Internet entrepreneurs have brought new meaning to the phrase “house calls.”
Online companies with names such as “MDLiveCare” and “RingADoc” are diagnosing and treating common conditions such as allergies and the flu over the Internet or on the phone, forcing state regulators to revisit decade-old rules about what constitutes a doctor/patient relationship.
They cater to time-pressed consumers, who, for an out-of-pocket payment ranging from $25 to $40, can talk on the phone or chat online with a doctor or a nurse practitioner. Some employers offer the services as part of their health plans.
“We definitely are not trying to replace that primary care physician,” says Jordan Michaels, a founder of RingADoc, which launched in mid-October and, for now, serves only California residents. Michaels and his competitors say they aim to replace the hassle and expense of visiting a doctor’s office or emergency room for a minor problem.
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Skeptics worry assessments of patients sight unseen, or via video cam, could miss signs of underlying conditions. Last year, a Colorado doctor was found guilty of practicing medicine without a license in California after prescribing an antidepressant to a 19-year-old student via an online pharmacy. The student committed suicide; the doctor got a nine-month jail sentence.
“None of these systems deal very well with undifferentiated problems of patients — (those saying) I’m tired, I don’t feel good — and those are very significant numbers of patients,” says Roland Goertz of the American Academy of Family Physicians.
Most state medical boards permit doctors to diagnose and treat only those patients whom they’ve seen at least once in person. Jennifer Simones, chief of legislation for the Medical Board of California, says her state prohibits Internet prescribing without an “appropriate” prior exam.
The examination doesn’t need to be in person if technology such as videoconferencing can provide the same information as a face-to-face visit, Simones said. Whether RingADoc or similar companies are in compliance can’t be known until a complaint to the medical board triggers an investigation, she said.
No one keeps a tally of the companies, and no one has studied their quality of care. The Federation of State Medical Boards, whose current policy about doctors’ communication technologies dates to 1996, will re-examine the issue at a March symposium, says federation president Humayun Chaudhry.
Such businesses “have become ubiquitous … partly because people want instant resolution,” he said. “If you have a doctor’s appointment in two days, it’s not soon enough.”
J. Kyle Mathews, MD
Plano OB Gyn Associates
Plano Urogynecology Associates