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Doctor visits by phone - a new trend?
Old 05-29-2008, 08:36 PM   #1
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Doctor visits by phone - a new trend?

What do you think of this service?

It's a physician network available 24/7/365 for physician-to-patient consultation over the phone. They don't give fees, but I'm guessing they will be in the range of a brief office visit, maybe $50 per call.

Could be the dream ESR job... , though my bet is that the devil is in the detail. I'll post back here if I learn anything of interest. But I'm curious as to the reaction of the group to the whole concept.
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Old 05-29-2008, 08:44 PM   #2
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I would feel kind of funny about having a doctor diagnose my medical problems over the phone. YKWIM? He wouldn't have all the input, since he wouldn't be able to see me and do a physical exam.

I guess it would be OK for just asking questions, or to get my cholesterol med prescription renewed, or if I know I have a cold and want a doctor's excuse for work. But not if I am really sick or injured.

One advantage is that I wouldn't have to sit for two hours in a waiting room full of sneezing, snorting, sick patients with the flu or whatever, just in order to get my prescription renewed!
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Old 05-29-2008, 08:44 PM   #3
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I suppose it could work for some things. But if I tell my DR my ear hurts or I have this weird rash. How do you work that out over the phone.

We have this quickie mart type of service that has Nurse Practitioner's you can see and its really fast. I would probably prefer that. At least someone looks at you then can send you to the DR if needed.
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Old 05-29-2008, 08:53 PM   #4
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We use the nurse lines provided by our health insurance companies on occasion. It is a great "threshold" service that lets us figure out whether we need to go see the doctor and what to do if not. Nothing like taking a sick infant or toddler to the family doctor's office and waiting 2 hrs (while they whine and moan) in order to be fit into the schedule just to be told "yep, she's sick. Get rest, plenty of fluids, and OTC children's tylenol, 10 ml every 4 hrs".

Definitely wouldn't have a problem w/ a consult over the phone. Especially if I didn't have to wait for a long time to receive treatment.
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Old 05-30-2008, 10:04 AM   #5
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If the old adage: the exam begins the moment you lay eyes on the patient, and smell him/her, then phone exam does not work too well, I presume.
For follow ups where visual/olfactory/contact cues are not needed, then I think OK.

Would like to know MDs opinion on the service.
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Old 05-30-2008, 10:18 AM   #6
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I like the idea. The website could be fleshed out a bit to show more examples of calls that are appropriate. I thought it was funny to mention asking for narcotic prescriptions as an inappropriate use of the service.

I can think of some examples where this would be nice. I have bad pollen allergies as the birch are in bloom, with my eyes in tough shape. I was curious if the new allergy eyedrops with antihistamine are the same as the old prescription eyedrops I have taken in the past.
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Old 05-30-2008, 10:18 AM   #7
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If the old adage: the exam begins the moment you lay eyes on the patient, and smell him/her, then phone exam does not work too well, I presume. For follow ups where visual/olfactory/contact cues are not needed, then I think OK.
There is no way a phone visit can replace a face-to-face visit and I don't think anyone is suggesting that. For potentially serious concerns, symptoms requiring a "look" or hands-on evaluation, etc. a visit is necessary. And, yes, I make my diagnoses within 3 minutes most of the time (the other 17 are spent listening, educating, empathizing, or whatever other people-things are appropriate). A focused exam usually serves to confirm my diagnosis although occasionally there are surprises.

The phone visit is designed to help make judgments - is this symptom from a drug side-effect or something else? Should I make an appt to see my doctor for this headache or is it safe to watch it for a week? I'm getting forgetful - should I see my internist, a neurologist, or just give it some more time? I realized I just took two of my water pills instead of 1 - do I need to do anything?

In my 33 years of practice I have done a lot of phone medicine - it comes (abundantly) with the territory. In fact, probably half of my office visits could have been handled with a phone call. I think the service is designed to fill that niche, not to replace a visit when called for.

