioned their doctors’ decisions. Doctors were supposed to “know what was best” for their patients.

Patients consulted when they were ill and doctors did not necessarily see themselves in the role of educators in health matters. This has changed, though not just because of the Internet.

The Internet appeared at a time when people were already showing a lot more interest in health matters and taking a more active role in decisions regarding their personal health. Public interest in health grew with increased general and scientific education, the advent of television and live debates on health issues, and with “doctor” columns in newspapers and magazines. Indeed, magazines appeared that were entirely devoted to health. Certain taboos fell and people felt more comfortable discussing their health with friends and acquaintances.

These days many people consult the Internet prior to visiting their doctor and often come to a consultation armed with their own putative diagnosis. Others consult the Internet after seeing their doctor to find out more about their particular problem or about the medication they have been prescribed.

Seeking information online is not an unhealthy practice, but it can result in misunderstanding and confusion, not to mention anxiety. A significant portion of medical information on the Internet is produced by universities and teaching hospitals and can be assumed to be highly reliable. However, even if the information is of high quality, it is often difficult for non-medics to distinguish likely from unlikely causes for their symptoms. Many people suspect the most serious possible disease listed as the likeliest explanation, though luckily for them they are most often mistaken.

Fortunately, most people still prefer to trust their doctor’s advice and see the Internet as more of an accessory to enrich their understanding of their condition. The traditional medical consultation provides a sense of professionalism and confidentiality, and a personal dimension that is not found by consulting the Internet.

However, there are many simple ailments that have simple solutions. For instance, urinary tract infections in women can be treated with a single dose of an antibiotic, and patients who are familiar with the symptoms of this or other benign conditions may prefer to buy their prescription medicine online without having to consult a doctor in person.

Internet sites now exist that sell medication directly to the patient without a doctor’s prescription. Responsible sites tend to cover themselves by warning their clients not to use any medicine without the prior approval of their doctor. They also state that they cannot be held responsible for deliveries being confiscated by customs if the product is being sent across borders.

Nevertheless, the sale of medication over the Internet raises many issues concerning product control and safety. It also challenges the contractual nature and legal responsibilities of the traditional doctor-patient relationship. In most countries drug companies are required to have an official product licence which determines the conditions of sale–such as prescription only versus over the counter. Government drug regulation and safety control bodies alert health authorities and doctors if a drug is found to have dangerous side effects. Doctors are also professionally and legally responsible for informing their patients on the potential adverse effects of a given treatment. Although the prescription of a drug may often seem banal or even redundant, every act of prescription engages the legal responsibility of many players.

The sale of medication over the Internet bypasses much of this control. Patients who purchase medication on the Internet may not know where or by which firm the drugs are manufactured and may lack access to legal recourse if something goes wrong.

Of course, in many countries with socialised medicine, it is not in a patient’s financial interest to buy drugs on the Internet since prescribed medicines are paid for or subsidised by the state. In the US, however, where medication costs can be very high and where many people have limited insurance, there is a real incentive to buying prescription drugs on the Internet if the price seems right.

Another complication relates to advertising. Health websites are hugely popular, and drug companies use the Internet to advertise directly to potential customers/patients. This practice has become very popular in the US but is illegal in countries such as France. Yet the global Internet escapes these national restrictions.

Internet medicine clearly appeals to particular groups of people. Many young people, particularly mobile urban professionals, are not “signed up” with a doctor and tend to use walk-in clinics or emergency services in the event of illness. Telemedicine or online consultation also attracts such people as they already spend much of their time online. Furthermore, as a result of the global nature of the Internet, people can, for a fee, consult a doctor online who is based in another country.

In this virtual world the traditional physical examination is not possible and the normal legal and professional constraints regarding confidentiality and responsibility are less readily defined. Healthcare websites are unlikely to replace the traditional office consultation, but they will draw patients who feel their doctors don’t spend enough time explaining things or who would like a second opinion. In fact, the Internet can enable patients to make more informed decisions with their doctors. In addition, patient interaction sites allow individuals to discuss their illnesses with others and to share personal experiences relating to different treatment approaches. There are even sites which allow patients to compare their experiences with different doctors in a given town or city.

Nowadays, patients are sometimes asked to choose between a number of treatment options for a given condition. The days of patients replying “you’re the doctor, I’m in your hands” are gone. The Internet can be particularly helpful in providing extensive information regarding treatment options. This in turn may help patients to feel more confident in their decisions. For example, a man with prostate cancer can be asked to choose from the following list of treatment possibilities–watchful waiting, radical surgery, external beam or internal pellet radiation, high-frequency focal ultrasound ablation therapy, proton therapy or hormone therapy–on the basis of the advantages and disadvantages of each treatment and without a most appropriate treatment being apparent at the outset.

Online consultation services have also developed for doctors. For example a general practitioner faced with interpreting a difficult electrocardiogram can now obtain an instant diagnosis from a cardiology online service by emailing a copy of the electrocardiogram. The same is true for the evaluation of X-rays, CT scans and MRIs. These types of service are particularly attractive to doctors working in remote areas.

