`I cannot stand being stared at for eight hours a day by others." That, said Sigmund Freud, was one of the reasons he and his patients never made eye contact during their sessions. What the founding father of psychoanalysis would have made of the fact that analyst and patient need no longer be in the same country, let alone the same room, would make interesting reading. Websites offering psychoanalysis and counselling are springing up on the Web with increasing regularity, each quoting "convenience" as its selling point. One of the first online psychiatric services (www.cyberanalysis.com) was set up by Dr Russell Razzaque, a psychiatrist trained in England, who says that "the physical distance between us being on the end of a PC becomes our greatest asset, as my role will be to guide and encourage you, not to direct you or impinge on your personal space." His service costs $65 for an initial 55-minute session and $250 thereafter for four sessions of 50 minutes each. Alternatively, dreams can be analysed for $13.50. The question arises: this can all be done, but should it be? Is the Internet the correct forum for a psychoanalysis session involving two people who have never spoken, let alone met?
According to Dr Maurice Geuret, editor of the Irish Medical Directory (www.iol.ie/imd): "Psychiatry is a field that lends itself fairly well to online consultation, but I would add the caveat that the psychiatrist should already have met the patient face-to-face and is just continuing follow up by email or online chat. I'm wary of consulting doctors or therapists abroad. Cultures vary hugely: American doctors might think that normal Irish traits could signify paranoid schizophrenia." Geuret is well aware of the increasing importance of the Internet in the medical world. There are differing attitudes in the medical community towards the Net, he says. Some doctors see it as "just another medium" or "something for the future", while others are very concerned about confidentiality, low-quality information and security. "I prefer to dwell on the positives," Geuret says. "People often get the information they deserve. If they choose to believe everything they read that's their problem. If they use common sense . . . they'll all survive the information age." On whether doctors and patients should use the Internet for communication and consultation, he is quite clear. "I'm quite happy to discuss results of tests and plan future care by email with patients whom I know, trust and have already seen in the surgery with their complaints," he says. "I won't entertain personal medical enquiries from strangers or those in foreign countries. New diseases and new symptoms should always be taken to the surgery first."
According to Martin Bridgeman, an academic researching health information management, with emphasis on the Internet, medicine on the Web, "is still at the early stages, but there is a growing dependence on the Internet". How is the Irish medical establishment coping?
A report on 60 Irish medical websites recently published in the Irish Medical Journal (www.imj.ie) by Dr Brian O'Mahony concluded: "Irish health-care websites are disappointing". As defects, it listed poor design, paucity of health information, little maintenance or updating, and the fact that sites provide static information and are not interactive. Dr Helen O'Neill, with her partner Dr Kieran Fulcher, has one of the few Irish GP websites (www.iol.ie/avondale) and she would agree with some of the criticism. After creating a website for their surgery she believes that there is room for improvement. However, the site has achieved one of their main goals by providing more information for patients. This includes opening hours, contact details, a noticeboard, a list of services provided and maps of how to get to their two surgeries in Co Meath.
"Creating the website," says Fulcher, "was mostly as a means of letting our patients know the services we offer and also as recognition to the importance to the World Wide Web for people who have it at home." Traffic on the site has increased over recent months, he says, even though "there is nothing on it that's not on our leaflets. Information and ease of access was the main idea." Information is one thing, consultation is another. "I don't think that you can practise medicine from a distance," he says. "How can you accurately diagnose without seeing people?"
noelgallagher@tinet.ie