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Virtual Visits To Doctors Spreading
tresho writes to tell us that virtual doctors visits seem to be on the rise. A new service, most recently deployed in Texas, from "NowClinic" is allowing doctors to make virtual house calls and prescribe anything short of controlled substances. "For $45, anyone in Texas can use NowClinic, whether or not they are insured, by visiting NowClinic.com. Doctors hold 10-minute appointments and can file prescriptions, except for controlled substances. Eventually they will be able to view patients’ medical histories if they are available. The introduction of NowClinic will be the first time that online care has been available nationwide, regardless of insurance coverage."
It's like a whole 'nother country.
The World Wide Web is dying. Soon, we shall have only the Internet.
Hell, most online pharmacies will find you a doctor to prescribe non-controlled substances!
the growth in cynicism and rebellion has not been without cause
Right, there's already a good free alternative: Yahoo Answers
It sounds like a good idea.
I hope the physicians are covered by some sort of indemnity so that they won't be sued for something that they cannot possibly figure out via a video phone and 10 minutes. Otherwise you'll see doctors figure out that it's just not worth the risk.
As a physician, I'll be happy to participate in something like this so long as my exposure to lawsuits is limited.
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Hi, is this NowClinic? Yes, I'd like to inquire about your special for the self-vasectomy.
Error reading device 'Signature'. (A)bort, (R)etry, (F)ail?
Doesn't a "virtual doctor visit" necessarily imply that there are virtual doctors? If so, please send me a check for $45 and proceed to http://www-ai.ijs.si/eliza/eliza.html
Thanks.
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grabbin' pills!
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If you call around asking doctors' offices if they'll see you for $45 cash at the time of service for an uncomplicated visit, you will not have to make many calls before you have a taker. This is already an option, "whether or not they are insured".
A dozen years ago I was a reporter in the Texas Panhandle and the Texas Department of Criminal Justice used "telemedicine" extensively. Interesting to see them finally moving it to the general population (no pun intended.) IIR, the patients/inmates were of mixed opinion on it, but the remote doctors seemed to prefer it ;)
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This sounds like a good idea.
A lot of the immigrants from Mexico and Somalia that have settled here (northern Colorado) could use this. We have a local clinic that is always so busy that you have to call first thing in the morning to get an appointment. I'd think that if they did offer this service, it'd be a big help.
Its nice to see the medical industry take steps to modernize finally.
Problems with visiting the doctor in person:
If you are sick you have to make an appointment - and wait. If you cant wait and you need answers you go to the ER (bad for many reasons)
If you are sick you have to drive to the doctor when the appointment comes, or get a ride or ride public transit and share the germs etc (bad for many reasons)
When you get to the doctors office, you wait with other sick people. (spread the germs - bad on many levels)
You speak to 2 people before you speak to the doctor (cost of receptionist, cost of nurse, miscommunication possible)
Skipping all of those steps may be a good idea for things where physical testing etc isn't needed.
Dj fuQ [url="http://djfuq.org"]djfuq urges you to listen to the beats[/url] [url="http://djfuq.org"]http://djfuq.org[
Seriously is this a good thing?
In the UK we have a service "NHS Direct" which is effectively a triage service which tells you whether you need to go to a doctor. Its in no way shape or form a replacement for a direct doctors appointment its just there to filter out cases that aren't overly serious or are serious enough to need an emergency visit. This service is staffed by nurses and its pretty good and does help with people who are concerned about medical issues.
The idea of someone prescribing drugs via this sort of service is just insane. It would be smarter to delegate prescriptions, or at least re-issuing prescriptions, to pharmacists who will at least see the patient. Or are we going to a world where you don't see the doctor and you get your drugs shipped direct so you never ever see anyone with any sort of medical training who can just briefly add a sanity check to the whole thing.
Its hard to imagine a better example as to why the US system is completely and utterly fucked than this being considered a good thing.
An Eye for an Eye will make the whole world blind - Gandhi
Can you show me where the "Prescribe Meds" button on Yahoo Answers is?
Say goodbye to this type of innovation if things continue down the pathetic road we're on. Thanks, politicians!
