Internet medicine

Internet medicine refers to any method of obtaining healthcare via a smartphone or website. It can involve telehealth, video visits with a doctor, or healthcare via live chat, as well as any combination of the above.

Internet medicine can also involve a variety of devices that monitor health and report results digitally. These can be as straightforward as a smartwatch that generally monitors activity, heart rate, and sleep or devices designed to detect blood sugar, sleep apnea, and more. These devices may report directly to a doctor or a medical office, or they may be used by individuals to monitor their health and well-being.

Internet medicine receives praise because it improves access to medical help. People who are bedridden, immunocompromised, or frail can still see and interact with medical professionals without having to put too much strain on their bodies or risk their overall health and well-being.

Others criticize it because they question whether medical experts can truly diagnose some conditions if they are not with a person face-to-face. They fear that patients may lie to their doctors and get away with it, or that doctors will miss important aspects of care because the patient is not directly in front of them. Despite these concerns, internet medicine remains an important part of many healthcare systems.

Background

As internet access and personal devices with which to access it have become ubiquitous, internet medicine has become more and more popular. During the height of the COVID-19 pandemic in 2020 and 2021, internet medicine experienced an exponential rise in popularity. Doctors were wary of having too many patients in their offices, where they could potentially infect staff and other patients. In some cases, medical offices had to close until they came up with a way to care for most patients remotely.

During this time, a variety of internet medicine platforms became popular. Platforms designed for medical use need to protect patient privacy while giving medical staff access to patients to evaluate symptoms and diagnose their causes. Medical providers such as primary care physicians, pediatricians, and specialists used these platforms when they could.

One early criticism was that they were sometimes confusing for elderly patients. Because this segment of the population typically uses the internet less and may not have a high level of comfort with it, some of them chose to put off needed healthcare visits in the hope that the pandemic would be over soon. When this did not happen, they were left without alternatives that they were comfortable with. Many medical offices created internal structures to make sure that people had the access they needed when they needed it. In some cases, this included creating jobs for individuals who could contact patients before appointments and ensure that they knew how to use the system when the time came to meet virtually with a doctor.

At about the same time, companies arose that offered medical care solely online. Some of these focused on specific medical issues, like attention deficit hyperactivity disorder (ADHD), hair loss, erectile dysfunction, depression, and anxiety. These platforms hired medical staff who specialized in these fields, then connected them with patients who needed that specific kind of care. These platforms often offered care at rates that were substantially lower than what many people would pay for in-person care. Many also required payment out of pocket rather than working with medical insurance companies.

While these companies offer care to anyone, they are most popular with younger patients. Younger people are more likely to have a higher degree of comfort with receiving medical care online and do not distrust medical professionals who operate online.

Critics of these companies say that many of the medical issues they address are not easy to diagnose. For example, they question whether a doctor can accurately diagnose mental health issues without questioning a patient extensively. They also note that the medications prescribed for these issues are not without side effects and are concerned about patients who need help managing their medication.

Proponents of this kind of care note that finding an in-person practitioner and getting an appointment can be difficult, and that alone can prevent some people from seeking help. They also note that many of the issues these companies treat can be stigmatized, so people may be more likely to get needed medical care if they can do it online.

Overview

Internet medicine, also known as digital healthcare, remained popular after the COVID-19 pandemic lessened and life mostly went back to normal. While some doctors and healthcare offices discontinued offering services over the internet, they did so as a personal preference, as they felt more confident about their diagnoses and treatments in person. Others did it for insurance purposes, as it can be more expensive to get malpractice insurance for certain specialties and in certain locations for doctors operating over the internet.

However, other practitioners have chosen to continue offering internet visits. Some leave the type of visit up to the patient and their preference, while others only permit internet visits for certain conditions, requiring face-to-face visits for others.

Additionally, there are medical practices that now operate exclusively, or almost exclusively, over the internet. They may even schedule in-person procedures that way, so that the first time a patient meets a doctor is when they go in to have a procedure performed.

More and more, doctors are also relying on internet-connected devices to make certain diagnoses. While the standard diagnostic procedure for sleep apnea was once to spend the night in a lab hooked up to a variety of equipment, many doctors now use wearable devices. The patient pays for the testing and then takes the device home. They wear the device while they sleep for one or more nights, and their results are sent directly to their physician. If the device notes patterns of breathing and sleeping consistent with apnea, the person qualifies for all of the standard treatments for that condition.

Some cardiologists are using internet-connected devices as well. While doctors have long sent people home with heart monitors, internet-connected devices are less intrusive and easier to hide under clothing. They may also send live data to the doctor, so the patient does not have to wait so long to get the results and determine what is going on with their heart.

Doctors are also training people to use more standard devices, like smartwatches, to oversee aspects of their own health. Depending on the device, many of these monitor aspects of health like heart rate, sleep duration, sleep quality, exercise intensity, and overall stress on the body. A wide variety of doctors are training patients on how to interpret this data so they can stay as healthy as possible. Doctors may give people targets, such as a certain number of minutes of exercise a week, and then challenge them to track this on their watch.

Internet medicine can help individuals take on more responsibility for their health than they have been able to previously. When they can get hard data to describe their lived experience every day, they can see where they are making good choices and where they could improve. They can also track over time how making better choices impacts their overall health.

Experts do worry that there is some danger that certain people may become obsessive over this data. For instance, obsessing over sleep data can actually cause some people to get poorer-quality sleep.

In addition, the data collected by these devices is not always the most accurate. Some devices are more accurate than others, and those that are available at the consumer level have some margin of error. This needs to be included in any training the people are given when it comes to how to use these devices to improve their health. Changes in device readouts may be due to changes in medical status, but they may also be due to device error or malfunction.

Internet medicine raises accessibility to healthcare, whether that comes via readouts on a smartwatch or easier appointments for those who are disabled. However, the drawbacks are also real. As technology improves and best practices are revised, health-care professionals hope that some of these may be mitigated so access does not have to come at the cost of accuracy, personalized care, or patient honesty.

Bibliography

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