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Old 1st December 2019, 12:19 PM   #1
LibraryLady
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"Doctor on Demand" and other telemedicine

I'm seeing a proliferation of online medical services, both physical and mental, and am, shall I say, skeptical about them? How does a doctor know when a patient isn't drug seeking or Munchausen? Can a real evaluation be done with no physical contact? I know there are situations, such as being in Antarctica, where actually meeting with the doctor might be impossible, but as a routine health practice, I find it suspect.

Phil McGraw, of "Dr. Phil" fame, is pushing the online service he created, and I think that's added to my unease with the idea.

Am I unjustified?
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Old 1st December 2019, 12:34 PM   #2
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I suspect they simply don't prescribe any opioids or other abusable drugs. They're more for simple stuff - sore throats, coughs, doctor's notes for work. Anything that seems too complex or risky will just get referred somewhere else.

But they can clear a lot of minimal stuff, and gatekeep a lot more, like saying a rash appears harmless, buy some cortisone cream, or looks contagious, call a doctor and tell them you may have a contagious illness before you go sit in the waiting room for an hour.
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Old 1st December 2019, 02:18 PM   #3
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Originally Posted by LibraryLady View Post
I'm seeing a proliferation of online medical services, both physical and mental, and am, shall I say, skeptical about them? How does a doctor know when a patient isn't drug seeking or Munchausen? Can a real evaluation be done with no physical contact? I know there are situations, such as being in Antarctica, where actually meeting with the doctor might be impossible, but as a routine health practice, I find it suspect.

Phil McGraw, of "Dr. Phil" fame, is pushing the online service he created, and I think that's added to my unease with the idea.

Am I unjustified?
Anything "Dr. Phil promotes, I am suspicious of. I would like to look into some honest reviews of experience people have had using these.
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Old 1st December 2019, 02:24 PM   #4
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Originally Posted by wasapi View Post
Anything "Dr. Phil promotes, I am suspicious of. I would like to look into some honest reviews of experience people have had using these.
Exactly. It might be a case of the stopped clock being right twice a day, but I've watched a lot of his show, for amusement and horror, and he's such a charlatan.
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Old 1st December 2019, 05:37 PM   #5
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I'll have to try it the next time my doctor's office staff tells me (regarding a medication I've been steadily on for decades) simultaneously: "Whatever you do, don't stop taking the medication," "No, your prescription can't be renewed/refilled until you've had an office visit," and "The next available appointment is in six weeks."
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Old 1st December 2019, 05:38 PM   #6
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Originally Posted by Myriad View Post
I'll have to try it the next time a doctor's office staff tells me (regarding a medication I've been steadily on for decades) simultaneously: "Whatever you do, don't stop taking the medication," "No, your prescription can't be renewed/refilled until you've had an office visit," and "The next available appointment is in six weeks."
Been there done that.
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Old 1st December 2019, 06:50 PM   #7
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Originally Posted by LibraryLady View Post
Been there done that.
Me too.
Doctor left the clinic.
"No, we can't refill until you see the doctor."
Who's the new one?
"You can see her in two months."
What now?
"Go to the walk-in clinic."
Ok, did that. One prescription with no refills.
Then had to make an appointment with the new doc for the next time.
Not just one, but TWO unnecessary appointments in order to keep my Rx's going.
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Old 1st December 2019, 06:53 PM   #8
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Originally Posted by wasapi View Post
Anything "Dr. Phil promotes, I am suspicious of. I would like to look into some honest reviews of experience people have had using these.
Dr. Phil is a PhD in psychology. Not a Doctor of Medicine. But he'd like you to think that.
Dr. Oz, on the other hand, is apparently a highly skilled surgeon. Who knows pretty much nothing about anything else.
Oprah has a lot to answer for.
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Old 1st December 2019, 07:36 PM   #9
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It seems like a good idea in general. As deadrose said there are probably a lot of routine and simple medical issues that can be solved by online consultation.

