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."

Comments

Re:Slashvertisement

[Brian Gordon]

Right, there's already a good free alternative: Yahoo Answers

Re:Slashvertisement

[Anonymous Coward]

How is Babby formed?

How girl get pregnant?

(captcha : excavate)

Finally moving into the "public sector"

[ubrgeek]

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 ;)

Don't worry about the quality, feel the cost

[MosesJones]

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.

Re:Don't worry about the quality, feel the cost

[fuzzyfuzzyfungus]

When they say "controlled", in this context, they mean something distinct from "by prescription only".

You have over-the-counter drugs, which you can purchase freely(unless, like Sudafed, they've been caught up in the War on Drugs(tm) in which case you still don't need a prescription; but you will face a hassle).

Then you have prescription drugs, which you'll need a doctor's OK to buy, and you'll only be able to get from a pharmacist.

Then you have "controlled" substances, which are generally prescription; but are also of interest to the DEA, generally because they are either exciting narcotic painkillers, or amphetamines, or suchlike. Those tend to have additional restrictions in terms of how much can be supplied per unit time(ie. 1 month supply only, vs. 3 month supply) and doctors are more likely to face investigation if they are perceived to be oversupplying the stuff.

Then, of course, there are "dietary supplements" which are subject to almost no regulation whatsoever.

Re:Don't worry about the quality, feel the cost

[icebrain]

Disclaimer: I worked in a pharmacy for a while.

As I remember it, the "controlled substances" were broken down into a couple different categories. Class IV drugs were things like percocet and other narcotic painkillers. They had some abuse potential but were still fairly common. You could get refills, but there were generally limits on quantity dispensed and (IIRC) you couldn't transfer them. These were stocked with the rest of the "regular" prescription drugs.

Class III drugs were more controlled for whatever reason. We still kept them stocked on the regular shelves too.

Class II drugs were the real heavy stuff, like methadone and adderall/ritalin. Those were kept locked up in a safe, and we had a continuing inventory sheet where we kept track of exactly how many were in stock. No refills on these suckers. I think this also included things like morphine and such that weren't stocked in a retail pharmacy but would be issued at a hospital, for example.

Class I drugs were illegal--cocaine, meth, pot, etc.

There were also special ones that got treated just like Class II (at least the locked-up and inventory part) because they had a high theft potential, like Viagra. That was a company policy, though, not an FDA/DEA requirement. I think there were also Class V drugs (can't remember what was special about them), and I think Class VI was "ordinary" prescription drugs.

You'd be amazed how many people would do things like claim their pills were "stolen" or try to change the quantity on the prescription. Usually it just took a phone call to the issuing doctor to confirm a bogus story before we called the cops. I helped take down a couple prescription fakers and a check fraud guy :)

Re:Lawsuits galore?

[nomadic]

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.

As a lawyer, I'd hope that if a doctor risks harming a patient by practicing through video phone, then maybe they shouldn't practice through videophone.

Re:Slashvertisement

[Liquidrage]

Can you show me where the "Prescribe Meds" button on Yahoo Answers is?

Look at whose backing this

[LockeOnLogic]

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...

I am a med student, and I am horrified

[tpjunkie]

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.

Re:I am a med student, and I am horrified

[alrudd1287]

dude- whatever. if this stuff is actually needed, the person over the net will say GO TO A DOCTOR. This sounds like a GREAT idea from a cost-savings perspective, which is the only one that matters here. Often, patients go in for an appointment with a drug in mind that they just need a script for. Like if i have poison ivy, i need steroids because in the past the topical stuff hasn't worked. If I don't get it the first time then i'll have to go in a 2nd time... costing me or my insurance something like 150$ each. clearly an online person could save alot of money here

Re:I am a med student, and I am horrified

[aleph]

Are you serious? More than $100? A visit to a non-bulk billing Doctor here in Aus will usually set you back $40-60. Typically you get ~$30 back from Medicare, but that's the rate for a 15-20m consult. Random person from street can rock up for that, no government subsidy involved.

Re:Lawsuits galore?

[natehoy]

As a patient, and it pains me deeply to say this... I'd have to agree with a lawyer.

There. I said it. I agree with a lawyer on something. I'm going to hell now.

But seriously, we use our insurance company's "dial-a-nurse" service and it works well if you have some idea of what is wrong with you and just want some "best practices" advice, like "I have either a cold or the flu, can you help me determine which it is, and what symptoms I would indicate that I should see my doctor as opposed to drinking plenty of fluids and staying home?"

I can see a service like this being useful for other minor ailments that are relatively easy to diagnose based on clear symptoms, but that require medications that need a prescription. I'd hope that any doctor who was concerned about it being "maybe this or maybe that" wouldn't just take a guess (or render a medical opinion beyond their training) and hide behind some special immunity from lawsuit. But that doesn't mean I'd want to extend that immunity. If you're unsure of your diagnosis because you can't get enough information, the correct answer would be "I cannot help you, proceed to an in-person clinic in your area, this will be a no-charge courtesy call, 'kthanksbye!"

