Privacy is revealed after medicine is taken, and it is difficult to reply to perfunctory refunds. The online health consulting platform is full of chaos: providing consulting information by pretending to be an identity | medical treatment | prescription | Internet | doctor | consultation | consultation | platform

Fake identity to provide consultation response, perfunctory refund difficulties, medication first, privacy leakage

Online health consultation platforms are full of chaos

"Dry eyes, foreign body sensation, and frequent tearing." Recently, Beijing resident Weng Hong went to a health consulting service platform for online consultation due to discomfort in her eyes. After inputting the above symptoms, the platform claimed that she had "Sjogren's syndrome" and taking propolis can greatly alleviate the symptoms. The platform shows that the person who received the consultation and provided this plan is a well-known doctor from a tertiary hospital in Beijing.

Weng Hong thought to herself, "The products recommended by experts are definitely not a problem," so she spent over 300 yuan to buy a box of propolis soft capsules, but after taking them for a while, they did not have any effect. Recently, she realized she had been tricked when she saw media reports claiming that the health consulting service platform was providing health consultations online under the guise of a doctor.

With the development of Internet medicine, online health consultation has become the choice of more and more people. The 51st Statistical Report on the Development of Internet in China released by China Internet Network Information Center shows that as of December 2022, the number of Internet medical users in China has reached 363 million, with a year-on-year growth of 21.7%, making it the fastest growing application last year.

However, the investigation by the reporter of the Legal Daily found that while the Internet health consultation service was developing rapidly, some responses were too casual, contained false information, used others' identities to provide health consultation, and advertised in the name of "health science popularization". In addition, issues such as misdiagnosis by doctors, medication before use, AI prescription medication, and leakage of patient personal information are also common.

Consultation on transplanting flowers and trees

Reply content violates the red line

Dr. Li is the deputy chief physician of the Rheumatology and Immunology Department at a tertiary hospital in Beijing. During his daily consultations, some patients reported to him that a platform that provides health consultation services has published a large number of health related answers in his name for users. Dr. Li said that the platform used its name to publish health consultation content, even to promote health care products. "From the perspective of medical ethics or professionalism, doctors will not give such feedback", so he sued the platform to the Beijing Internet Court.

After trial, the court found that the platform involved in the case used the plaintiff's name, photo, and professional title to post consultation responses on the website without the plaintiff's authorization, infringing on the plaintiff's right to name and reputation. The court ordered the platform to apologize and compensate for mental damages and consolation money.

It is understood that recently, the Beijing Internet Court has added a number of online tort liability disputes on health consulting service platforms. The plaintiffs in these disputes are all doctors from major tertiary hospitals in Beijing. They accidentally discovered that the above platform provided a large number of health related answers in their own name, and these answers contained content that clearly exceeded the normal scope of medical consultation responses.

"There is a difference between Internet health consultation and diagnosis and treatment. For Internet diagnosis and treatment, the National Health Commission has clearly stipulated that institutions and doctors engaged in Internet diagnosis and treatment must meet specific requirements, can engage in re diagnosis of common and chronic diseases, and can issue diagnosis and treatment plans. Health consultation has no clear provisions, but there is a red line that cannot be broken, that is, cannot issue specific diagnosis and treatment plans." Guo Sheng, judge of the First Comprehensive Trial Division of Beijing Internet Court, told reporters.

As the presiding judge of the aforementioned series of cases, Guo Sheng noticed that there have also been cases of patients suing health consulting platforms for their right to health in other courts. "Online health consulting platforms are full of chaos, but the number of cases entering the judicial field is still relatively small.".

He believes that the lack of effective regulation, coupled with platforms actively cooperating with infringement in order to attract traffic, has led to frequent chaos in health consultation and consultation. For example, there are those who advertise for medical institutions under the name of health consultation, those who sell drugs, and those who attract traffic to institutions without medical diagnosis and treatment qualifications.

The reporter searched online for topics such as "to what extent hair loss is considered" and "what causes hair loss", and a series of links popped up, answering doctors from various hospitals across the country. The reporter clicked on the first link on the webpage and redirected to a certain integrated traditional Chinese and Western medicine dermatology hospital, which showed a team of 10 doctors.

If the other party asks the reporter to leave their name, contact information, and other information, they can provide free consultation. When the reporter asked questions such as "does the hospital have relevant qualifications", the other party avoided answering and instead emphasized that "as long as targeted treatment is given, hair loss can be treated quickly" and "the situation you described can be recovered through reasonable treatment". They repeatedly reminded the reporter to add their social account, saying "it is more convenient to answer".

No consultation but no refund

Lack of standard consultation prices

"After waiting for a long time, the doctor did not reply. When I saw the reply, the service was over. I asked for a refund, but the platform did not return it. After spending 60 yuan, I got a reply of less than 20 words, or the result I already knew, which did not achieve the purpose of consultation." Guo Ming, from Changde, Hunan, complained.

