Next time you need to go to the doctor, instead of making an appointment, why not just fire up your smartphone? New programs by companies such as Doctor on Demand and the University of Pittsburgh’s AnywhereCare offer one-on-one conferencing with doctors, either over the phone or through video on your phone or computer – giving you all the medical advice you need without having to set foot in a doctor’s office. This new breed of checkup, known as telemedicine, has the opportunity to revolutionize personal health, says Pat Basu, chief medical officer of Doctor on Demand and a former Stanford University physician. “Two of the most important skills we use as physicians are looking and listening,” he says. “Video conferencing lets me use those skills and diagnose things like colds, coughs and even sprains in a manner more convenient for you.” Here’s how it works – fire up the app, register and list your symptoms and any medication you are taking or allergic to, and you’re immediately connected with a doctor. “I ask questions and have you describe your condition to me,” Basu says. “I can even have you take a photo and upload it for me to see. So if you tell me you have a bunch of white spots on your tongue or a rash, you can send me a photo of that.” The average appointment lasts 10 to 15 minutes and has a flat cost of about $40 per appointment for both apps. (Some insurances offer free or reduced cost consultations with Doctor on Demand.) You’re then sent on your way with detailed instructions on how to proceed and, in some cases, a prescription, Basu says. “One of the things our system won’t let them do is prescribe any controlled substances, like painkillers,” he says. “But in some cases, we will prescribe antibiotics if we feel it’s necessary.” But Thomas Nesbitt, associate vice chancellor for strategic technologies and alliances at the University of California Davis Health System, says it isn’t prudent to be prescribing medication over this medium. “Overprescription of antibiotics is such a big problem in this country,” he says, “so physicians need to be extra cautious. Doctors need to run blood work or throat cultures to test for infection – you need information you just can’t get over video.” Basu agrees there are definitely cases where telemedicine isn’t the right choice. “This is really meant to be for acute care, not for chronic care like diabetes or hypertension,” he says. “For cases like that or when the patient needs to undergo tests, I refer them for an in-person visit.” Even though Nesbitt is an advocate for telemedicine, he admits there are issues that need to be ironed out before it becomes mainstream. “There’s the concern that without an established relationship, the standard of care may not be as good, because the doctor doesn’t know everything about the patient,” he says. “Health care requires authentic relationships, and I don’t think you can deliver as good care if you don’t have a relationship with the patient.” Using telemedicine frequently may also make it difficult for doctors to keep track of your medical history, since you will often see a different doctor each time, Nesbitt says. “Acute care on someone you’ve never met before is hard,” he says, “because you don’t know if the acute case is part of a chronic problem.” Doctor on Demand is trying to work around that problem by offering access to doctors a patient has seen before. “Once you’ve see one of our doctors, they reside in your favorites list, so you can request to connect with them again,” Basu says. “We’re trying to encourage continuity of care.” Telemedicine isn’t trying to get rid of doctor’s offices completely, says Lawrence Wechsler, vice president of telemedicine in the University of Pittsburgh Medical Center's physician services division, so you can’t look at it as a competitor to traditional office visits. “Anytime you have new models there are going to be advantages and disadvantages,” he says. “Patients and doctors need to weigh the pros and cons to figure out what’s right for them.” AnywhereCare, which launched in 2005, sets up patients with doctors in as little as 30 minutes. “It’s a way to maintain contact with patients for things that are relatively minor,” Wechsler says. “If we run into a situation that a doctor can’t handle over video, we can tell the patient to come into the office.” AnywhereCare is only available in Pennsylvania at this time, but Doctor on Demand, which has been available since late 2013 and connects users with more than 1,000 doctors, is offered in every state and the District of Columbia except Alaska, Arkansas and Oklahoma. As time goes on, Wechsler says, the technology will only get better and likely become available nationwide. “Our goal with all this is to drop the ‘tele’ part,” he says, “so this eventually becomes just another way to practice medicine. Those who like it will use it, those who don’t will continue to come in just like they do now.” source