I'm not saying that a service like this would be useless, but if a good relatively confident diagnosis is not practical, the answer is to refer the patient to an in-person diagnosis, NOT to protect the doctor from indemnity if they made a diagnosis based on insufficient data because the tools they chose to use couldn't give them the data they needed.

Of course, that argument also leads down the slippery slope of requiring an MRI for a splinter removal as a lawsuit-prevention device, but any doctor who chooses to use "telediagnosis" should be aware of the limits of the technology and adjust their confidence in their diagnosis accordingly.

Better than no visit at all...

[ravenscar]

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.

Re:Nationwide, for anyone in Texas?

[Shakrai]

It's like a whole 'nother country.

Actually I have a funny story about that. I called Dell once upon a time to get a warranty replacement for a power supply that had gone up in smoke. My company has a support agreement with them and is supposed to receive priority support from Americans. Somehow I wound up in the queue talking to the morons from New Delhi. That went something like this:

Heavy Indian Accent: Thank you so much for calling Dell, my name is "Bob" (yeah, I bet it is buddy....), how many I assist you?
Me: *sigh* (well, might as well give it a shot) "Yeah, I have a bad power supply here and I need to get a replacement for it."
Tech Guy: Yes, yes, I am understanding that you have a bad power supply. Please insert the system diagnostics CD into the CD-ROM drive.
Me: I can't do that. When I plug the system in sparks come out of the back.
Tech Guy: Yes, yes, I am understanding your problem, please insert the system diagnostics CD into the CD-ROM drive.
Me: No, you don't understand, I can't plug the system in, the power supply failed.
Tech Guy: Please insert the system diagnostics CD into the CD-ROM drive.
Me: (trying different tack) I can't get the CD-ROM drive to open.
Tech Guy: Yes, I understand, is the computer plugged into the wall outlet?
Me: (back to square one) No, sparks will come out of it.
Tech Guy: Please insert the system diagnostics CD into the CD-ROM drive.
Me: *click*

So I call them back and go through the same exact menu system. Somehow I wind up with an American this time. He had the thickest Texan drawl that I've ever heard in my life.

Tech Guy: Thanks for calling Dell, my name is John, how may I help you?
Me: John, are you in the United States?
John: No sir! I'm in Texas.

Needless to say I knew I had somebody on the phone that I could do business with ;)

Amazingly enough he didn't ask me to use the system diagnostics CD either. I don't know how he was able to troubleshoot my "sparks are coming out of the back of it" problem without the assistance of the system diagnostics CD, but somehow he managed.....

Re:Paying cash always helps

[Hatta]

Chances are, you're getting the same quality treatment no matter which you see. Most of what a doctor sees is really pretty routine and can be handled by a nurse or PA just fine.

Re:Nationwide, for anyone in Texas?

[jcr]

Dell Support is a business-school case study in how cutting corners and trying to save costs can piss away tens of billions of dollars of shareholders' equity. There was a time when Dell support was as good or better than the average in their industry.

-jcr

Re:Nationwide, for anyone in Texas?

[Shakrai]

The business support people are very good in my experience. I've had issues with Windows Server that Microsoft couldn't figure out but there was always some Dell guy at Level 3 that could come up with a solution. Figure that one out.

The consumer support group sucks donkey balls. It absolutely amazes me that I can buy a Lenovo (Chinese company) off the shelf and get an American on the phone but if I buy a Dell (American company) off the shelf I wind up talking to New Delhi. WTF is wrong with that picture?

Maybe we should all welcome our Chinese overlords, because apparently they can afford to pay us to work for them.....

Re:Nationwide, for anyone in Texas?

[EvanED]

Hell, I remember when Dell was ranked at the top of customer service ratings in PC magazines.

Re:let me be the first to say

[mcgrew]

That's the danger of a joke comment. If the mods don't get it, or if you fail at being funny, you lose karma, but if you succeed you still don't gain any.

If you see "the comedian" in somebody's achievements page, it's a sure sign they're not a karma whore.

Re:Nationwide, for anyone in Texas?

[NoKaOi]

You remember PC magazines? Is that what they had before web sites? You must be old.

Re:Paying cash always helps

[Anonymous Coward]

$45 for a guaranteed ten minutes of access to an actual MD is probably well worth it. I've been with my current doctor for 6 years now, and I've met her once when one of the RNs wanted to do an in-office biopsy

Wow - be glad you're not in one of those "socialist" countries that has government-run healthcare, or you might actually have to see the doctor every visit! And it would be 100% covered by your insurance! (Oh, the horror!)

Seriously though - I had a girlfriend who was a nurse, and I had some earwax impacted in one ear... I couldn't see the doctor until the next day, so I bought an ear syringe and asked her if she'd do it.. she said technically she wasn't allowed to, as it was a medical procedure.

I hate to think of what the hell goes on in the US, where RNs will perform friggin biopsies by themselves.

Cleveland Clinic offers virtual 2nd opinions

[cbunix23]

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.