Dr Tom Ferguson, who tragically died aged 62 in 2006, was one of the giants of the early years of the Internet. He urged patients to educate themselves and share knowledge with one another, and encouraged doctors to collaborate with patients rather than command them. Predicting the Internet's potential for disseminating medical information long before it became a familiar conduit, he was an early proponent of its use, terming laymen who did so e-patients. He classified doctors consultation styles on the net into two types. He talked about Type 1 doctors who are "advisors, coaches and information providers" but who specifically do not attempt to diagnose or treat. These doctors, or other health professionals, are typically available through their own sites, or through the many commercial sites. They generally don't advise the same patient twice, usually don't even give their name, although the commercial sites "guarantee" that they are fully qualified, and will often refer you to a local face to face doctor or hospital. Interestingly, I understand, this is how many of them receive payment for their services - the sites get a "spotters fee" from local services that they refer to.



Ferguson also defined type 2 doctors, the majority of medical providers on the net. These are doctors like me who provide normal face to face care, and who encourage their patients to also use email to contact them directly - a rational and sensible use of new technologies which, as long as guidelines for Internet consultations are followed, is a great way of working for both patient and doctor.

I deliberately don't recommend any online doctors from any particular sites because it is really impossible to tell how good they are, although there are many such sites easily accessible via Google. Interestingly a recent study undertaken by the television program Good Morning America found that, while consultations from three major web sites could be useful for routine problems, the sites doctors made misleading diagnoses in more difficult cases. The program concluded that patients should avoid online consults for problems that could not wait more than 24 hours, but that it would be reasonable to consult with their regular physician online about routine problems that they had had before.

There is another group of health care providers, however, who attempt to provide full health services only on the Internet. Many of these provide counseling or therapy services for mental health problems, or alternative therapies of an often bizarre and inappropriate nature. At the present time my advice is generally to stay away from many of these, unless you can be sure who they are, and ideally can also see them face to face. Full time Internet health services and providers will become much more common in the next few years, however, as we move to being able to use secure video systems over the Internet. I predict that eventually as many as 10-20% of all health consultations will take place in cyberspace within 10 years or so. This will be a real revolution in healthcare.

I do think that the emergence of online doctors who are prepared to treat their patients in a collaborative manner, both face to face and online, is the way of the future. This approach to care has been termed participatory medicine and features the empowered e-patients that Ferguson also described, communicating with their online providers. A fascinating example of a website devoted to participatory medicine, and which includes an excellent white paper written by Ferguson, is www.e-patients.net.