Practicing Medicine in The Time of The Internet

By Dr. Luis Miguel Zetina Toache, Cáncer Consultants Guatemala

As a clinical oncologist, I started my work day early, expecting a morning full of appointments, some of which are going to be complicated due to the nature of my practice – diagnosing and treating cancer. My patients depend on me for comfort and guidance so they can feel more optimistic in the face of what might be unpleasant news.

The first patient arrived with four relatives, which I do not mind. One of the young grand-daughters asked me several questions related to what she had read last night on the internet about bone cancer. I patiently tried to explain to them that her grandfather did not have bone cancer, but a bone metastasis from the prostate cancer, which usually occurs in the advanced stages of the disease.

They were happy with my explanation, but I’m sure they went to check the internet about the latest treatments in prostate cancer, which, of course, is understandable due to the worrying situation. However, I and many other doctors in other specialties feel the same way: There are so many websites about cancer and other medical topics on the internet that have not been up-dated with correct information in several years, such that the recommendations there are more harmful than helpful. This outdated and useless information should be disregarded and burned, so that it can never be reproduced by patients who are looking for accurate, honest answers.


The next patient came alone, but she carried with her the 100 most recent articles on breast cancer and its treatment. The dialogue was very fluid and scientific and her last comment left me totally amazed, because she had reviewed all the protocol points for NSABP B38, or the National Surgical Adjuvant Breast Protocol B-38. I had suggested that we should follow up on this treatment to avoid recurrence of breast cancer, which was recently diagnosed.

She questioned me as to why I would recommend this course of chemotherapy if the protocol did not include patients with her characteristics. “You bring up an excellent point”, I told her.

Fortunately, my clinic, Cancer Consultants GT, had participated in a similar protocol in Guatemala. We made a final amendment to the study to include patients in her exact situation. Because this break-through finding was so new, it was not yet reviewed and up-loaded to the internet. I felt very fortunate to have such up-to-date inside experience with the best possible treatment for her case. I just hope that I can provide such conclusive answers to the intelligent questions of all my patients.


I finished the morning checking my email inquiries. Two of the patients I can answer quickly. The other emails included anonymous reviews on cancer treatment, and “experts in the field” writing about the risk of eating sugars and using deodorant, or the benefits of taking blue scorpion or cat’s claw. There were reviews from foreign universities, but without accreditation of the author or publication site, they are questionable, at best.

Sadly, our patients consider these data to be absolute truths, sometimes because they are found on the internet and sometimes because they are written in English. They are brought up in conversations in our offices, and in the worst cases applied to their own diagnosis and treatment. We understand, of course, whether or not we are doctors, that if we are not experts in a particular subject, we must first consult with those who are. The advice of an educated, certified and experienced medical doctor cannot be compared to the complicated data digested in an over-night session on the internet.

Then of course, I can’t forget to check my Facebook, Twitter, Linked-In and Webpage, not to be “out of it” or a loser, as my children might say. In the old days, we were up-dated in the most scientific way possible, with relevant statistical data, and by attending local seminars and international scientific conferences. Now, we have to be able to interact with the avalanche of data circulating freely on the internet, where our patients are fed a stream of stories that they transfer into questions about their own medical care. We have to take that misinformation and respond in a persuasive and intelligent way, to dispel their insecurities. We must prepare ourselves in some way to have sufficient emotional intelligence and scientific patience to venture into the new practice of internet-assisted medicine.

I suggest to colleagues in my specialty and in others, that we should immerse ourselves in “cyber-medicine” and keep up to date with new technology and materials. However, we know that the most important element of our patients’ treatment and care is the interpersonal human relationship between the doctor and the patient. Well, let’s not complain too much about the internet – it’s the price we pay for growth and development.

Dr Zetina

Dr Zetina


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