This doctor does e-mails, not house calls...

[Nords]

Hey, Rich, here's your chance to get in on the ground floor of the latest medical trend:

Internet helps doctor get back to basics

Stark has moved most of his practice, based in Washington, onto the Internet and he couldn't be happier. Since he started his Web-based service two years ago, he has received 14,000 e-mails.

 

[RetireeRobert]

That is great for lots of patient questions. But how can the doc make remote diagnoses all the time? At some point it seems like the doc has got to see things "live and in living color".

 

[Rich_by_the_Bay]

I imagine that license issues will arise shortly. I can't even give one of my own patients advice across state lines when they are travelling (at least officially). Of course if they don't tell me where they are, you would assume they're local...

 

[travelover]

I had a doc for a while at a local university affiliated clinic that would give advice via email. It was great and saved me a lot of time and expense. For simple stuff, I think it should be reimbursed and encouraged.

His replacement doesn't do the email thing and I've since drifted to a closer clinic that is more patient friendly.

I'd add that my insurance company has a 800 number or email chat with nurses that is free, though I have not used it. Seems like a good idea.

 

[Rich_by_the_Bay]

I have toyed with the idea of a post-FIRE medical coaching web site, not too different from some of the semi-serious replies I occasionally give here: general information, what to ask your doctor, sound evidence, working through decisions, etc.

It would be fun, but concerns about liability and licensing are too great. Maybe you can get around it with waivers, consents, etc. but despite all that, it would take only one user who did poorly and claims it was because of something I advised, etc.

Then again, there are lots of medical columnists doing just that...

Doing it within the confines of a practice and restricting it to patients you know seems do-able, though -- really little different from a phone call.

 

[FUEGO]

I noticed through our health insurance website (aetna), some doctors can send/receive emails from patients. My docs don't use this yet, but they might someday soon.

 

[sailor]

I see it more and more.
You can send a message to any of our Kaiser doctors through Kaiser web page.
Also our pediatrician responds to emails (which we frequently use instead of follow-up calls).

 

[CyclingInvestor]

That is great for lots of patient questions. But how can the doc make remote diagnoses all the time? At some point it seems like the doc has got to see things "live and in living color".

This could lead to some funny incidents / positions with the scanner or webcam.

 

[pfpelican]

"Now make an incision...."

 

[HFWR]

This could lead to some funny incidents / positions with the scanner or webcam.

Your x-ray came back, and we think we've found a problem...

 

[Nords]

I see it more and more.
You can send a message to any of our Kaiser doctors through Kaiser web page.
Also our pediatrician responds to emails (which we frequently use instead of follow-up calls).

A year later, looks like the concept is spreading:
Is There A Doctor In The House? Yes, Just Use Your Mouse | MidWeek Cover Story | Midweek.com

It’s HMSA’s Online Care, and it’s the first system of its kind in the nation. [...] And while there are those who hail it as a revolutionary new step, the program is drawing its share of critics. The Hawaii Medical Association, which represents the state’s doctors, has yet to take an official position on the program, but individual doctors are speaking out about their concerns about this new physician-patient relationship.
The Hawaii Medical Board, which licenses Hawaii’s doctors, also has its questions, although executive officer Connie Cabral didn’t want to go into details as the board is still in discussions with HMSA about how to resolve those issues.

With Online Care, you can connect with a doctor right away, with no waiting in waiting rooms or juggling appointment schedules. First, log on to Hawaii Medical Service Association and click on the link to Online Care. Choose the doctor you wish to speak with. You can search by specialty, the language the doctor speaks and even review the doctor’s education background and patient-satisfaction ratings. Before logging on, you type the nature of your concern, choose if you want to make your health history available to the doctor, indicate which pharmacy you would like any prescriptions sent to and enter your credit card information. When you’re ready, click connect, and your consultation begins either via videoconference, secure chat or telephone. HMSA members pay a $10 co-pay for a 10-minute consultation (non-members pay $45). During test runs, the 10-minute time block has proven more than ample, says Michael Stollar, HMSA’s vice president for corporate communications. If you want to extend the consultation, another five minutes costs $5 (or $12.50 for non-members).

 

[deserat]

While working at Kaiser, we were furiously building infrastructure and using technology for this type of 'telehealth' - and based on my last consulting gig and upcoming ones, this is the future. Lots of issues to resolve for wide adoption, however, if just half of those issues are fixed, then this will expand greatly. It's basically having the consumer market push the medical market using the existing and near future networking infrastructures.

 

[Rich_by_the_Bay]

It's better than the phone because it self-documents.

It's worse than the phone cause you can't use your intuition to know when this patient "just doesn't sound right."

Sometimes patients get annoyed when you tell them this is not something we can safely deal with via email. It's not always just to generate more office visits.

It needs to be reimbursable at some point, or you'd spend unpaid hours a day (or practice with a "capitated" panel where you are reimbursed by the number of patients, and the email is an efficiency tool).

It's liability issues are unexplored.

You cannot legally do this if the patient is out of state, for licensing reasons.

But still, I think it will be overall positive.

 

[FUEGO]

Rich, what is reciprocity like for MD's between multiple jurisdictions? Can you hold multiple state licenses concurrently?

 

[Rich_by_the_Bay]

Rich, what is reciprocity like for MD's between multiple jurisdictions? Can you hold multiple state licenses concurrently?

You can hold licenses from any number of states, but you have to apply separately for each one. They are expensive to obtain and to renew. I held 3 at one point.

There is no reciprocity other than that the fed accepts any valid state license for practice in a federal facility.

It's a royal pain, and the requirement for every state are 99% the same. Some take 6-9 months from completion. It should be federal by any logical argument, but not so.

 

[FUEGO]

So you could staff an email/internet based medical practice if you were to get each of the docs licensed in multiple states and they were to only handle issues from the states in which they were licensed? It would be an interesting business model.

 

[BunsGettingFirm]

Your x-ray came back, and we think we've found a problem...

Yes, I see the problem. The problem is that you're a monkey because humans don't have bones in that area -- unless you meant to depict that the implant broke. In that case, my condolence to the patient.

 

[Nords]

A few months later, I think we've found a downside to the telemedicine concept:

http://www.starbulletin.com/news/20090711_Former_dial-a-doc_on_Kauai_pleads_guilty_to_5_drug_charges.html

Considering the controversy swirling around Michael Jackson's death, I bet the doc's lawyer advised him to plea-bargain.