I am all for advances in technology – it is what makes medicine more of a science than an art – but… I think we are heading in the wrong direction. In USA Today’s Money Section there is a front page article titled: The Doctor will see you now – online. The article says that Internet sites run by NowClinic, which is a subsiduary of United Health Group, which is the parent of United Healthcare Insurance company, is actively treating patients via the Internet.
The article mentions a patient that was diagnosed online with an upper respiratory infection and given a prescription for an antibiotic. This “doctor visit” only cost 45 dollars. The fee may be a bargain, but not when the patient is being short-changed. I truly cannot think of one time that I have gone to the doctor and thought for a second my ailment could have been treated over the phone… or worse, the Internet.
My medical training has taught me to assess a patient’s condition from their facial appearance and gait. A physical exam for asthma or bronchitis patients is critical in deciding if a chest X-Ray, antibiotics, or no medicine at all is needed to heal the patient.
The other issue is, of course, how well your doctor knows you. I feel confident advising one of my patients that I know well and have examined in the past over the phone, but many times if they continue to feel unwell, I strongly advise them to come in for a visit. I’ll never forget the patient who called me and said she had broken out in hives and the itching was terrible. She pleaded with me to call in some cortisone because it had worked when this happened in the past. However, she also had a fever and the combination worried me. I asked that she come into the office the next day. Her diagnosis wasn’t hives… it was the Chickenpox! She had caught it from her daughter – she had never had Chickenpox as a child. If I had prescribed oral cortisone it could have been disasterous!
My feeling is that “Virtual Care” can be a virtual nightmare. The insurance companies have a vested interest in this type of care – cost containment. If you don’t go to a doctor’s office you will probably get less care, and they, in turn, save money. And to think things couldn’t get any worse – RiteAid Pharmacies are testing out these NowClinics in their stores to replace their current clinics, which are staffed with doctors and nurses. Yikes!
There is one area of medicine where I think Telemedicine may have some benefit and that is with skin rashes. I frequently ask patients to take photos of their rashes and send them to me so I can evaluate their condition as quickly as possible as rashes can frequently change.
I teach at The Touro College of Osteopathic Medicine in New York City. I enjoy training these doctors in using their minds and their hands – they are specially trained in physical manipulation to relieve certain medical conditions. I would hate to see these young doctors who will have much to offer their patients reduced to a 17 inch monitor where they cannot use the skills they have learned and that medicine needs so desperately… now more than ever.