It could both save a lot of people's time and money for more minor medical issues and lead to people getting treatment who otherwise might not bother to go into to a clinic but would be willing to seek an online consultation. If the result of that is "Go see a doctor now." a lot of good might be done.

There are also some real issues so I'm not sure how this will turn out in practice, but I can at least see some potential for it.
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Old 1st December 2019, 11:30 PM   #10
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Originally Posted by Roboramma View Post
It seems like a good idea in general. As deadrose said there are probably a lot of routine and simple medical issues that can be solved by online consultation.

It could both save a lot of people's time and money for more minor medical issues and lead to people getting treatment who otherwise might not bother to go into to a clinic but would be willing to seek an online consultation. If the result of that is "Go see a doctor now." a lot of good might be done.

There are also some real issues so I'm not sure how this will turn out in practice, but I can at least see some potential for it.
Our provincial healthcare system (I'm in BC Canada) has had a free 'nursing hotline' for over 20 years - I'm thinking these ones described in the OP are similar. There's a lot you can do for patients who are describing non life threatening symptoms, usually annoying discomfort of some sort (runny nose, persistent cough, joint pain...), which is statistically the vast majority of complaints.

For anything that looks like it will need a physical exam, the hotline would advise either arranging a regular doctor's appointment or maybe even a hospital emergency room, or they have even called an ambulance when it's clearly urgent.

They're plugged into the provincial database that has a patient's history, so can take that into account when considering pattern behaviour like opiate seeking &c. Prescriptions would require ID to get filled, which is SOP even for a face to face visit.

We also have some private intermediaries supporting the public health system's MDs, such as my employer's version, which is called [Babylon] for some reason. And hey, there's an app.
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Old 1st December 2019, 11:35 PM   #11
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Originally Posted by blutoski View Post
Our provincial healthcare system (I'm in BC Canada) has had a free 'nursing hotline' for over 20 years - I'm thinking these ones described in the OP are similar. There's a lot you can do for patients who are describing non life threatening symptoms, usually annoying discomfort of some sort (runny nose, persistent cough, joint pain...), which is statistically the vast majority of complaints.

For anything that looks like it will need a physical exam, the hotline would advise either arranging a regular doctor's appointment or maybe even a hospital emergency room, or they have even called an ambulance when it's clearly urgent.

They're plugged into the provincial database that has a patient's history, so can take that into account when considering pattern behaviour like opiate seeking &c. Prescriptions would require ID to get filled, which is SOP even for a face to face visit.

We also have some private intermediaries supporting the public health system's MDs, such as my employer's version, which is called [Babylon] for some reason. And hey, there's an app.
Oh, something I forgot about all this. The long term goal is to build a telemedicine model that can be offshored at the first convenience.

The cost savings of migrating the MD suppliers from local BC physicians to a sweatshop call center in Mumbai are too big to ignore.
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Old 2nd December 2019, 04:26 AM   #12
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The first lawsuit whereby a serious condition wasn't caught early enough will ensure that "Doctor on Demand" will only ever recommend that you go to see a doctor in person.
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Old 2nd December 2019, 07:14 AM   #13
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NPR’s Morning Edition had a segment on this a few days again. They pointed out the extreme health-care shortage in rural America, where a great many small towns have effectively no medical facilities.
Vicious circle... A lot of rural residents can’t afford health insurance, so hospital visits are so low that local hospitals can’t stay open. The closing of a hospital, with all of it’s employment opportunities, often spells death for small towns.
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Old 2nd December 2019, 07:25 AM   #14
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I wonder if doctor via teleconference will be meaningfully different than the urgent care model. The few time that I've visited urgent care, they've instructed me to either go to the ER or schedule an appointment with a non-urgent care doctor. These hospital alternatives have very limited capability to meaningfully distribute medical care.

I could see tele-medicine being a useful tool for triage, but are they actually going to be effective ways to administer medical care?