Not long ago, Guo Ming had a lot of ulcers in his mouth, causing pain even when drinking water. He wanted to consult the cause online first, so he registered an account on a certain health platform and spent money to purchase services. However, he ended up buying a troublesome one.

Guo Ming's experience is not unique. "Doctors who answer questions incorrectly, do not respond to questions, and the platform does not issue refunds." "It is not the doctor who received the consultation." The reporter found that as of June 5th, there were over 2000 complaints regarding health consultation and consultation on a third-party complaint platform. From these complaints, many consumers believe that it is difficult for doctors on health platforms to respond perfunctorily and provide refunds, and there have even been cases where doctors do not receive treatment but do not receive refunds.

In addition, the lack of a unified standard for consultation prices is also a common issue among many consumers. Zhang Xingze, a senior student at a certain university in Beijing, often suffers from physical weakness and illnesses. For a period of time, he often used a health consultation and consultation platform, but his experience was that it was convenient but not very reliable, especially with chaotic pricing.

Taking a certain health platform as an example, doctors in the same hospital and department as deputy chief physicians have graphic and textual consultation prices of 99 yuan and 200 yuan respectively on the platform, with a difference of nearly 100 yuan. Zhang Xingze also noticed that doctors with higher prices for online consultations only have a price of over 10 yuan for offline consultations, while doctors with lower prices for online consultations have not found this person.

Another consultation experience left a deep impression on him. He had some small red spots on his skin, which were extremely itchy. In order to quickly solve the problem, he opened an online consultation app and spent 109 yuan to select a professional doctor for graphic and textual consultation. The doctor said he had a skin disease and suggested purchasing corresponding medication for treatment. Due to the lack of effectiveness, he went to an offline hospital for examination, but the result was an allergy to pineapple.

A doctor surnamed Liu from a tertiary hospital in Beijing told reporters that the doctor's response was perfunctory, unprofessional, and the prices were chaotic. In addition, a series of situations such as users paying but not receiving corresponding services indicate that there is still a certain lack of regulation on health platforms.

Prescription drugs are not prescribed

The review process is virtually non-existent

In addition to consultation, the purchase of prescription drugs is another feature of the "Internet plus+health care" convenience. However, the reporter found in the investigation that some Internet medical platforms have adopted the operation mode of "selecting and purchasing drugs first, then depending on the drug formula, or even automatically generating prescriptions by AI software".

Recently, after placing an order for the prescription drug levofloxacin capsules on a certain drug purchasing platform, the platform prompted "Please choose an offline confirmed disease". The reporter randomly selected several items in the "Disease" column, and the "Prescription/Medical Record/Examination Report" column was empty. It was confirmed that "this disease has been diagnosed and the drug has been used, and there is no allergy history, related contraindications, or adverse reactions". The verification was quickly passed. After submitting the list, the system jumped to the consultation section.

Soon, there was a "doctor" receiving the patient, and several messages were sent in succession. The first one emphasized that "Internet hospitals only provide medical services to users for follow-up visits", and the following messages were all to confirm whether there was a history of allergy or in a special period. In the absence of a response from the reporter, the other party also sent a prescription and purchase link.

Beijing resident Yang Mu has also had a similar experience, suspecting that the person receiving the consultation behind the screen is not a real practicing physician: "When purchasing prescription drugs on the XX platform, I feel like the other person is no different from the robot. As long as I type it, the other person will quickly agree within a few seconds without giving any professional advice." Once, he deliberately described some situations that were not suitable for the intended medication, but the other person still quickly prescribed the prescription.

Many insiders believe that the "space separation" diagnosis and treatment is not suitable for all patients, and the re diagnosis of common and chronic diseases is the positioning of Internet diagnosis and treatment for a long time. However, there has been a lack of specific standards in the industry for what constitutes follow-up visits, leading to some regulatory vacuum.

"If it is a formal Internet hospital, the electronic prescription issued by a qualified doctor should have the signature of the doctor and the electronic seal of the Internet hospital. It is not ruled out that some small Internet medical platforms use AI, robots and other tools to automatically generate prescriptions. Some large platforms will use AI and other tools to assist doctors in their consultation, such as asking how old the patient is and where he is uncomfortable, but the prescription must be issued by the doctor." said Dr. Liu, a top three hospital in Beijing.

He also noticed that many platforms, in order to seek benefits, adopt the "AI prescription, customers directly take medication" model. The prescription issuance and review process is virtually non-existent, either directly skipping the prescription issuance process or not actually reviewing the prescriptions uploaded by users. Such behavior seriously violates China's drug management system and also poses risks and hidden dangers to patient medication safety.

Once patient information is leaked

Or be used to commit fraud

The online health platform consultation and consultation on whether personal information will be leaked is also a question raised by multiple interviewed patients.

