consulta virtual Eysenbach

Se trata de un excelente trabajo realizado en Alemania, cuyas inquietudes son las mismas que tenemos nosotros. El autor acepta que la consulta virtual es un procedimiento de avanzada que llevará la medicina a lugares distantes, pero reconoce que se deberán resolver los problemas previamente.

Objectives: To analyze the motivation, expectations, and misconceptions of patients seeking teleadvice or medical information on the Internet. To explore the possible economics and problems of direct physician-to-patient teleadvice via electronic mails (e-mail).

Design: Exploratory survey of 209 unsolicited e-mails mostly sent to physicians by individuals seeking teleadvice.

Patients: Two hundred nine patients and information-seeking individuals, mainly with dermatologic problems.

Main Outcome Measures: Previous contacts with live physicians, disease duration, level of frustration expressed in the e-mails, and type of information sought.

Results: Many dermatologic patients who request teleadvice have a chronic disease (81%) and seek a second opinion. Seventeen percent express frustration about previous encounters with live physicians. Forty percent of all e-mails could have been answered by a librarian, 28% of all e-mails were suitable to be answered by a physician via e-mail alone, and in 27% of the cases any kind of consultation would not have been possible without seeing the patient. In at least 5 instances patients attempt self-diagnosis.

Conclusions: We found examples for the beneficial effects of the provision of medical information on the World Wide Web but also evidence suggesting that patients are trying to use information on the Internet as a supplement for physicians and that teleadvice might be overused by chronically ill and frustrated patients looking desperately for additional information. Telemedicine via e-mail could substitute a physician visit or telephone call in some cases, but many principal problems must be solved beforehand.

From the Unit for Medical Informatics, Epidemiology and Public Health, Department of Dermatology, University Hospital of Erlangen, Erlangen, Germany.

This work was supported by a grant from the German Research Net Association (DFN-Verein), Berlin, and grant TK 598-VA/I3 from the the German Research Ministry, Bonn (BMBF), Germany.

Reprints: Gunther Eysenbach, MD, Unit for Medical Informatics, Epidemiology and Public Health, Department of Dermatology, University Hospital of Erlangen, Hartmannstr 14, 91052 Erlangen, Germany (e-mail: eysenbach@derma.med.uni-erlangen.de).

1. Eysenbach G. Präventivmedizin und Internet: Prävention durch Information. In: Allhoff PG, Leidel J, Ollenschläger G, Voigt HP, eds. Präventivmedizin. 6th ed. New York, NY: Springer-Verlag NY Inc; 1997.

2. Neill RA, Mainous AG 3rd, Clark JR, Hagen MD. The utility of electronic mail as a medium for patient-physician communication. Arch Fam Med. 1994;3:268-271.

3. Fridsma DB, Ford P, Altman R. A survey of patient access to electronic mail: attitudes, barriers and opportunities. Proc Annu Symp Comput Appl Med Care. 1994:15-19.

5. Widman LE, Tong DA. Requests for medical advice from patients and families to health care providers who publish on the World Wide Web. Arch Intern Med. 1997;157:209-212. Available at: http://www.ama-assn.org/sci-pubs/journals/archive/inte/vol_157/no_2/oi60166.htm. Accessed August 31, 1997.

6. Bittorf A, Krejci-Papa NC, Diepgen TL. Development of a dermatologic image atlas with world wide access for the continuous education of physicians. J Telemed Telecare. 1995;1:45-53.

7. Bittorf A, Bauer J, Simon M, Diepgen TL. Web-based training modules in dermatology. MD Comput. 1997;14:371-381.

10. US Congress, Office of Technology Assessment. Bringing Health Care Online: The Role of Information Technologies, OTA-ITC-624. Washington, DC: US Government Printing Office; 1995. Available at: http://www.cc.emory.edu/WHSCL/HealthCareOnlineToc.html. Accessed August 31, 1997.

11. Balas A, Jaffrey F, Kuperman GJ, et al. Electronic communication with patients: evaluation of distance medicine technology. JAMA. 1997;278:152-159.

12. Allaert FA, Duesserre L. Legal requirements for tele-assistance and tele-medicine. Medinfo. 1995;8(pt 2):1593-1595.