Why the hell should I have to take time out of my day to go sit in a doc's office for a hour, for a 30 second consult, to get my prescription meds? If I can do it from the privacy of my own home, and the doc already has access to my charts, why not?
OptumHealth, a division of UnitedHealth Group, the nation’s largest health insurer, plans to offer NowClinic
When the devil hands me a gift I'm wary of opening it...
One might hope that it is pretty close to the "auto euthanise" button.....
The secret of success is honesty and fair dealing. If you can fake those, you've got it made. (Marx)
This is a bad idea. No, this is a TERRIBLE idea. With a virtual doctors visit you are missing out on a very important component of data collection leading to a diagnosis; the physical exam. Without ascultation, you are missing out on a ton of information about a patient's cardiovascular, gastrointestinal and pulmonary systems. Without physical contact, you cannot perform any kind of neurological or musculor skeletal exam, or even really determine a patient's mental status, especially if you are using just a instant messenger style window for communication. I think it is highly irresponsible and certainly opens up a practitioner to a lot of liability to be diagnosing and prescribing meds in such a manner. As a doctor, I'd say this is not for me. And as a patient, moreso.
To see how effective this is as a diagnostic mechanism(and I don't mean some bullshit anecdote/contra-anecdote thing, I mean a genuinely rigorous study).
On the one hand, there are definitely lots of conditions that can be diagnosed, with fair accuracy, by basically asking the patient questions and traversing a decision tree. Heck, that slice of the population(and it is a large one) could probably be handled by an expert system no more complex than the one that makes calling most support lines an exercise in pain.
However, when you go to see the doctor, there are also a number of signs that the doctor looks for that a (cheap, nasty, web)camera isn't going to capture. Really shitty cameras aren't even going to let you see if the patient is flushed, pale, or an odd yellowish color. Even the nicest camera isn't going to tell you what the patient's breath smells like, or allow you to palpate some gland that may or may not be inflamed.
That's the real trick. While diagnosis, in the sense of traversing a decision tree based on symptom data, might very well be amenable to substantial automation(it might even be better as well as cheaper: computers don't get tired, don't suffer lapses of memory, and don't form snap social judgements based on primitive primate instincts); gathering the symptom data is going to be pretty tricky without good old fashioned face time. Suitably trained humans are really good at picking up social cues while talking with the patient, as well as the routine(but difficult to do with robots) work of taking temperatures, palpating organs, swabbing throats, and the like.
Whether or not this service is a good thing, it seems to me, will depend largely on one (empirically testable) point: There are conditions that are easy to diagnose over video chat. There are conditions that are hard to diagnose over video chat. How many conditions look easy to diagnose over video chat; but are actually something else entirely? If, 90% of the time, the doctor can say "Yeah, colds suck, sleep it off and get lots of fluids" or "Sounds like strep, fill this prescription and take as directed" and the other 10% say "Christ, man, get yourself to an ER right the fuck yesterday!" then this should save a lot of time and money. If, though, they can't usefully distinguish between these two categories, there will be trouble.
More generally, since humans are so good at gathering data face to face, I would be very curious to see an experiment with an alternate model: Instead of having patients see real, MD, doctors over video conferencing, what about having patients see, in person, cheaper nurse/tech types, who would be supported by a mixture of diagnostic software and teleconference with doctors? Still cheaper than seeing a doctor in person; but also allows a large number of common/safe tests, examinations, and sampling procedures to be done in person.
Aren't all prescription medications "controlled"?
What would be the point? Aren't all medications that require prescriptions before dispensing "controlled" substances, or are we talking about Schedule II only?
Or will they write "prescriptions" for overpriced formulations like Ibuprofen 800 (just take 4 of the over the counter 200s)?
I like the idea of telemedicine, I think it holds a lot of promise for reducing costs and increasing access (both in terms of speed and breadth of access), but it sucks we have to let our moronic prohibitionist mentality get in the way.
This is simply taking it to another level. Why make a pretense of actual examination when one can write a prescription serving as a bandaid to mask symptoms sight unseen and move on to the next "patient"? That's what most doctors do today anyway, except they go through a 5 minute theater of taking your vital signs.