Once, Yang Mu had a lot of red rashes on his back and went for a consultation on a certain health platform. However, within a few days, he received multiple advertising calls and text messages, including inquiries about hair transplant needs, promotion of skincare products, and even sales calls from loan companies.

"During consultations, will the personal information and health status collected by the platform be well preserved, and will this information flow to third parties?" Yang Mu was very worried.

Ren Wei, who lives in Changchun, Jilin, also has this concern: "Whether it is my own or my family's health problems, I am used to searching for relevant cases online as a reference, and I am particularly worried about my health information being leaked or even exposed."

Previously, the Ministry of Industry and Information Technology reported that many Internet medical apps had serious problems in the collection and use of personal information, including collecting personal privacy information beyond the scope, providing personal information to others without my consent, and collecting personal information unrelated to medical services.

According to media reports, a mobile security service provider conducted professional security checks on 10 popular medical apps, and the results showed that the security of these apps was very low, and even some apps did not take any protective measures.

"Compared to other types of apps, medical apps that leak personal information may lead to more serious legal issues. If personal health information is leaked, criminals may use this information to carry out precise fraud, such as using the mentality of 'seeking medical treatment in a hurry' to illegally sell or promote drugs to patients." Dr. Liu said.

Strictly review qualification conditions

Improve the drug traceability system

In recent years, in order to standardize Internet diagnosis and treatment behavior, normative documents such as Internet Diagnosis and Treatment Management Measures, Internet Hospital Management Measures, and Telemedicine Service Management Standards have been successively issued. In particular, the Detailed Rules for the Supervision of Internet Diagnosis and Treatment jointly formulated by the National Health Commission and the State Administration of Traditional Chinese Medicine in June last year set out detailed regulations on prescription review, privacy protection, diagnosis and treatment quality control and other social concerns in Internet diagnosis and treatment.

Li Yiling, a commentator in the medical field who has long been concerned about the phenomenon of online health consultations, believes that these regulations have gradually made clear provisions for medical institutions, personnel, business, quality and safety supervision, which is conducive to promoting the standardized development of online consultations. However, to completely eliminate consultation traps, regulatory departments and relevant platforms still need to work together to promote the industry on the path of standardization and normalization.

"The health administrative department should strictly establish an administrative licensing system, improve the electronic registration system of local Internet medical institutions and practitioners, carefully verify the qualifications of practitioners, and publish their photos, employment experience and main achievements in prominent positions on the platform, so that patients can be selective when consulting online." Li Yiling said.

He proposed that the Internet health consultation and consultation platform should achieve the goal of leaving traces throughout the process. For medical institutions or doctors and experts who plan to set up online consultation, the qualification conditions, including licenses, medical qualifications and credit records, should be reviewed in strict accordance with relevant regulations.

"The regulatory authorities should also strengthen information communication with the Internet health consultation and consultation platform, improve the mechanisms such as online informed consent of patients, review and reminder of regulators' backstage, and achieve dynamic supervision throughout the process. Once illegal behaviors such as cheating patients and selling counterfeit drugs are found, the online account should be closed in a timely manner and submitted to the relevant departments for legal accountability." Li Yiling suggested.

Deng Yong, a professor at the Law Department of Beijing University of Traditional Chinese Medicine, said that in order to implement the regulation of "strictly prohibiting the use of artificial intelligence and other automatically generated prescriptions", multiple factors must be considered and the status of artificial intelligence and other entities must be clarified. The current "Prescription Management Measures" and "Regulations on the Management of Medical Institutions" stipulate that the punishment targets are limited to "personnel". In the future, the special characteristics of artificial intelligence and other entities should be taken into consideration. For those who only generate prescriptions automatically by artificial intelligence and other entities, the responsibility of medical institutions should be directly pursued, just like "using non health technology personnel".

In addition, it is necessary to improve the drug traceability system. "The relevant departments should increase the review of the authenticity of prescription sources, establish a strict review system for prescription sources, and improve the laws and regulations on prescription sources. Take advantage of the Internet, make full use of the two-dimensional code recognition function to do a good job in the review of online prescriptions. At the same time, completely retain transaction records and transaction evidence, to ensure that the supervision can trace the source," said Deng Yong.

Guo Sheng put forward suggestions from the perspective of patients: patients should first understand that "even Internet hospitals that officially provide Internet diagnosis and treatment services cannot provide the first diagnosis service for the first time, and the first diagnosis must go to offline medical institutions for diagnosis". If it is a common disease or chronic disease, you can choose to go through a regular Internet hospital. For health consultation platforms, patients can learn about health knowledge, such as popular science about common diseases and contraindications for the use of common drugs. If such platforms involve providing specific diagnosis and medication advice for specific diseases, it is suspected of violating regulations.