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Virtual Visits To Doctors Spreading 215

Posted by ScuttleMonkey from the what-could-possibly-go-wrong dept.
tresho writes to tell us that virtual doctors visits seem to be on the rise. A new service, most recently deployed in Texas, from "NowClinic" is allowing doctors to make virtual house calls and prescribe anything short of controlled substances. "For $45, anyone in Texas can use NowClinic, whether or not they are insured, by visiting NowClinic.com. Doctors hold 10-minute appointments and can file prescriptions, except for controlled substances. Eventually they will be able to view patients’ medical histories if they are available. The introduction of NowClinic will be the first time that online care has been available nationwide, regardless of insurance coverage."
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Virtual Visits To Doctors Spreading More

Virtual Visits To Doctors Spreading

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  • It's like a whole 'nother country.

    • Comment removed (Score:5, Funny)

      by account_deleted ( 4530225 ) on Monday December 21, 2009 @04:01PM (#30516738)
      Comment removed based on user account deletion

      • Comment removed (Score:4, Interesting)

        by account_deleted ( 4530225 ) on Monday December 21, 2009 @04:14PM (#30516898)
        Comment removed based on user account deletion

      • Re: (Score:2)

        by dbIII ( 701233 )
        The Indian guy is probably more qualified and experienced and knows the whole thing is stupid but if his boss plays back the recording and he isn't sticking to the script he's lost his job.
        It's Dell and micromanagement that is the problem.

        • The Indian guy is probably more qualified and experienced and knows the whole thing is stupid

          I doubt that. There are procedures for escalation if the problem does not fit the script. He was unable to realize the script would not work because he lacked core understanding of what a power supply is and does. It was just another part on the catalog to him. He needed the customer to insert the diagnostic CD because he was unable to think on his own without the error code it would have provided. If he had a real

  • Hell, most online pharmacies will find you a doctor to prescribe non-controlled substances!

    • Re: (Score:2)

      by mcgrew ( 92797 ) *

      If it's not a controlled substance you can prescribe it for yourself. What's the point? I don't need a doctor to buy aspirin or cold medicine. If I need an antibiotic I need a real visit to a real doctor.

      • If it's not a controlled substance you can prescribe it for yourself. What's the point? I don't need a doctor to buy aspirin or cold medicine. If I need an antibiotic I need a real visit to a real doctor.

        Insurance may cover (some of) the medication's cost if you have a prescription. I can buy my infant's vitamin for $15 a bottle over the counter - with the prescription written by his doctor, my insurance covers half.

      • If it's not a controlled substance you can prescribe it for yourself. What's the point? I don't need a doctor to buy aspirin or cold medicine. If I need an antibiotic I need a real visit to a real doctor.

        Control substance != requires prescription. Control substances require additional accounting and verifications before they can be dispensed. Good examples would be vicodin, codeine, etc. Mostly the stuff that can be abused or has a street value. There are different schedules that dictate the amount of controls and accountability required. For example some of the drugs must be kept in a safe at the pharmacy.

        From Wikipedia: "A controlled substance is generally a drug or chemical whose manufacture, posses

  • Lawsuits galore? (Score:2, Insightful)

    by MMC Monster ( 602931 )

    It sounds like a good idea.

    I hope the physicians are covered by some sort of indemnity so that they won't be sued for something that they cannot possibly figure out via a video phone and 10 minutes. Otherwise you'll see doctors figure out that it's just not worth the risk.

    As a physician, I'll be happy to participate in something like this so long as my exposure to lawsuits is limited.

    • Yeah, it sounds like it'd be great as long as everyone can sign something that they realize this isn't a full examination and there's a limit to what the doctor can do ( and of course, a fair number of the answers from this should be "come in to the office").

      I bet there are a ton of standard issues that can be resolved with a quick Q&A and a couple webcam pics of the effected areas. And I know that I've personally had a fair number of minor medical issues that I never get looked at because I don't think

    • Re:Lawsuits galore? (Score:4, Insightful)

      by nomadic ( 141991 ) <nomadicworld@ g m a i l . com> on Monday December 21, 2009 @03:26PM (#30516344) Homepage
      I hope the physicians are covered by some sort of indemnity so that they won't be sued for something that they cannot possibly figure out via a video phone and 10 minutes. Otherwise you'll see doctors figure out that it's just not worth the risk. As a physician, I'll be happy to participate in something like this so long as my exposure to lawsuits is limited.