This may be a good step, however, if it results in computers one day diagnosing patients. They will possess vast medical knowledge and will actually attempt to correlate multiple symptoms. Today most doctors seem utterly incapable of not only telling a cause from effect, but also of looking systemically at more than one symptom at a time. If anyone, god forbid, has a complex issue, most will diagnose it as 5 unrelated issues, and will treat them separately, at best helping none, and usually making it worse.
So for now, let's cut the pretense, and one day let's move to a system that may help patients instead of just separating sick people from their money.
End anonymous moderation and posting on
I assume these virtual doctors cure only virtual diseases.
America will shortly have a large influx of Docs from China doing virtual visits. This will be another form of outsourcing. the difference is that when docs screws up and kills someone, there will not be lawsuits. Instead, China will say that the doc did not have right to practice medicine even if they had been embraced by the Chinese gov. for the last 20 years.
The good news on this, will be that now, more professionals will re-think through what is happening with regard to the outsourcing back to China. I am just waiting for politicians to be outsourced. They will be just as corrupt, but at least will cost America less.
It's just Eliza repackaged
Most commenters have only mentioned that a web diagnosis is likely to be inferior to an in-person diagnosis. I generally agree with that statement.
What I feel people are failing to catch is that a web diagnosis, conducted by a qualified individual is better than no diagnosis at all.
How many people skip or put off doctor visits because they don't have the desire or time to block 2+ hours of their day for a 5 minute visit with a doctor? How many others can't afford $150+ for a visit? Now that you're thinking about those numbers consider how many people miss out the on the potential benefits of an early diagnosis.
If this service can expand access to medical care and encourage more people to seek care when they need it I think it could have significant benefits. I think it also has the potential to limit unnecessary doctor/ER visits.
As long as the doctors stay within the bounds of what they can really do on the web I think there is upside potential in this model.
There is no way in hell that a doctor can accurately and safely prescribe medicine after a 10 minute virtual visit with a patient, especially without a medical history or records of any kind. This is nothing more than a scheme to make money off of hypochondriacs and those who are uninsured.
Depending on your state, your medical board may not approve.
Per TFA, the Texas board seems to have a problem with it if doctor and patient have never met in person.
10 minutes?! Shit, I am sold! Here in BFE Indiana, you are lucky to get 30 seconds of your doctor's time for $65 and that is after waiting in the waiting room for two hours. Physical exam? You might get a whole minute of your doctor's time if they actually listen to your chest, look at your throat, nose, ears... Usually, it is just the 30 second "what hurts? Oh. Okay..take this OR, more commonly, it is a viral thing...drink plenty of fluids, rest, call me next week."
Why allow 10 minutes? Completely unnecessary! This online crap should only take a minute, not 10 and should be billed at $9.95/minute (limit of one minute to be enforced under ObamaCare). $600 an hour from the beach in the Bahamas is plenty...hell, make it a beach in a country without an extradition treaty and you can skip medical school! And you never need to go face to face with the contagious...how AWESOME is that?! Another Mai Tai please!
...a lawsuit in the making.
Prescriptions are controlled substances...otherwise you wouldn't need a prescription to get them!
>Why make a pretense of actual examination when one can write a prescription serving as a bandaid
>to mask symptoms sight unseen and move on to the next "patient"? That's what most doctors do today
>anyway, except they go through a 5 minute theater of taking your vital signs.
This is why I think this telemedicine is a great idea. Since the doctor examination is theater anyway, why not just run down the symptom checklist and guess at a prescription just like they do in doctor's offices anyway!
Most of the time I have gone to the doctor when I was sick they did not bother with blood work - they just prescribed some medicine to treat my symptoms. In the few cases where they did order blood work, I was well on my own by the time the blood work came back.
Hopefully the time is coming when you can go to your local drug store and get an instant blood test done by a machine, and then call up one of these tele-doctors to have the right medicine prescribed. Hell, maybe a computer will do the analysis and cut the doctor out of the loop entirely.
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So the company is setup in texas but where are the doctors? I have a bad feeling that you are actually calling doctors in india.
