Would you use virtual medicine?

[Marie]

Have you ever wished you could just email your doctor to ask a quick question? What if you could IM her? Or do a videoconference?

Virtual Medicine is on its way, at least, according to the Boston Globe.

Their article discusses some current virtual medicine "pilots" taking place in America - one study here in Boston, and another taking place in Hawaii.

I wasn't surprised to learn that the program in Hawaii was using software designed by American Well, a Boston-based Health 2.0 company that's looking to bring virtual medicine to patients through their insurance companies.

At first, I was a bit surprised by the price point - $10 for 10 minutes of online chat or video conference with a doctor? That seemed steep until I remembered that the average doctor's appointment lasts about 15 minutes - my copay is definitely more than $15, though. For simple questions like, "How serious is this?" etc. that pricing seems more than reasonable.

I was also a little surprised that HelloHealth didn't get mentioned in the Globe article (a little city rivalry, perhaps?) Dr Jay Parkinson has been working hard to provide his patients with a whole host of virtual medicine options (in addition to more traditional appointments) for some time now.

I think I love the idea of virtual medicine, the convenience, the practicality, but I'm still a little apprehensive. Could my doctor really diagnose me without even seeing me?

I'm sure the answer is "Yes, sometimes." But it's still going to take me a little while to get used to.

So, would you use virtual medicine if it was available to you?

[amanda]

Initially my thought was - Hey I'm all for replacing awkward phone conversations and waiting in the ER/doctor's office just to be passed around from receptionist to nurse to doctor to receptionist. Treatment via the web certainly would keep you from sitting close to someone who's potentially bleeding or sneezing everywhere.

Already we've seen this transition with many other industries. Within the last week I've gone to websites that offer the option to instant message someone who can: diagnose your computer, be your personal shopper, find library books for you, and give you advertising advice or a rate quote for your company. Instant messaging/email is, I think, already well on its way to replacing phone correspondence.

However, because IM and computer-to-computer communication is SO easy - I'm sure people are using it more than they actually NEED to. Ie: we've all gotten used to having a question answered within a few minutes thanks to internet searching. In fact, I've actually done a pretty good job of self-diagnosing minor ailments via the internet. So it DOES work. But, to be sure, I always got my self-diagnoses confirmed with an actual doctor's appointment. That confirmation is essential if you need medication or some other medical treatment.

I'm not sure doctors could properly diagnose via webcam or IM. They could certainly cover the questions that you get asked every time: "what medication are you taking? etc." Maybe you could do a pre-visit conference and then come in after? That could speed up the process in a way, perhaps. But as far as being absolutely certain about a diagnosis - I think you might actually want to be face-to-face.

And it seems like a doctor who provided this service would be setting him/herself up for a lot of added trouble. If they accidentally misdiagnose (seems pretty likely) - at the very least: a patient might needs to be re-treated. (They could also end up far worse off too.)

Even if they did properly diagnose the ailment via web - they would have to send you all of the information via web too. We'd be missing out on the free gauze, little ointment packets, and helpful illustrated directions - and we also be missing out on the physical interaction of doctor-patient. Would the doctor provide youtube links to show you how to properly dress your wound or send you a podcast about preparing at-home remedies? (These actually sound pretty cool.)

No matter what - I think we're going to get there eventually. Right now, going to the doctor is one of the remaining things that we must go out in the world to do. We can get everything else delivered to us (dates, books, groceries, etc). So I think virtual medicine is next. There are benefits - ie: it might be a way to get people that live in remote areas better healthcare if they could web conference with a specialist that's miles away. It also might cut costs (depending on their rate!) and cut down on ER traffic. But I'm not sure. I'm excited that we're able to watch as this unfolds though!

[amanda]

Just saw an editorial on the NYT called "When your Doctor is on Twitter" and thought it would be a good addition to the idea of "virtual medicine" that you've brought up here. This brief article mentions the benefits of doctors using social media: and claims "tweeting, friending and blogging may add real value to patient care."

"There continues to be anecdotal evidence regarding social media’s potential to strengthen the patient-doctor relationship. “One way I see that power is through education,” said Dr. Christian Sinclair... “I can help to inform the public, I can put the knowledge I have out there. And if there are patients or families who need this knowledge, I can help them because of this network.” Dr. Sinclair has, for example, helped individuals he has met through Twitter connect with local hospices, a process he believes was expedited by Twitter’s particular platform." -Dr. Chen

Read the whole article here
Learn more from Dr. Chen, and her compelling story of Eddie (a patient she believes might have benefited from social media) read “Medicine in the Age of Twitter.”

[Ellen S]

I was offered virtual medicine years ago when my Grave's Disease was quite bad. I refused. Some things are visual (like the tremors and twitches I suffered), some need to be felt and judged, and I felt it was important for my serious condition that I needed to be seen by a human being. There really is a point to the poking and prodding! However, I didn't like my doctor much and it was a good excuse to find another.

Now I've been told that I may have to resort to virtual Neurology. I'm not crazy about the idea I must say. Yes, the costs are nice, and it's easier for everybody than a 4 hr drive to the doc each way for an appointment where all we do is chit-chat a few minutes. I guess my visits don't usually work that way, so I prefer to find a doc I can see in person... at least for now. I think this is going to be something we're going to have to get used to tho...

If my doc was on Twitter, I'd follow him in a heartbeat. :)

[Marie]

Great point, Ellen! I think virtual medicine makes me a little nervous because there's this "all or nothing" idea about it. I think it will probably become more of a supplement though - that personal contact isn't going to be replaced completely, but it might be reduced.