      As a lawyer, I'd hope that if a doctor risks harming a patient by practicing through video phone, then maybe they shouldn't practice through videophone.

      • Re: (Score:3, Funny)

        by natehoy ( 1608657 )

        As a patient, and it pains me deeply to say this... I'd have to agree with a lawyer.

        There. I said it. I agree with a lawyer on something. I'm going to hell now.

        But seriously, we use our insurance company's "dial-a-nurse" service and it works well if you have some idea of what is wrong with you and just want some "best practices" advice, like "I have either a cold or the flu, can you help me determine which it is, and what symptoms I would indicate that I should see my doctor as opposed to drinking plenty

    • More worrying perhaps than lawsuits galore is the health risks. If this gained popularity I think we'll see a lot of people skipping going to the clinic so they can do this. And pretty much anything not common and obvious will be misdiagnosed or impossible to diagnose. If you were going to be limiting diagnosis to simple things over voice then a simple app could take place pretty easily and likely do a better job. It could work like 20 questions for maladies. (So long as it doesn't do guessing)

      When combine
    • Regardless of any indemnity, a clever tort lawyer has got you at the very least with strict liability.

  • Doesn't a "virtual doctor visit" necessarily imply that there are virtual doctors? If so, please send me a check for $45 and proceed to http://www-ai.ijs.si/eliza/eliza.html [www-ai.ijs.si]

    Thanks.

    • That thing is possessed or something. I said something but it came out as a keycode and confused the bot. So I said "I'm sorry for the bad input" and this is what displayed:

      ...
      You: i need a blowjob
      Eliza: What would it mean to you if you got a blowjob?

      Is it trying to subconsciously mess with me?

    • I'm sorry but Slashdot will not allow me to send a Unicode check nor its reasonable approximation, the root symbol. Therefore, please accept the attached Unicode point reference in its stead. Thank you.

      U+2713

    • Re: (Score:2)

      by mcgrew ( 92797 ) *

      Maybe it's Janeaway's holographic Johnnycab doctor?

    • Hmmm. I don't think Eliza counts as a virtual doctor. She appears to be clueless.

      You: Can I get a prescription for Vicodin?
      Eliza: Do you want to be able to get a prescription for vicodin?
      You: Yes!
      Eliza: You are sure?
      You: Yes, I am sure. I'm in pain!
      Eliza: You are sure?
      You: Just give me my pain medications already!!
      Eliza: Why do you say your pain medications already?
      You: I just wasted $45. Goodbye.
      Eliza: Can you elaborate on that?

  • Re: (Score:2, Offtopic)

    by account_deleted ( 4530225 )
    Comment removed based on user account deletion

    • Re: (Score:2, Troll)

      by Lordrashmi ( 167121 )

      Sad the mods don't get a L4D reference.

  • A dozen years ago I was a reporter in the Texas Panhandle and the Texas Department of Criminal Justice used "telemedicine" extensively. Interesting to see them finally moving it to the general population (no pun intended.) IIR, the patients/inmates were of mixed opinion on it, but the remote doctors seemed to prefer it ;)

  • Don't worry about the quality, feel the cost (Score:4, Insightful)

    by MosesJones ( 55544 ) on Monday December 21, 2009 @03:26PM (#30516334) Homepage

    Seriously is this a good thing?

    In the UK we have a service "NHS Direct" which is effectively a triage service which tells you whether you need to go to a doctor. Its in no way shape or form a replacement for a direct doctors appointment its just there to filter out cases that aren't overly serious or are serious enough to need an emergency visit. This service is staffed by nurses and its pretty good and does help with people who are concerned about medical issues.

    The idea of someone prescribing drugs via this sort of service is just insane. It would be smarter to delegate prescriptions, or at least re-issuing prescriptions, to pharmacists who will at least see the patient. Or are we going to a world where you don't see the doctor and you get your drugs shipped direct so you never ever see anyone with any sort of medical training who can just briefly add a sanity check to the whole thing.

    Its hard to imagine a better example as to why the US system is completely and utterly fucked than this being considered a good thing.