Next stop India. "Is there anything else I can help you with today?"
"The ferrets, they're every where I tell you!"
Get with the times, doctor, we're up to unicocultation now.
Really, that's all that's important.
Is it just me or does this sound like code for offshore outsourcing of doctors? If the doctor doesn't have to actually see you in person then the next logical question is: Does it matter where the doctor is physically located? If the answer to that is 'no' then you can bet your bottom dollar (or rupee if you prefer) that you 'personal physician' will be some video conference station linked to some 'doctor center' in India. Of course, most American senior citizens have a hard enough time understanding Indian accented English when the get 'outsourced to India' for phone tech support so just imagine how they will feel when their doctor is outsourced too as a 'cost saving' measure. The outsourcing of front line medical services (it is already being done with back office tasks like reading x-rays) may become the next big battleground issue in the offshoring debate; the demand is there, cost is the issue in health care, and the tech makes it possible or at least plausible.
I can't wait to cut ignorant (yet arrogant) and error-prone human doctors out of the loop altogether. I for one welcome our new virtual doctor overlords.
This definitely fills a need - sometimes you just need a little consultation or prescription without needing a full blown appointment. Or sometimes you don't know if your symptoms require a full blown appointment or not - this would let you talk to a doctor without going through all the rigamarole. $45 seems a bit steep for 10 minutes though.
or else!
This kind of service will blow the market open for an array of USB medical sensors. Subscribe to the service at a certain level and receive various gizmos for temp, BP, EKG, pulse Ox, and thoracic "listening." A simple webcam with a light would allow for visual inspection of just about any body part. In Belgium, one can get a doctor to make a housecall for about this much and they don't carry much more for diagnostics than what fits into a little black bag. Could work well for most.
Another brilliant idea! For those who have never seen a triage tag: http://en.wikipedia.org/wiki/File:Deconference-2002-triage-tag.jpg
The four color-coded groups at the bottom determine how long you can wait for treatment.
So think about doing this online:
Triage: Sir, are you breathing?
Patient: No, I am not.
Triage: Sir, do you have a pulse?
Patient: No, I do not.
Triage: Please print out the tag, select "Morgue," and tie it to your wrist. A hearse will be by to pick you up shortly.
Patient: Zombie gets ride in car . . . with braaainns!
Schroedinger's Brexit: The UK is both in and out of the EU at the same time!
...Its guaranteed to virtually pay for virtually everything with virtual money! Wooohooo!
While it may not matter where the doctor is physically located, I am sure it matters where the doctor is licensed. I doubt the Texas Board of Medicine, or any other state board, will license many doctors in a 'doctor center' in India.
This could actually be beneficial: getting people with highly communicable diseases "seen" without exposing to a whole bunch of other people in waiting rooms.
If they aren't sick, they aren't risking picking up something in a crowded hospital. If they are sick, they aren't going to be giving their funk to anybody or picking up a superinfection on top of their original problem. Empirical treatments like first line antibiotics don't require lab tests in most cases, and can drastically reduce the infectious potential of an affected individual.
To say nothing of the appointments for being prescribed birth control! As long as a woman has had a yearly, a basic interview is usually all a doc needs to prescribe birth control (though some places will want a pregnancy test).
Of course there will be cases that can't be diagnosed by this method, but by using this technology appropriately we could provide people with a service that could improve both their health and the well being of others while reducing some of the burden on in-person services.
Lisa: Maybe I ought to check with the doctor. ... diagnose. [pushes
[Lisa, Bart, and Homer gather around Lisa's
computer. She starts a program that displays a
medical logo -- the one with two snakes wrapped
around a staff]
Snake 1: Welcome to "Virtual Doctor."
Snake 2: From the makers of "Dragon Quest," and
"SimSandwich."
Snakes 1 + 2: Enter symptoms now.
Lisa: Let's see. [types on keyboard] Crusty sores?
Homer: Yes.
Lisa: Horrible wailing?
Homer: Yes, yes!
Lisa: Any exposure to unsanitary conditions?
Bart: Duh! We're pigs.
Lisa: [finishes typing] Okay. And
a key]
Virtual Doc: You've got: leprosy.
