Wednesday, August 20, 2008

E-Medicine, virtual medicine - E-Medicine for Routine Ailments: Virtual Vs. Face-to-Face Visits

A compelling reason for Internet medicine is you can treat patients without them being in your physical presence. If you’re paid for the e-visit, that may makes this form of medicine practical. For patients, benefits are convenience, time saved, being spared from parking and travel expenses.

Here, Benjamin Brewer, MD, the WSJ’s Doctor’s Office Forum blogger, discusses e-medicine.

My patient probably would have rather been anywhere else. He and his wife were in my office to discuss his erectile dysfunction for the first time.
He looked uncomfortable. For a guy who doesn't go to the doctor much, a medical office can seem as foreign and intimidating as the dark side of the moon.

His exam was normal, but he needed to quit smoking. Would it have been easier for you to fill out a questionnaire on the Internet and skip the office visit? I asked. "You bet," he replied.

The way I see it, he didn't really need to come in at all. He needed a risk assessment for heart disease, a prescription for medication, counseling and help with stopping smoking. The results would have been the same online or in person.
The average American's health-care experience is fraught with high cost, poor service and uncertain quality. But the prudent practice of medicine online would improve health care on all three counts.

Patients want access to safe, reliable medical care on the Internet, just like banking, shopping or booking a flight. Eighty percent of the public want doctors to use email to communicate with patients, but only 9% of physicians actually do that even occasionally.

I think 20% of my routine office visits could be handled safely and less expensively over the Internet. There is nothing magical about the four office walls that make face-to-face visits superior. Demanding an in-person visit for every little thing is based on tradition and consensus opinion -- not science.

Doctors trot out excuses about why they don't use the Internet as a tool for working with patients. I think doctors' big fear is that the online discussions with patients will eat up time, with little or no extra payment for the service.

A big impediment is that in most states it is illegal to prescribe drugs for a patient based on an online evaluation. That seems strange to me because physicians have been prescribing medicines by telephone for simple things without the safety net the computer provides.

Of course, there have been cases of inappropriate prescribing of narcotic medications in my home state, Illinois, and others. And regulators put the clamps on even legitimate use of Internet medicine without a face-to-face physical exam.
The medical establishment has been reluctant to embrace online medicine. Indeed, medical societies and the Federation of State Medical Boards have taken a very aggressive position against Internet prescribing in the name of patient safety. In their world, only in-person visits are thought to be safe.

Are the boards of medical examiners' policies really protecting patient safety or only mandating face-to-face office visits as economic protection for doctors, I wonder.

If I tried to prescribe ED drugs today based on an Internet questionnaire and email correspondence, the state medical board could take my license away and fine me thousands of dollars for every patient I treated.

I have no desire to be a Viagra prescription mill. I bring up the medicine because ED care over the Internet is probably the most studied of online options.
There are broader applications for Internet treatment beyond ED. And to be absolutely clear, there's no evidence that only face-to-face office visits are safe, effective and high-quality.

Traditionalists in medicine may be afraid to learn how good Internet medicine can be. One of the first substantial studies of Internet medicine was conducted by the University of Utah and published this month in the journal Mayo Clinic Proceedings. The researchers compared traditional office treatment of erectile dysfunction versus Internet practice.

The patients treated online had no face-to-face exam. The traditional doctors had the benefit of a computerized record system but they still lost out to the Internet doctors, who took a more thorough history and provided more counseling with the aide of a standardized Internet-based system.

Internet practice for ED was equal to traditional office practice or safer in all areas studied.

As a small-town doctor who still makes house calls, the prospect of an Internet practice is quite a departure from business as usual. As the Internet-savvy population ages and the number of primary care doctors dwindles, the demand for safe online medicine will grow.

Until the regulators come around to the advantages of Internet medicine, patients will continue to miss work over minor ailments and I'll keep seeing them at the office.


1. Benjamin Brewer MD, Internet Visits With Doctors Can Beat Office Appointments, August 20, 2008.
2. Mark Munger, et al, Safety of Prescribing PDE-Inhibitors via e-Medicine vs Traditional Medicine, Mayo Clin Pr0, August, 2008.

1 comment:

kevinh76 said...

I would be happy to safely treat patients via the Internet, video chat, text message, IM, smoke signals or any other method of communication. However, Medicare and other insurers demand a face to face appointment for billing. I deserve to be paid for my time and services. Like so much in medicine, it's not the doctors, it's the insurers. People should be complaining about the insurers.