Nurse lines have proven useful, too, though with more limitations on what can be done or said. The phone visit deal I heard about allows me to prescribe medication, advise treatment plans, etc. when it appears safe to do so. BTW, they do not prescribe controlled substances or "lifestyle" drugs - I guess they mean viagra, weight control meds, etc.
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Old 05-30-2008, 10:25 AM   #8
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Thanks RiT. The last 3 paragraphs nicely sum up when it would be very useful.
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Old 05-30-2008, 10:26 AM   #9
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Internet video camera hookup between Doctor & patient might be useful.
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Old 05-30-2008, 10:28 AM   #10
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Internet video camera hookup between Doctor & patient might be useful.
Yes, that's the next level. It's used in a number of rural areas, Indian reservations in remote locations, correctional institutions, etc. The equipment is fairly costly, and a physician's assistant or nurse practitioner acts as the ears and hands for the physician.

Unfortunately, aside from those special circumstances it has so far proven impractical and is not consistently reimbursed.
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Old 05-30-2008, 01:15 PM   #11
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I can call and get an Rx renewed now without a fee, so I wouldn't want to pay for that.

I've wished I could e-mail a question to my doc at times.
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Old 05-30-2008, 01:20 PM   #12
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Yes, that's the next level. It's used in a number of rural areas, Indian reservations in remote locations, correctional institutions, etc. The equipment is fairly costly, and a physician's assistant or nurse practitioner acts as the ears and hands for the physician.

Unfortunately, aside from those special circumstances it has so far proven impractical and is not consistently reimbursed.
Actually in my area we do thousands of consultations every year using videoconferencing. It's used for psychiatry, pediatric developmental follow up, and much else. Kids in particular love being "on TV" and interact very naturally with the camera. it can also be used to read echocardiograms, retinal scans, etc, in real time. Even robotic surgery is possible, though we don't do that yet. While the infrastructure is costly, in my neck of the woods the cost of travel would be much greater. As for billing, in my (single payer, universal health care, Canadian) province, there is a billing code for videoconsults. Problem solved!
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Old 05-30-2008, 01:39 PM   #13
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I suppose its possible - kind of like the New York surgeon that removed a woman's gallbladder in France.

The Badger Herald - Doctors complete first transatlantic surgery

I would rather visit the doctor.
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Old 05-30-2008, 02:12 PM   #14
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Actually in my area we do thousands of consultations every year using videoconferencing.
Interesting. I suspect that until there's a way someone can make money at it, it is unlikely to happen other than in small niches as mentioned earlier. For the agency I found, the primary clients are large employers and insurance carriers. In that setting, the savings are seen by the carriers as real money.

I did learn a little more about the phoneVisit protocol. They maintain an on-line medical record for participating patients. This can be accessed on the web or over the phone via a dictation retrieval system. All the calls are routed through a central phone server and they are matched with the right specialty as well as being able to do a follow-up call with the same physician.
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Old 05-30-2008, 03:30 PM   #15
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I think health care is heading to any other customer service industry. That is non existent or just a facade. Phone work seems the logical next step. To few people taking care of too many.
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Old 05-30-2008, 03:59 PM   #16
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If this can all be done electronically, with access to the medical records, why should an insurance company pay you $50? They could outsource it to India and pay a physician there $5 a visit.
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Old 05-30-2008, 04:56 PM   #17
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If this can all be done electronically, with access to the medical records, why should an insurance company pay you $50? They could outsource it to India and pay a physician there $5 a visit.
It would be practicing medicine without a license.

Even in the US of A, I could only take calls from Florida residents (since I am licensed in Fla) because license jurisdiction is by state in most cases.

BTW, that $50 fee (or whatever it is) would not go 100% to the doctor.
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Old 05-30-2008, 05:03 PM   #18
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If this can all be done electronically, with access to the medical records, why should an insurance company pay you $50? They could outsource it to India and pay a physician there $5 a visit.

I dont see why either. They could easily change the rules if the insurance industry applied enough pressure
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Old 05-30-2008, 05:07 PM   #19
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Rich you mentioned the availability of medical records online. I go to the Cleveland Clinic and all patient records are online. I can see the results of any tests and make appointments and receive e-mail from my doctors. It is truly wonderful!
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Old 05-30-2008, 06:04 PM   #20
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Rich you mentioned the availability of medical records online. I go to the Cleveland Clinic and all patient records are online. I can see the results of any tests and make appointments and receive e-mail from my doctors. It is truly wonderful!
Most advanced centers have electronic medical records, but most do not have a "patient portal" just yet. I think it's a great idea.
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