Homer +
Bart: Leprosy?! Aaah! [point at one another] Unclean!
Bart: Unclean!
Homer: Unclean! Help us virtual Doc! Look at me -- I'm on
my knees.
Virtual Doc: Goodbye. [leaves the virtual office]
[Homer and Bart whimper]
Get used to a lot of "virtual" medicine with Obamacare, like in it won't be there. The taxes will be real though.
an ill wind that blows no good
This service could work in conjunction with those Wal-mart clinics. I can also see were consumer medical equipment is instrumented for internet access thereby providing an online doctor with more information.
With the amount of Federal money currently tied up in health care reform there will be massive pressure to cut costs which means threat of Federal preemption of state licensing rules if states refuse cost cutting measures like out of state doctors. I am not saying that this is a good thing, but I can definitely see it happening. This, among other things, is one of the main reasons why so many Americans oppose health care reform as currently proposed because once the Federal government gets involved and Federal money starts flowing there will be strong pressure to centralize and control all health care and related issues at the Federal level. Naturally, this would constitute a massive expansion of the power and intrusiveness of Federal government; hence the visceral opposition of most freedom loving and clear thinking Americans.
Related to that, the Cleveland Clinic offers "Remove Medical Second Opinion". http://www.eclevelandclinic.org/myConsultHome It is a bit pricey, but this is one of the best medical centers in the world.
Thats a disgrace. For zero dollars I can go see a REAL GP.
Of course, I live in a country with decent health care (Australia).
A couple of posters, tongue in cheek, have mentioned offshoring. This is actually possible. Medical tourism has already begun and remote surgeries is beginning as well. It's only a matter of time before offshored medical care becomes common, probably driven by the health insurance companies.
Looks like medicine may be the next profession to tank.
putting the 'B' in LGBTQ+
Sounds great to me. Of course, I go to the doctor for one reason and one reason only: he has a prescription pad. I find that I'm usually better informed than he is about what's actually ailing me--something to do with him getting most of his continuing education courtesy of drug reps. Case in point... I'm a diabetic. My treatment? Low-carb diet and Metformin. His treatment? Low-fat diet and Metformin, then Metformin and Byetta, then I quit listening to him and went on a low-carb diet. Guess which one worked?
Another case in point... chronic asthma. His treatment? Steroids, inhalers, etc. etc. My treatment? Prilosec, as I thought it was being caused by Gastric Reflux (at the time a prescription med.) Guess which one worked?
In this day of Google, it's amazing how much a smart, critical thinker can find out about their own health. I just wish the law would recognize that with drugs that don't have high abuse potential, maybe I have the right to buy whatever I think would help me. Or maybe even with drugs that do have abuse potential.
"He who would learn astronomy, and other recondite arts, let him go elsewhere. " -- John Calvin, commenting on Genesis 1
What the heck does the ability to "prescribe anything short of controlled substances" mean when only controlled substances require prescriptions in the first place??!!??
I am not a number - I am a free man!
Could I open one like this and claim to be a gynecologist? If I'd get paid for watching webcam porn I'd be rich
dude, it's a script writing service :p anything more and would get sued into the stone-age.
looking at the how health operates in the US, they're giving the razor for free and charging for the blades. $45 for a con-sult and here's the repeats on 50 different drugs. You know who's pockets are going to be padded from this.
The sad thing is that they'll be going after the people that can't afford to see a "real-doctor" and will simply be promoting pill-popping.
A couple of GOMERs will get killed by some kid straight out of internship using this system, there'll be lawsuits, crying, hugging. Maybe some kind of new oversight or regulations and a bunch of executives will go for a swim in their money bin.
what can you say? it's not as though the "real" medical system in the US can handle the steaming-masses..
Doctors shouldn't fear this. All it does is keep patients from feeling pain. I was in major pain last night and all I needed to know was if i could take thee pain killer pills instead of two. Ended up going to the emergency room. Ended up with a better solution- but the emergency had to get an exception for me to be treated The severe pain I was kept me from sleeping and wasn't going away. I had been one different meds, seen lots of doctors, and had severe pain for over a month, and it was something that was on and off for several months. I had an appointment scheduled in a far away land (big city with a hospital with specialized division) 10 days away and this was the third time in the ER. They finally called that big far away hospital with the special division and found out how to treat me and it was so simple that they just did it on the spot. It took one hour.