Seems like a great way for insurance companies in the US to try to avoid paying expensive ER and clinic bills by insisting that their customers use this cheaper, sub-par system instead of receiving proper medical care.
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Old 2nd December 2019, 11:16 AM   #15
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Originally Posted by blutoski View Post
Our provincial healthcare system (I'm in BC Canada) has had a free 'nursing hotline' for over 20 years - I'm thinking these ones described in the OP are similar. There's a lot you can do for patients who are describing non life threatening symptoms, usually annoying discomfort of some sort (runny nose, persistent cough, joint pain...), which is statistically the vast majority of complaints.

For anything that looks like it will need a physical exam, the hotline would advise either arranging a regular doctor's appointment or maybe even a hospital emergency room, or they have even called an ambulance when it's clearly urgent.

They're plugged into the provincial database that has a patient's history, so can take that into account when considering pattern behaviour like opiate seeking &c. Prescriptions would require ID to get filled, which is SOP even for a face to face visit.

We also have some private intermediaries supporting the public health system's MDs, such as my employer's version, which is called [Babylon] for some reason. And hey, there's an app.
Also in BC pharmacists are authorized to perform certain tasks when a physician is not readily available. From their website:

Providing an emergency supply of medication
Reviewing the medications of those who take multiple drugs to ensure they work together
Providing vaccines, such as measles, flu, shingles, HPV and more
Renewing a prescription for up to a year
Advising and make changes to your prescription to avoid drug interactions
Helping smokers quit and providing access to free smoking cessation products
Providing emergency contraception
Advising on over-the-counter medications

Refilling a prescription should never be an onerous task here.
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Old 2nd December 2019, 11:54 AM   #16
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Most of a doctor visit is you telling the doctor what is wrong. Might as well do it over the phone.
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Old 2nd December 2019, 12:22 PM   #17
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Originally Posted by casebro View Post
Most of a doctor visit is you telling the doctor what is wrong. Might as well do it over the phone.
If I tell my doctor that I have discomfort in my chest he will listen with his stethoscope. He will likely also take my blood pressure.

If I ask about a lesion on my skin he will look at it. Closely.

If I go to him with a fever he will take my temperature, look in my throat and ears, and listen to my respirations.

When we discuss my chronic rotator cuff main my doctor will manipulate my shoulder to determine the current limitations to my movement.

Maybe you need to find a doctor that actually treats his patients.
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Old 2nd December 2019, 12:39 PM   #18
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Originally Posted by Steve View Post
If I tell my doctor that I have discomfort in my chest he will listen with his stethoscope. He will likely also take my blood pressure.

If I ask about a lesion on my skin he will look at it. Closely.

If I go to him with a fever he will take my temperature, look in my throat and ears, and listen to my respirations.

When we discuss my chronic rotator cuff main my doctor will manipulate my shoulder to determine the current limitations to my movement.

Maybe you need to find a doctor that actually treats his patients.
I am struggling to imagine what a remote doc could actually do that would justify such a system. Maybe a few small things here and there, but most things that warrant a trip to the clinic probably warrant some sort of physical exam. Maybe it could be useful to triage people who can't decide whether some minor ailment warrants a trip to the doctor.

I can't think of any of my doctor's exams in my life that could have been conducted remotely.
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Old 2nd December 2019, 12:44 PM   #19
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Originally Posted by SuburbanTurkey View Post
I am struggling to imagine what a remote doc could actually do that would justify such a system.
Cost less than an in-person one.
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Old 2nd December 2019, 12:48 PM   #20
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Originally Posted by Trebuchet View Post
Cost less than an in-person one.
Are you sure?
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Old 2nd December 2019, 12:49 PM   #21
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Originally Posted by Trebuchet View Post
Cost less than an in-person one.
Only if the visit can be conducted purely by sight/conversation.