    • Its hard to imagine a better example as to why the US system

      Just wait. Plenty more examples in years to come if things continue to go the way they are going. :)

    • Re: (Score:2)

      by ceoyoyo ( 59147 )

      I don't think this amounts to anything that much different. The online doctor's visit will likely almost always boil down to some variation on:

      1) You've got a cold. Get plenty of rest and fluids and take an aspirin. If it doesn't get better in 5-7 days, go see a doctor in person.

      2) You've got something I can't diagnose over the Internet. You need to make an appointment to go see a doctor in person.

      So like you said, triage. Except in the US it has to be a doctor who does it, because nobody would settle

      • Re: (Score:3, Informative)

        by fuzzyfuzzyfungus ( 1223518 )
        When they say "controlled", in this context, they mean something distinct from "by prescription only".

        You have over-the-counter drugs, which you can purchase freely(unless, like Sudafed, they've been caught up in the War on Drugs(tm) in which case you still don't need a prescription; but you will face a hassle).

        Then you have prescription drugs, which you'll need a doctor's OK to buy, and you'll only be able to get from a pharmacist.

        Then you have "controlled" substances, which are generally prescrip

        • Re: (Score:2, Informative)

          by icebrain ( 944107 )

          Disclaimer: I worked in a pharmacy for a while.

          As I remember it, the "controlled substances" were broken down into a couple different categories. Class IV drugs were things like percocet and other narcotic painkillers. They had some abuse potential but were still fairly common. You could get refills, but there were generally limits on quantity dispensed and (IIRC) you couldn't transfer them. These were stocked with the rest of the "regular" prescription drugs.

          Class III drugs were more controlled for wha

          • Maybe you worked in a pharmacy awhile back...but I can tell you right now that Percocet is NOT a Class IV. In fact, it is a class II. I believe the only narcotic painkillers that aren't class II (or I) are Hydrocodone (Vicodin) and Codeine.

            Here are some common drugs by class...

            Class V: Cough Medicines such as Promethazine with a bit of Codeine

            Class IV: Anti-Diarrheals, Benzodiazapines, Provigil

            Class III: Hydrocodone, Suboxone, Marinol, and....Ketamine! (I know someone who was recently in a house that had

      • Re: (Score:2)

        by mea37 ( 1201159 )

        Uh, actually, a lot of people do settle for nurses to do triage. My insurance offers me a phone number where I can reach a nurse at any time of day or night to determine if I have a medical concern that needs a doctor's attention.

      • Except in the US it has to be a doctor who does it, because nobody would settle for a nurse.

        Blue Shield/Blue Cross of California and Kaiser Permanente both have a nurse available on the phone, 24/7. I've used it a couple times and it worked out well... many simple things can be diagnosed over the phone with a simple questionnaire. If not, they'll tell you to come and see the doctor, often with a priority appointment the next morning.

        • Our pediatrician does this as well. If you call up about pink eye or an ear infection, the receptionist takes your name for a scrip. When the local pharmacy calls, everything is on the up and up. The upside for the office is that you don't get kids with highly infectious conditions coming in and "sharing the love". I believe you can get similar service inside some chain pharmacies: There's a nurse on hand to confirm the condition and then you get your antibiotics right there. No waiting room, no dickin

    • Not just the UK...

      France has a very good system for this, apparently.

      My personal experience with NHS Direct was actually (all things considered) pretty damn good. Mind you I am a strong proponent of the NHS, despite its neglect over the past decade, Its still a valid and potent solution, and one which I am grateful for! And have been a lot throughout my life!

      Driving a motorbike, having a son, and an accident prone girlfriend makes you very happy that a relatively small proportion of your income goes to thos

    • Seriously is this a good thing?

      In the UK we have a service "NHS Direct" which is effectively a triage service which tells you whether you need to go to a doctor. Its in no way shape or form a replacement for a direct doctors appointment its just there to filter out cases that aren't overly serious or are serious enough to need an emergency visit. This service is staffed by nurses and its pretty good and does help with people who are concerned about medical issues.

      The idea of someone prescribing drugs via this sort of service is just insane. It would be smarter to delegate prescriptions, or at least re-issuing prescriptions, to pharmacists who will at least see the patient. Or are we going to a world where you don't see the doctor and you get your drugs shipped direct so you never ever see anyone with any sort of medical training who can just briefly add a sanity check to the whole thing.