"But, *of course*, $45 for a *guaranteed* ten minutes of access to an *actual* MD [or nurse practitioner or physician's assistant]is probably well... worth it (?)"
I used to joke with friends who worked in hospital about the fact that somewhere, out there, the world's least qualified doctor was practicing medicine. We all hoped that he improved without serious incident. All of a sudden, I have a prescient feeling that I know how to access his service without ever having him ask me to turn my head and cough. (Cue the sound of a throat clearing.)
Oh, and at $270/hr with virtually no overhead, the profits will be rolling in. And being that no one working for these companies need be located anywhere in particular, the wages and quality of service can go the way of all other off-shored business. I wonder if the docs will speak American English any better than the rest of their countrymen... in Bangalore or wherever the "talent" will be located? And what will they be called, Doctor 1U? Ironically, we can't import drugs from other countries legally, but that's because it interferes with profitable, established business models that the stockholder friends of congressmen pay to preserve. In this new case, the 'efficiencies' will be good for us all.
If this is new model is successful, someday you'll be able to lease time in a tele-medicine clinic and perform your own surgery, on yourself, from a distance. And if there's malpractice, you can still have a fool for an attorney, up close and personal, providing you survive.
They'll call the new service, Suture Yourself!
Doctor virtually visits you
>If this is what your doctor does, you need to find a new one.
This is what very doctor I've ever been to does. I've quit going to the doctor when I get sick, because there is no cure available. All they do is ask you what your symptoms are, and write a prescription for medicine to address the symptoms.
Really - I could check my symptoms off of a web page with the same level of effectiveness. The doctor is completely relying on me, the patient, to tell them what is wrong with me, so that they can prescribe the appropriate medicine.
>Perhaps your symptoms didn't warrant a blood test. There are hundreds of tests than can be ordered,
>they all cost money, and none of them are perfect. If someone has a cold, should blood tests be ordered?
>Of course not. The likelihood is that the person will get over their symptoms in a few days on their own.
>Ordering blood tests in this situation, on a macro level, will result in lots of false positives that
>lead to further work-up of non-existent problems. This leads to patient anxiety, possible iatrogenic
>diseases, and (even more) skyrocketing health costs.
Thank you for exactly proving my point. Because testing is expensive and often inconclusive, most doctors don't perform any real diagnostics on their patients. They simply ask them "what's wrong with you", and, based on what the patient describes, they guess at an appropriate medicine to treat those symptoms. I have often wondered what it would be like to just go to the doctor and say nothing more than "I am sick" and see if they could figure it out.
As it is, diagnosis is based on patient interview. A web page could do that.
I think most of the time going to a "doctor" is overkill. No doubt, when you have a serious illness or injury and they have figured out what is actually wrong with you, all those expensive skill sets definitely come into play in solving the problem.
But going to the doctor with any non-obvious illness is pretty much a waste of time. Nobody has the ability to actually diagnose.
I want my Star Trek medicine.
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If it is competently organised, it can work safely :
As long as it is only organised as a "first-line", just to take care of the most simple problem, and recommend going to a clinic for everything else.
Simple uncomplicated disease are much common than obscure syndromes (no matter what you might think after seeing "House, MD"). Lots of people come to the doctor just because they have the same flu/cold/runny nose as anyone else in town and just want to get a prescription for a couple of meds (As in "I don't have any aspirin left at home and need a prescription otherwise the insurance won't reimburse it").
If these phone- / web- doctors are limited to only obvious cases, and throughly ask the proper questions to be sure that nothing suspicious is happening, and clearly inform the patient that he/she should consult a doctor in real-life if anything new/unexpected happens or if the disease takes longer than it should, if everything is done clearly to identify which cases are simple and could be done over the phone, this kind of web-doctors could work. And in fact could help diminish the load put on clinics/hospitals due to simple uncomplicated cases.
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