Camera-shyness is an exceedingly rare condition among medical professionals. In recent years there’s been a veritable epidemic of reality TV shows featuring physicians in starring roles, from Channel 4’s Embarrassing Bodies to RTÉ’s Operation Transformation. Seeing a doctor — while not being seen by one — has never been easier.
Nobody in the medical establishment seems even vaguely perturbed about the prominence of docs on the gogglebox. Amusingly, however, many of the profession’s leading figures are evidently scandalised by a similar rise in the frequency with which GPs have been appearing on computer monitors.
The popularity of so-called telemedicine — the remote diagnosis and treatment of patients via the internet — has become a bugbear among clinical traditionalists. It has been denounced as a poor substitute for in-person consultations by groups including the Irish Medical Organisation and the Irish College of General Practitioners, whose concerns include an increased risk of misdiagnosis and uncertainty surrounding continuity of care.
Last week, telemedicine’s most vociferous critics were joined by Tony O’Brien, director-general of the HSE, who likened online GP services to calling a fortune teller. “Personally, I would not use such a service,” he tweeted in response to questions about a “GP Live” facility offered by an insurance company. “I’d sooner phone Psychics Live.”
Medics and medical administrators are justifiably late adopters of new technology. Teething problems are inevitable with any technological advance so healthcare providers are wise to approach such developments with caution. The move towards online consultations, however, already seems unstoppable, not least because of their potential to reduce costs and waiting lists.
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As a profession, therefore, doctors would be well-advised to assume a less antagonistic attitude towards telemedicine, identifying how it can be improved rather than dismissing it. But, in truth, this is unlikely to happen any time soon because, as far as most old-school physicians are concerned, the internet is the archenemy of good medical practice.
Cyberspace is the frontline in an often bitter battle between snake-oil and science but it’s a battle that the forces of enlightenment appear to be losing. Health-related online content provides the public with a treasure-trove of medical information but it’s also a Pandora’s Box of half-truths, lies and propaganda. Nevertheless, for a disconcertingly sizeable section of the populace, Dr Google is a more trusted source of medical expertise than the family doctor.
As we know from the growth of fake news and the conspiracy-theory industry, credibility online is largely a function of presentation. Some of the most noxious and misleading claims are made by the slickest sites. This is also the case when it comes to medical misinformation, with all manner of hocus-pocus voodoo hawked or endorsed with theatrical fireworks often involving celebrities or (worse still) celebrity doctors.
The damage that can be wrought by the spread of this toxic nonsense is highlighted by the drop in the uptake of the HPV vaccine — a drop that health officials believe is a direct consequence of “unsubstantiated concerns” propagated online by highly motivated and often well-funded anti-vaccine groups.
Human papillomavirus (HPV) is a sexually transmitted infection, some strains of which can lead to cervical cancer. A vaccine, Gardasil, has been offered to girls aged 12-13 in the first year of secondary school since 2010. Following an initially enthusiastic response, with uptake of 87 per cent in 2015, the trend collapsed. In the 2016/2017 academic year, half of eligible girls refused to be vaccinated.
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Broadly speaking, opposition to the HPV vaccine can be separated into two distinct categories. The first expresses itself as moral concern: a sizable contingent of adults find it disquieting that their children will eventually have normal sexual urges. This moral objection is voiced most aggressively by religious conservatives in the US, who focus on the undesirability of sexual activity rather than the effectiveness of the vaccine.
The second category is rooted in safety fears. Like all clinical compounds, Gardasil has been extensively tested for years and monitored for potential adverse effects. Its safety and efficacy have been reaffirmed by numerous independent studies, including a 2015 report based on data from more than a million individuals. Nevertheless, spurious assertions about its “dangers” have gained deep purchase in online forums where it has become an article of unquestioned faith that all medical practitioners are in the pocket of Big Pharma.
Government and cancer charities agree that the fall-off in uptake of the HPV vaccine in the last academic year will result in a minimum of 40 deaths. Another 100 girls will need life-changing treatment and 1,000 more will need invasive therapy. The HSE has begun a promotional fight-back, with campaigns on social media and in schools, but warns that it will take years to repair the damage caused by misinformation.
Not for the first time, the medical profession is on the back foot over an important issue of public health, scrambling to assert itself on an argument that it should have won hands down years ago. The reasons for the declining credibility of doctors are many and complex. Scepticism about authority in all forms is undoubtedly a factor. Many people are instinctively inclined to disbelieve just about anything they hear from credentialed experts or official sources. However, the medical profession has to accept a share of the blame for its fall from grace.
Doctors were once trusted pillars of the community but these days they are regarded by many as something close to a public menace: arrogant, blundering jargon-addicts with an aversion to transparency. Much of this perception is groundless but there are enough grains of truth within the caricature to give it widespread appeal.
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Many doctors are fiercely conservative in their response to the opportunities presented by the digital age but, at the same time, they ignore the blurring of the line between healthcare advocacy and showbiz, a phenomenon manifested in the aforementioned proliferation of doctor-lead TV programmes.
Telemedicine can hardly be presented as a terminal ill if telly medicine gets a clean bill of health.