      Its hard to imagine a better example as to why the US system is completely and utterly fucked than this being considered a good thing.

      I agree - better to staff a clinic with a Physician / Nurse Practitioner and Nurses who confer with an MD, even virtually to ensure quality of care. A PA/NP is quite capable of delivering primary care (or even specialty care) in a safe and cost effective manner; but there is no real substitute for being seen where they can detect subtle things, that may get unnoticed otherwise, which might indicate a more serious or additional problem.

      Now, followup visits or routine test results can often be handled virt

    • Yeah, the addition of "can issue prescriptions" does make it a little scary. I would hope that any qualified doctor would reserve their actual diagnosis for easy and obvious cases ("what, the over-the-counter hayfever medications aren't working for you? OK, let me send you a scrip for Claritin-whatever_letter_they_are_at_now").

      But, of course, that means that the utility of such a service is limited. It's rather expensive for 10 minutes with someone who is either horribly overqualified to diagnose your co

      • But, of course, that means that the utility of such a service is limited.

        Yeah, I'm trying to figure out why this is supposedly a big deal (I am an MD). Sure, for a lot minor things, you don't need to see the doctor. You don't likely need to do anything at all. So self help books / web sites, nurse triage programs and Ouija boards would work well. For the things you would typically prescribe drugs for, you would likely want at least a cursory physical exam.

        While TFA disses the physical exam portion

    • Another brilliant idea! For those who have never seen a triage tag: http://en.wikipedia.org/wiki/File:Deconference-2002-triage-tag.jpg [wikipedia.org]

      The four color-coded groups at the bottom determine how long you can wait for treatment.

      So think about doing this online:

      Triage: Sir, are you breathing?

      Patient: No, I am not.

      Triage: Sir, do you have a pulse?

      Patient: No, I do not.

      Triage: Please print out the tag, select "Morgue," and tie it to your wrist. A hearse will be by to pick you up shortly.

      Patient: Zombie get

    • If you paired this concept with some sort of remote diagnostic package and mail-in testing of bodily fluids and the like (which is already done every day, after all) then it could be a useful tool for remote diagnosis that, yes, has the potential to eliminate many needless visits to doctor's offices. You don't want to be prescribing potentially dangerous drugs, but the idea is not entirely without merit.

  • Say goodbye to this type of innovation if things continue down the pathetic road we're on. Thanks, politicians!

    Why the hell should I have to take time out of my day to go sit in a doc's office for a hour, for a 30 second consult, to get my prescription meds? If I can do it from the privacy of my own home, and the doc already has access to my charts, why not?

    • Re: (Score:2)

      by Xtravar ( 725372 )

      Nice try making this political, but those terrible politicians recently passed a law that requires health care IT to improve. It's called the HITECH act. So you may not be getting innovations and improvements the way you'd prefer, but you'll be getting them nonetheless.

      • "So you may not be getting innovations and improvements the way you'd prefer,"

        I like the sort that innovate and improve. What we'll get is anyone's guess.

        • Re: (Score:2)

          by Xtravar ( 725372 )

          Well, for example, the HITECH Act mandated a certain level of encryption for health data, and punishes those who lose data that does not meet the requirements.

          Believe it or not, there were and still are health care IT vendors out there that do not use strong encryption, or encryption at all. God forbid that protecting patient privacy isn't monetarily beneficial.

          Look, I'll defend the free market as much as the next Slashdotter who voted for Ron Paul. But the reality is you and most people here don't know d

    • Yeah, the government totally fucks over any and all innovation. I mean, look at what those commies in England thought up: http://en.wikipedia.org/wiki/Nhs_direct#History_and_background [wikipedia.org]

      Those bastards totally cut out the innovation by prenovating!

  • Look at whose backing this (Score:4, Insightful)

    by LockeOnLogic ( 723968 ) on Monday December 21, 2009 @03:37PM (#30516478)

    OptumHealth, a division of UnitedHealth Group, the nation’s largest health insurer, plans to offer NowClinic

    When the devil hands me a gift I'm wary of opening it...

    • Re: (Score:2)

      by rho ( 6063 )

      Having a way for people with simple needs to get quick medical attention and out of the waiting rooms so that people who do NOT have simple needs is a good idea.

      It doesn't matter if the good idea comes from a source you think is compromised. The good idea stands on its own merits.