Hopefully that leads to things like lower costs and better management of conditions, but I do worry that people will start to slip through the cracks. How many times do we forget to email someone back, or return a phone call?

Prioritizing all of that could be hard.

[John]

I think virtual medicine sounds like a great idea! Especially for those already on medications and whose doctors require “check up” appointments to see how the medication is working or if there are any side effects. This can easily be conveyed over the Internet and wouldn’t require an actual office visit.

For minor appointments like that I think virtual medicine would be very useful. The doctor could cut their time in half and spend more face-to-face time with people with serious problems and in need of more attentive care.

As far as diagnosing, I think there are a certain health problems that can be easily diagnosed over the Internet. I feel like Depression is one condition that can be diagnosed over the Internet because the diagnosis primarily comes from the patient’s description of how they are feeling. There are no medical tests needed to diagnose depression. There are already countless questionnaires that doctors use to diagnose mental health disorders—I don’t see why they can’t be filled out online instead of in a doctor’s office.

Overall, I think the mere convenience of virtual medicine would be very beneficial to patients with certain conditions, or patients that just need to check in with their doctor. Other patients may need face-to-face contact with a doctor. Virtual medicine would provide doctors with more time to spend with these patients.
I think it is important that virtual medicine, if available, should always be a preference and never something a patient is forced to do. For a number of reasons, many patients would much rather be seen in person—I don’t think there is any way to fully get around that.

[amanda]

I think the idea that Depression could be diagnosed online is really interesting. It might take more than one session to do - but the idea of having online therapy is, I think, a great one. Instead traveling all the way to your therapist for your next counseling session, you could turn on your computer and live chat. As long as both parties had a webcam - this would definitely work.

Although, I worry that being on the computer might distract the doctor from being focused on what the patient is saying - especially if it were a longer session (45-60mins might be outside someone's regular attention span, let alone their online attention span!). But as long as you could see that your doctor was taking notes and paying attention - I think this would be a really convenient way for people to get therapy. Although, perhaps encouraging people who are not likely to leave the house (due to depression, OCD, etc) maybe this would make it "too easy" ? Leaving the house to specifically go to your counseling session is often a very routine, expected, and almost enjoyable experience for some patients since they finally get the chance to see someone and talk openly.

I suppose, depending on the patient and the type of therapy - this could be really great. I wonder if it could spread from there into all types of counseling - even group sessions, ie: AA meetings or grief counseling?

[chili4you]

Wow - I would be a little weary of a virtual doctor. How would you know who is at the other end? Furthermore, how can this individual properly diagnose your symptoms? Finally, one can usually get a diagnosis just by Googling or going to medical sites.

[Ellen S]

These sites give potential diagnosis which may or may not be correct and they always tell you to use it as information only and seek medical care/help. Please, do not diagnose yourself - This can be very dangerous! Use the internet to educate yourself and in conjunction with your doctor's advice. Use it to give you ideas that will begin a dialog with your doctor. Use it to become a wise and educated patient. Don't use it as a 'doctor substitute'.

[ahayes13]

i would definitely use virtual medicine. unfortunately with a lot of experiences with doctors, many times it does seem like guesswork. so if i had something non threatening and just had a question i would have no problem just giving a quick call.

[Janeen]

This is a very interesting topic! I think virtual medicine could be very helpful in some circumstances. Even if it was just to say "Yep, you need to come in and I need to take a closer look at that". Right now, I think I could use it to get a referral for my next mammogram. It's a 6 month follow up and I need nothing else but a referral from my primary doctor. When I call and speak to the nurse, the referral is never filled out correctly and it causes problems when I go to the mammogram center (they CAN NOT do one without a correct referral). So I actually have to make an appointment and go in to see the doctor to get it filled out correctly.

I definitely can see Amanda's point about possible malpractice suits due to misdiagnosis. But I think if used properly and for minor situations, virtual medicine could be very helpful.

[Ricky]

Hello, I would and I am actually looking into starting a non-profit to give doctors a "space" in virtual worlds to hold consultations. Right now I am looking for board members to turn in the forms to become a non-profit in the state of Texas and then will pursue tax exempt status. There are lot of medical colleges and support groups using virtual worlds and bringing in the general public on a larger scale will happen in time. It would be a lot easier to go in to do your bloodwork at your convenience and then have the doctor go over the results virtually saving time and money. Initial consultations could be virtual and then if the doctor feels a in-person is needed then they can schedule that.

[EilBak]

Well I actually do not really believe that this option of taking a medicine could ever be safe if I just get in mind how horribly easy a computer can get a virus that destroys the whole fixed hard disc, imagine how easily you can get the wrong medicine.

I prefer the usual way of going to a doctor and getting a prescription and picking it up at the apothecary, at least this way is safer than getting medicine via internet transportation on your e-mail account. Really dangerous to my mind and really unnecessary too. People cannot seriously be that lazy, that they cannot even pick up a prescription or the medicine at an apothecary, honestly, that is so unbelievably unnecessary that I cannot even find words for such a laziness.

Do not get me wrong, the whole e-mail and computer system thing is really great and honestly, I am a huge fan of computers, but come on, we do not need to solve everything via internet and computer.
At next we transport smells of flowers via internet so we do not need to buy some. Ridiculous, absolutely ridiculous and unnecessary and so wrong.

So this was a long and big and easily understandable NO to using virtual medicine, not even it would be available for free.