Dr Paul Miller is one of the partners in a busy Glasgow general practice. He first set up their internet site two-and-a-half years ago.
This area is one of the poorest in the UK, but as more homes get computers we're starting to get a lot more feedback. We're going to have a repeat prescription service on this site, which will hopefully save patients some time, though not us at the moment: the emails will come straight through to me, and I'll pass them on to our prescription clerk. I'd love to get online appointment booking, but we have to think about security.
"Eventually, even registrations will be electronic: obviously you do have to physically examine the person, that will never change, but patients will be able to email us details, and we'll be able to email reminders of smear tests and so on.
"I'm a bit of an IT junky; I had a ZX81 when I was a teenager. When I did the first site, web design was still quite simple; it's certainly more complex these days, but I'm trying not to sell my soul to Microsoft. We're using computers increasingly for every aspect of clinical care. Five years from now I'll be very surprised if I'm still writing my notes by hand."
Doctor Yoosuf Ibrahim has been practising as a GP in west London for 27 years.
A few patients have mentioned things they have read about on the internet, such as the weight-reducing drug Zenical, antioxidants or other new treatments. But I explain to them that the British medical establishment has certain ways of doing things. We are a conservative people, and don't think that everything that comes with the internet is automatically good.
"I'm sure it's useful, but I don't think it could ever be used for diagnosis or prescription. If you're dealing with a patient with kidney disease or diabetes, you need to see them every couple of months: you need to look at their eyes; you need to remind patients to watch their diet - this is the human mind we're dealing with, and if you don't say it to their face, they forget. The internet can come up with some interesting diagnoses, but patients still have to discuss them with us."
Doctor Lotte Newman was president of the Royal College of General Practitioners, and still practises privately part-time.
I have to admit I'm totally ignorant of IT matters. Fortunately, my secretary can work my email. I suppose that generally I feel that the internet is a great facilitator of communication of information, but it would worry me if I thought that instead of talking to patients, one would just stare into a computer.
"The Royal College was recently involved in a research project, and decided to do without a press conference to launch the intermediate results. Instead it launched them on its internet site. I feel it might have been more successful if it had been done in person.
Perhaps I'm a fuddy-duddy about this, but I'm very worried about the dehumanisation of society. I think we're losing human contact and the ability to communicate directly. Maybe if I was younger I would be more enthused."
Dr Tim Peachey is a consultant anaesthetist at the Royal Free Hospital in London, and is a member of MITAG, the Medical Information and Technology Advisory Group.
I have colleagues who have used tele-medicine for consultation, but I don't think it's particularly useful. You actually need two doctors for a diagnosis or exam: you set it up at a GP's office and link up to a specialist. With the amount of time it takes to set up, you're looking at 20 or more minutes: the doctors could see four patients in that time. It may save the patient travelling, but the NHS faces a terrific shortage of resources, so you have to think about bringing the doctor to the patient or vice versa.
"Where the internet is brilliant is for research - it's much faster to call up a couple of pages rather than searching through miles and miles of indexes - and for communication. Trying to get hold of people within the hospital can be impossible, with one or the other of you in surgery or a meeting all the time. Email solves those problems: the virtual conversation goes on all day, and by the time you leave, you've solved whatever the problem was.
Email also improves communication between GPs and hospitals, an area where the NHS is especially weak. The internet is certainly a huge part of my life, both private and professional. But it's not the answer to every problem."