      This is like the self-checkout line at grocery stores. I say they should go for it.

  • I am a med student, and I am horrified (Score:5, Informative)

    by tpjunkie ( 911544 ) on Monday December 21, 2009 @03:41PM (#30516516) Journal
    This is a bad idea. No, this is a TERRIBLE idea. With a virtual doctors visit you are missing out on a very important component of data collection leading to a diagnosis; the physical exam. Without ascultation, you are missing out on a ton of information about a patient's cardiovascular, gastrointestinal and pulmonary systems. Without physical contact, you cannot perform any kind of neurological or musculor skeletal exam, or even really determine a patient's mental status, especially if you are using just a instant messenger style window for communication. I think it is highly irresponsible and certainly opens up a practitioner to a lot of liability to be diagnosing and prescribing meds in such a manner. As a doctor, I'd say this is not for me. And as a patient, moreso.

    • Re: (Score:2, Funny)

      by alrudd1287 ( 1288914 )
      dude- whatever. if this stuff is actually needed, the person over the net will say GO TO A DOCTOR. This sounds like a GREAT idea from a cost-savings perspective, which is the only one that matters here. Often, patients go in for an appointment with a drug in mind that they just need a script for. Like if i have poison ivy, i need steroids because in the past the topical stuff hasn't worked. If I don't get it the first time then i'll have to go in a 2nd time... costing me or my insurance something like

    • Uhm. Maybe the doctors you go to work like they do on House, but for the rest of us, the deal is simple: You get 10 minutes of a doctor's expertise and you pay a least 100 bucks. No references will be consulted, not too many notes will be taken. No follow up is guaranteed unless there's a charge to go with it.

      This is the same business model Hookers use, and we're sick of it.

      The medical industry here in the US is pathetic. We spend the most pre capita, 2-3 times what most industrialized nations spend, and ha

    • Yes, well, do you need to need to perform a neurological and skeletal exam to re-fill someone's acne medication?

      Obviously there are some things this works well for and others that it doesn't. I don't see why you automatically assume this will be used for the latter. Presumably a doctor is conscious of the holes in the information obtained this way and thus if able to state if he requires a personal visit.

      On that note, you are also assuming you have the given patient at your mercy. The truth is a lot o

    • Re: (Score:2)

      by rossdee ( 243626 )

      Most of that stuff isn't done by a doctor anyway. An LPN will check your weight, height, blood pressure, heartrate, and so on.

  • To see how effective this is as a diagnostic mechanism(and I don't mean some bullshit anecdote/contra-anecdote thing, I mean a genuinely rigorous study).

    On the one hand, there are definitely lots of conditions that can be diagnosed, with fair accuracy, by basically asking the patient questions and traversing a decision tree. Heck, that slice of the population(and it is a large one) could probably be handled by an expert system no more complex than the one that makes calling most support lines an exercise

    • Your example of "sounds like strep" is exactly where something like this can fail. Strep requires antibiotics , and those are bad for us all if used incorrectly. A test is required for verification.

      Your final alternate model is dead on , and in fact my wife's work has this exact scenario... and she loves it. She works at a school, so there is already a nurse on campus. She can arrange a doctor visit without having to take time off work, and she will see the nurse who has a video conference with a real docto

  • What would be the point? Aren't all medications that require prescriptions before dispensing "controlled" substances, or are we talking about Schedule II only?

    Or will they write "prescriptions" for overpriced formulations like Ibuprofen 800 (just take 4 of the over the counter 200s)?

    I like the idea of telemedicine, I think it holds a lot of promise for reducing costs and increasing access (both in terms of speed and breadth of access), but it sucks we have to let our moronic prohibitionist mentality get in

    • I would assume that they mean anything in Schedules II through V of the controlled substances act.

      Lots of drugs are "Rx only", but that doesn't make them "controlled substances" in the legal definition.

  • This is simply taking it to another level. Why make a pretense of actual examination when one can write a prescription serving as a bandaid to mask symptoms sight unseen and move on to the next "patient"? That's what most doctors do today anyway, except they go through a 5 minute theater of taking your vital signs.

