Do you think homeopathic online consultation or e-consultation, where homeopath and the patient do not meet in person, is ethical and permissible?

Since I’m rounding up the results of three individual polls in this month’s issue, I’m going to keep my summaries and commentaries very brief.

First: the subject of E-Consultations.

Our poll asked “Do you think homeopathic online consultation or e-consultation, where homeopath and the patient do not meet in person, is ethical and permissible?”

This particular poll brought forth a huge number of responses. More than 650 responses were logged to this question, with the largest number of responses supporting the “Yes” vote.

Poll Results:

Do you think homeopathic online consultation or e-consultation, where homeopath and the patient do not meet in person, is ethical and permissible?

Yes (60.5 %) 402 votes
No (30.1 %) 200 votes
Can’t say (9.3 %) 62 votes
Total votes #: 664

To look at the full results for this poll, click here

The majority of the “yes” responses came with a qualifier, reflected succinctly in this comment from Nikstar, posted on March 15, 2006:
Yes it is ethical, though not ideal.

Better online homeopathy than none at all.

Those who posted a “yes” response without this qualifier reflected opinions such as those expressed by Carol Ann Mercier (3/15/2006):

I don’t know why it wouldn’t be ethical or permissible. I ask questions of people all the time. I don’t want to go to my homeopathic doctor’s office every time I just have a question. There are risks to the practitioner because if people don’t get the results they want, they can trump up charges against the practitioner and cause legal problems. I don’t see any risk to the patient. Homeopathic remedies are safe and don’t interfere with other medications the patient is taking. However, if a practitioner deems a situation needs more than just an online consultation, he should tell the patient. Then the patient must decide what to do. I’m not sure there should be any license or regulation except the person who is giving the consultation should be a licensed homeopath since that is what people are expecting.

Or the opinion posted by Dr. Okeke Frank (also 03/15/06):

Yes. Whatever we can do to rid a hurting humanity of the hurt and pain must be done, especially to those who have confidence in us.
However the following hurdles must be cleared.
Ascertain the patient’s condition in order to decide whether to take up the case or to decline.
Homeopathic case-taking usually involves a series of cross-examinations.
Having collated our symptoms, we must ensure our patient obtains the prescribed drugs from the pharmacy.
When these conditions are met one can consult on-line.
The most effective regulation will proceed from the physician and the community of homeopathic physicians in each nation.

The “No” respondents always included reasons why on-line consultations could never replace the face-to-face consultations required. S. V. Swamy (03/14/06) writes:
No. There are several ethical issues including fake identities, inability to check the patient’s physical symptoms including facial expressions, clarity of speech etc., which render the process dangerous and thus unethical. Only as a follow-up of a patient whose history is well-known, it could be used occasionally.

Sandra Russo (3/13/2006) concludes:
I vote NO to consults that are not face to face. Any acute situation that can be treated not face to face, should already be a patient that has been seen face to face.

There is so much that an astute homoeopath observes when they see the patient that cannot be gathered over the airways. Things that the patient would not deem important. Color, odor, nature of sweat (if shiny) posture, sighing etc. etc. height, weight, type of muscular texture… the list could go on.

To create yet another board with regulations as …suggested, is another bureaucratic oxymoron that would not work. There are enough homoeopaths around the world to deal with situations – one need only… source a good Homoeopath.

The only time I would say that it was okay was if the patient lived in a very remote area. Even then I would have reservations, as first aid kits can be purchased, and one can be quite okay with these remedies, and I am sure that at least once a year… or more, most people go to the city to get supplies or do other business… we are in 2006 after all, and transport is very efficient etc. I think as Homoeopaths we should stop making excuses for treating people who are not willing to come in for an appointment… it is their health, and this is in their hands. As patients what are they willing to put into it? We should not be too accommodating and bring Homoeopathy into disrepute.

Though online consultations can be done in such a way which allows a limited amount of observation (high-speed connection video interaction, for example), there are still concerns which most homeopaths who responded to the poll find too great to overlook. Though video interactions can be obtained these days, how many people actually have access to high speed internet connections and expensive video and computer components, and how many of those can be assured of reliable access and connections? If online consultations are to be available to those with limited financial means, how are they expected to have these necessary and expensive items handy? Simple written communication, online, is far too prone to failure—there is no way to gauge appearance, cadence/peculiarities of speech, odour, physical examination of particular and general symptoms, habits, gestures, etc. As well, both patients and practitioners can be open to risk—practitioners can be open to abuse, and patients can also be vulnerable to practitioners who practice out of the jurisdiction of any particular national law, or code of ethics assigned to professional practice (since, technically, their consultation business takes place in cyberspace, outside of any one country’s stipulated legalities).

I very much appreciate Sandra Russo’s insistence that patients be required to make a commitment to homeopathic treatment, doing whatever is required in terms of their own efforts to ensure that homeopathy can be effective: very often when Homeopaths are the only ones going out of their way to treat patients, they lose so much of the power they need over the process, and any kind of treatment fails under such circumstances. It’s easy to see how Homeopathy itself would be seen as “the failure”, and easy to see how its reputation as a medical system could suffer, on an international scale, when we simply don’t insist on commitment from our patients.

There is no doubt, however, that the kind of worldwide access we’re talking about in these types of consultations would further much more widespread acceptance of Homeopathy, or at least provide a means for so many more people to become familiar with it. Perhaps the real question here is “How can we make on-line interactions focusing on Homeopathy safe, accessible, affordable, and ethical for as many people as possible, now that we know the Internet can be such a valuable tool for Homeopathy?” Maybe we need to focus on the internet as an education tool instead of a consultation format—or, perhaps we might be able to find a way to make its use in consultation effective enough to overcome the sizable limitations. Now that we’re clear on what the limitations are, we can use our gifts as innovators to try and remove them, so that the potential we all see for growth can be achieved.