Doctors also rely more and more on the Internet for researching topics and for personal continuing education, as well as for sharing information with each other.

All leading medical journals are now available online. Full journal access usually requires a fee which is generally lower than for a regular (hard copy) subscription, with the additional advantage of giving access to back issues.

In the “age of information” it is only natural that the Internet will play an ever more significant role in the sharing of knowledge on health issues. Doctors are realising that their patients are demanding more and more information and that they have a legal duty to inform them of the potential benefits, risks and alternatives of any given treatment. The traditional consultation provides a human dimension not available on the Internet. The more complex the problem, the greater the need for this kind of interaction becomes. While cyber-medicine has much to contribute to the development of how medicine is practised, it ought not to replace the personal dimension of the traditional consultation in which the doctor provides not only a listening ear, but also words of comfort, reassurance and hope.

*Dr Slattery’s practice is based in Paris. He has also worked as a medical doctor at the OECD. The views in this article are the author’s alone.

©OECD Observer No 268 June 2008

Economic data

GDP growth: +0.6% Q1 2019 year-on-year
Consumer price inflation: 2.3% May 2019 annual
Trade: +0.4% exp, -1.2% imp, Q1 2019
Unemployment: 5.2% July 2019
Last update: 8 July 2019

OECD Observer Newsletter

Stay up-to-date with the latest news from the OECD by signing up for our e-newsletter :

Twitter feed

Subscribe now

<b>Subscribe now!</b>

To order your own paper editions,email

Online edition
Previous editions

Don't miss

  • MCM logo
  • The following communiqué and Chair’s statement were issued at the close of the OECD Council Meeting at Ministerial level, this year presided by the Slovak Republic.
  • Food production will suffer some of the most immediate and brutal effects of climate change, with some regions of the world suffering far more than others. Only through unhindered global trade can we ensure that high-quality, nutritious food reaches those who need it most, Angel Gurría, Secretary-General of the OECD, and José Graziano da Silva, Director-General of the United Nations Food and Agriculture Organization, write in their latest Project Syndicate article. Read the article here.
  • Globalisation will continue and get stronger, and how to harness it is the great challenge, says OECD Secretary-General Gurría on Bloomberg TV. Watch the interview here.
  • OECD Secretary-General Angel Gurría with UN Secretary-General António Guterres at the 73rd Session of the UN General Assembly, in New York City.
  • The new OECD Observer Crossword, with Myles Mellor. Try it online!
  • Listen to the "Robots are coming for our jobs" episode of The Guardian's "Chips with Everything podcast", in which The Guardian’s economics editor, Larry Elliott, and Jeremy Wyatt, a professor of robotics and artificial intelligence at the University of Birmingham, and Jordan Erica Webber, freelance journalist, discuss the findings of the new OECD report "Automation, skills use and training". Listen here.
  • Do we really know the difference between right and wrong? Alison Taylor of BSR and Susan Hawley of Corruption Watch tell us why it matters to play by the rules. Watch the recording of our Facebook live interview here.
  • Has public decision-making been hijacked by a privileged few? Watch the recording of our Facebook live interview with Stav Shaffir, MK (Zionist Union) Chair of the Knesset Committee on Transparency here.
  • Can a nudge help us make more ethical decisions? Watch the recording of our Facebook live interview with Saugatto Datta, managing director at ideas42 here.
  • The fight against tax evasion is gaining further momentum as Barbados, Côte d’Ivoire, Jamaica, Malaysia, Panama and Tunisia signed the BEPS Multilateral Convention on 24 January, bringing the total number of signatories to 78. The Convention strengthens existing tax treaties and reduces opportunities for tax avoidance by multinational enterprises.
  • Globalisation’s many benefits have been unequally shared, and public policy has struggled to keep up with a rapidly-shifting world. The OECD is working alongside governments and international organisations to help improve and harness the gains while tackling the root causes of inequality, and ensuring a level playing field globally. Please watch.
  • Checking out the job situation with the OECD scoreboard of labour market performances: do you want to know how your country compares with neighbours and competitors on income levels or employment?
  • Trade is an important point of focus in today’s international economy. This video presents facts and statistics from OECD’s most recent publications on this topic.
  • The OECD Gender Initiative examines existing barriers to gender equality in education, employment, and entrepreneurship. The gender portal monitors the progress made by governments to promote gender equality in both OECD and non-OECD countries and provides good practices based on analytical tools and reliable data.
  • Interested in a career in Paris at the OECD? The OECD is a major international organisation, with a mission to build better policies for better lives. With our hub based in one of the world's global cities and offices across continents, find out more at .
  • Visit the OECD Gender Data Portal. Selected indicators shedding light on gender inequalities in education, employment and entrepreneurship.

Most Popular Articles

OECD Insights Blog

NOTE: All signed articles in the OECD Observer express the opinions of the authors
and do not necessarily represent the official views of OECD member countries.

All rights reserved. OECD 2019