I remember the big push by insurance companies to use urgent care facilities rather than the ER. The handful of times myself or my wife used one, they just sent us to the ER because their capabilities were extremely limited.
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Old 2nd December 2019, 12:50 PM   #22
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My Fiancee and I have used a teledoc a few times.

I think it can take some strain off other medical services. A question that often comes up is what kind of medical intervention particular symptoms warrant. Does this need the emergency room right now, a walk-in visit in the morning, a doctors appointment later in the week or just a trip to the pharamacy?

When she tweaked her neck throwing a garbage bag into a dumpster, they recommended a walk-in with an orthopedist. When I was having back spasms, they told me to try to sleep on it and hit the walk-in if it wasn't significantly better in the morning.

In both cases they gave us tips on what to do and what not to do to manage pain, stay comfortable and avoid aggravating the injury.

I'd say the advice worked out well.

Without the teledoc, since both injuries happened late in the day, we could have either gone to the emergency room (expensive and stressfull) or spent the night in pain wondering how much we had to worry.

The advice we got was reassuring, useful and appropriate.

YMMV
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Old 2nd December 2019, 01:45 PM   #23
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Originally Posted by Cavemonster View Post
My Fiancee and I have used a teledoc a few times.

I think it can take some strain off other medical services. A question that often comes up is what kind of medical intervention particular symptoms warrant. Does this need the emergency room right now, a walk-in visit in the morning, a doctors appointment later in the week or just a trip to the pharamacy?

When she tweaked her neck throwing a garbage bag into a dumpster, they recommended a walk-in with an orthopedist. When I was having back spasms, they told me to try to sleep on it and hit the walk-in if it wasn't significantly better in the morning.

In both cases they gave us tips on what to do and what not to do to manage pain, stay comfortable and avoid aggravating the injury.

I'd say the advice worked out well.

Without the teledoc, since both injuries happened late in the day, we could have either gone to the emergency room (expensive and stressfull) or spent the night in pain wondering how much we had to worry.

The advice we got was reassuring, useful and appropriate.

YMMV
Triage and preventing needless worry are worthy goals. How did you choose the service you use?
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Old 2nd December 2019, 10:05 PM   #24
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Originally Posted by Steve View Post
If I tell my doctor that I have discomfort in my chest he will listen with his stethoscope. He will likely also take my blood pressure.
Computer mic and optional USB sphyg.

Quote:
If I ask about a lesion on my skin he will look at it. Closely.
Macro webcam

Quote:
If I go to him with a fever he will take my temperature, look in my throat and ears, and listen to my respirations.
Buy a thermometer. Camera, Mic.

Quote:
When we discuss my chronic rotator cuff main my doctor will manipulate my shoulder to determine the current limitations to my movement.
Ummm hmmm....got it! Bring a neighbor over - does this hurt (twist)?

Quote:
Maybe you need to find a doctor that actually treats his patients.

I'm kidding above, but kinda not. Perhaps Amazon will sell a Dr. Kit (with fake reviews) that you plug into your computer. Sphyg, thermo, camera, mic for the heart and lungs, anal probe...

You get your Doc on chat and plug that junk into your USB port, then into yourself. Heck an Apple watch has an EKG right? I can't believe people actually want that, but could be useful in this scenario.

Beats sitting in a waiting room for hours with annoying sick adults and kids.

Also, when I tell my doctor (er, "practitioner") my symptoms, a lot of times they appear to be looking it up on a website. I can do that! Where do I buy my kit? I already have dental tools.

I've been misdiagnosed twice by my doctor recently (I asked for a new one and got one), so they aren't perfect either.

In fact the older I get the more I learn that it is very helpful to do your own research.

Finally, this virtual doctor thing is going to be the new norm someday.
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Old 3rd December 2019, 07:55 AM   #25
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Originally Posted by LibraryLady View Post
Triage and preventing needless worry are worthy goals. How did you choose the service you use?
It was listed as a benefit from my partner's employer.
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