    This may be a good step, however, if it results in computers one day diagnosing patients. They will possess vast medical knowledge and will actually attempt to correlate multiple symptoms. Today m

    • >Why make a pretense of actual examination when one can write a prescription serving as a bandaid
      >to mask symptoms sight unseen and move on to the next "patient"? That's what most doctors do today
      >anyway, except they go through a 5 minute theater of taking your vital signs.

      This is why I think this telemedicine is a great idea. Since the doctor examination is theater anyway, why not just run down the symptom checklist and guess at a prescription just like they do in doctor's offices anyway!

      Most of

    • Re: (Score:2)

      by RingDev ( 879105 )

      Sure, some people will be idiots looking for prescriptions. But think of the number of people who every year show up at doctors' offices and emergency rooms across the country because they have cold/flu symptoms. How many millions of doctor visits can you filter out with T1 support every year?

      Imagine if every user incident was immediately sent to a developer. Even if the incident was that the user didn't have their PC plugged in. It wastes the developer's time, it could have been handled much faster by a T1

  • Better than no visit at all... (Score:3, Insightful)

    by ravenscar ( 1662985 ) on Monday December 21, 2009 @04:00PM (#30516724)
    Most commenters have only mentioned that a web diagnosis is likely to be inferior to an in-person diagnosis. I generally agree with that statement.
    What I feel people are failing to catch is that a web diagnosis, conducted by a qualified individual is better than no diagnosis at all.
    How many people skip or put off doctor visits because they don't have the desire or time to block 2+ hours of their day for a 5 minute visit with a doctor? How many others can't afford $150+ for a visit? Now that you're thinking about those numbers consider how many people miss out the on the potential benefits of an early diagnosis.
    If this service can expand access to medical care and encourage more people to seek care when they need it I think it could have significant benefits. I think it also has the potential to limit unnecessary doctor/ER visits.
    As long as the doctors stay within the bounds of what they can really do on the web I think there is upside potential in this model.
  • Next stop India. "Is there anything else I can help you with today?"
  • Is it just me or does this sound like code for offshore outsourcing of doctors? If the doctor doesn't have to actually see you in person then the next logical question is: Does it matter where the doctor is physically located? If the answer to that is 'no' then you can bet your bottom dollar (or rupee if you prefer) that you 'personal physician' will be some video conference station linked to some 'doctor center' in India. Of course, most American senior citizens have a hard enough time understanding Indian

  • This definitely fills a need - sometimes you just need a little consultation or prescription without needing a full blown appointment. Or sometimes you don't know if your symptoms require a full blown appointment or not - this would let you talk to a doctor without going through all the rigamarole. $45 seems a bit steep for 10 minutes though.

  • ...Its guaranteed to virtually pay for virtually everything with virtual money! Wooohooo!

  • This could actually be beneficial: getting people with highly communicable diseases "seen" without exposing to a whole bunch of other people in waiting rooms.
    If they aren't sick, they aren't risking picking up something in a crowded hospital. If they are sick, they aren't going to be giving their funk to anybody or picking up a superinfection on top of their original problem. Empirical treatments like first line antibiotics don't require lab tests in most cases, and can drastically reduce the infectious p

  • Lisa: Maybe I ought to check with the doctor.
    [Lisa, Bart, and Homer gather around Lisa's
    computer. She starts a program that displays a
    medical logo -- the one with two snakes wrapped
    around a staff]
    Snake 1: Welcome to "Virtual Doctor."
    Snake 2: From the makers of "Dragon Q

  • Related to that, the Cleveland Clinic offers "Remove Medical Second Opinion". http://www.eclevelandclinic.org/myConsultHome [eclevelandclinic.org] It is a bit pricey, but this is one of the best medical centers in the world.

  • A couple of posters, tongue in cheek, have mentioned offshoring. This is actually possible. Medical tourism has already begun and remote surgeries is beginning as well. It's only a matter of time before offshored medical care becomes common, probably driven by the health insurance companies.

    Looks like medicine may be the next profession to tank.

  • Sounds great to me. Of course, I go to the doctor for one reason and one reason only: he has a prescription pad. I find that I'm usually better informed than he is about what's actually ailing me--something to do with him getting most of his continuing education courtesy of drug reps. Case in point... I'm a diabetic. My treatment? Low-carb diet and Metformin. His treatment? Low-fat diet and Metformin, then Metformin and Byetta, then I quit listening to him and went on a low-carb diet. Guess which on

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