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The new house call: Your doctor's at the door, er, on your Web cam

Too busy to go to the doctor? Unfortunately, it's the rare one who makes house calls these days. But how about the next best thing? The Hawaii Medical Service Association (HMSA) next week is set to begin offering doctor consults via Web cam, an emerging form of telemedicine.

The association (the state's Blue Cross Blue Shield insurance provider) will offer the 10-minute Internet visits through American Well, a Boston-based company that  provides video conferencing and electronic medical record-keeping to doctors and patients, the New York Times reports today. HMSA is its first customer, the Times says.
 
“It’s a better iteration on, ‘Take two aspirin and call me in the morning,’” Robert Sussman, a family practice doctor on Oahu, tells the newspaper. “We can’t lay on the hands, but we can lay on the eyes and get a better feel" than from a simple phone consult. 

Telemedicine – by Internet or phone – is touted as a convenience for folks who don’t want to wait days for a doctor’s appointment, who don’t live near a physician, and who are willing to pay out of pocket for the perk of a visit on their own schedule. The cost is a $10 co-pay for HMSA members and $45 for non-members. Proponents say doctors can take care of about half of medical problems without a face-to-face workup.

While some traditional doctors consult with regular patients by phone or email, many don’t, says Jay Parkinson, a primary-care doctor who runs the telemedicine business Hello Health in Brooklyn, N.Y. “Doctors don’t get paid for communications – only office visits and procedures,” Parkinson tells ScientificAmerican.com. “Nowadays doctors see so many patients – 30, 40, 50 patients a day. When the day is over, they can’t sit down and answer 50 emails for free.”

Hello Health's fees are based on the length and type of visit: $100-to-$200 for an office visit versus $50-to-$100 for video, instant message and phone visits. (If the latter leads to an office visit or house call, that charge is applied to the cost of the in-person exam.) A similar service, Doctokr in Vienna, Va., a suburb of Washington, D.C., also provides scaled fees for phone, office and house consults. Both businesses require patients to be seen at least once in person.

Internet-based medicine is still in its infancy, Parkinson says, and whether it’s ideally practiced via Web cam or by text-based instant messaging or email is an open question. Just 16 percent of Internet users have used a Web cam, according to a 2005 report by the Pew Internet & American Life Project.

Whatever its form, telemedicine is really best suited for relatively minor problems, Parkinson says, and to determine whether further medical attention or lab tests are needed to check out, say, swollen lymph nodes or whether a sore throat may be strep. “We target someone who communicates and transacts online, and that’s everyone under 65 these days,” he says. But, a doctor really needs "to have a [previous] relationship with someone. Otherwise, it’s sort of reckless.”

Image © iStockphoto/Yanik Chauvin

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