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Abstract
The staggering growth of the Internet has provided its huge global audience with potentially the world’s most powerful information source. It has made a huge amount of information readily available to both the public and the medical community which has the potential to result in important changes in the dynamics of the physician-patient relationship.
Web information and advice is created by a range of different providers which varies in terms of its expertise and credibility. In searching online for health advice, it is likely that the user will come across inconsistencies in terms of the advice they find. This contrasts with the single expert viewpoint offered by the family doctor
Physician-patient relationship is considered established when the cyber doctor provides information to the Internet user. If the information extends beyond generic information and becomes patient-specific, and if it involves diagnosis or specific advice, it seems reasonable for the user to assume that some semblance of a professional relationship exists. Hence, a doctor is under the duty to exercise skill and care, independently of any contract for services, from the moment he assumes responsibility for giving advice or treatment to a patient.
Poor monitoring of content and unregulated nature of health Web sites raise concerns about the quality of information on the Web, additionally, some websites provide misleading information. They also raise multiple concerns about privacy, confidentiality, quality assurance, professionalism, liability, and responsible medical practice.
As the internet can affect physician-patient relationship and change the way of practicing medicine, this study was carried out to:
1- Evaluate the ethical and legal considerations of the Arabic websites providing health services in the form of medical consultation, health related information and selling or advertising health products.
2- Design a website that can guide health seekers to reliable sites according to the international guidelines.
This is a descriptive study where search engines ”Google.com and Yahoo.com” were searched for Arabic health websites entering the term ”Arabic Health Websites” in Arabic language. from Google search, 57 links were retrieved and from yahoo search, 200 links were retrieved. Snowball sampling was used to locate other sites through those links.
The study included Arab countries health websites providing health services to the public in Arabic language in the form of medical consultation, health related information, selling or advertising health products. Websites having technical difficulties in the host server, advertising only sites without offering any educational material and duplicated sites were excluded.
Four hundreds and thirty Arabic Health Websites were retrieved and classified into four groups, governmental, non governmental, professional and private. They were evaluated using a checklist designed by the research team (the researcher and the supervisors on the study) and based on E-Health Code of Ethics, 2000. Reliability Coefficient (Cronbach’s alpha) was used to measure the internal consistency of items of the used checklist.
The used checklist included the following criteria:
Candor: Disclosure of information that if known by consumers would likely affect consumers’ understanding or use of the site or purchase or use of a product or service.
Honesty: Sites should be truthful and not deceptive and they should clearly distinguish content intended to promote or sell a product, service, or organization from educational or scientific content.
Quality: Provide health information that is accurate, easy to understand and up to date. Provide the information that users need to make their own judgments about the health information, products, or services provided by the site
Informed consent: Respect user’ rights to determine whether or how their personal data may be collected, used or shared.
Responsible partnering: Ensure that organizations and sites with which they affiliate are trustworthy
Accountability: Provide meaningful opportunity for users to give feedback about the site.
Privacy: Respect the obligation to respect users’ privacy
Professionalism in online healthcare: Respect fundamental ethical obligations to patients and clients. Inform and educate patients about the limitations of online healthcare.
A comparison of the means of the scores percentages for the previously mentioned criteria among the four studied groups has also been done.
The study has concluded the following results:
• The present study revealed that private group websites were 59.8% of all studied websites, NGOs websites were 16.5%, followed by governmental websites (13.7%) and at last professional websites (10%).
• The mean of scores percentages for all studied websites for the criteria of candor was 48.42%. The mean of score percentages was 48.56% in private group websites, 54.88% in professional group websites, 45.07% in NGOs websites and 47.12% in governmental websites. These results showed no statistically significant difference among the studied groups of websites.
• Regarding honesty, the mean of scores percentages for all studied websites was 70.45%. The means of scores percentages in descending order were, 100% in professional group websites, 86.00% in NGOs websites, 81.25% in governmental websites and finally 61.39% in private group websites. These results showed a statistically significant difference among the studied groups of websites (p-value= 0.001).
• Regarding criteria of quality, the mean of scores percentages for all studied websites was 27.71%. The means of scores percentages in descending order were, 35.60% in professional group websites, 33.61% in governmental websites, 29.37% in NGOs websites and finally, 24.58% in private group websites. These results also showed a statistically significant difference among the studied groups of websites (p-value= 0.001).
• Regarding criteria of informed consent, the mean of scores percentages for all studied websites was 8.26%. The mean of score percentages was 10.51% in private group websites, 3.10% in professional group websites, 4.93% in NGOs websites and 6.21% in governmental websites. These results showed no statistically significant difference among the studied groups of websites
• Regarding criteria of responsible partnering, the mean of scores percentages for all studied websites was 6.74%. The mean of score percentages was 6.49% in private group websites, 6.59% in professional group websites, 8.69% in NGOs websites and 5.65% in governmental websites. These results showed no statistically significant difference among the studied groups of websites.
• Concerning criteria of accountability, the mean of scores percentages for all studied websites was high (77.21%). The mean of score percentages was 77.24% in private group websites, 76.74% in professional group websites, 76.76% in NGOs websites and 77.97% in governmental websites. These results showed no statistically significant difference among the studied groups of websites.
• Comparing the means of scores percentages among the studied groups websites for privacy, the mean of scores percentages for all studied websites was low (3.74%) with no statistically significant difference among the studied groups of websites. It represented 4.12% in private group websites, 3.26%in professional group websites, 3.82% in NGOs websites and 3.56% in governmental website.
• Finally, on comparing the means of scores percentages among the studied groups’ websites for professionalism in online healthcare, the mean of scores percentages for all studied websites was 31.79 with no statistically significant difference among the studied groups of websites. It represented 33.05% in private group websites, 26.70% in professional group websites, 35.06% in NGOs websites and 24.87% in governmental website.
The study concluded that studied Arabic Health Websites showed poor adherence to ethical criteria of candor, quality, informed consent, responsible partnering, privacy and professionalism in online healthcare, while they showed good adherence to ethical criteria of honesty and accountability.
The study had also concluded that relationship between the physician (provider) and the patient (health seeker) over the internet through Arabic health websites could possibly be exposed to risks which might lead to medical responsibility. Reformulation of this relationship should be considered according to international ethical guidelines.
This study recommended that health seekers should be educated how to find credible health information on the Web. It also recommended that public awareness of E-health Ethics should be increased using media, seminars, lectures, etc…. . There should also be a system for evaluation and accreditation of Arabic health websites
A website has been developed by the researcher. This site presents ethical guidelines that can help health seekers to identify reliable health information on the web and credible health websites, provided in both Arabic and English languages. The site URL: www.e-health.yoo7.com.