Sometime in the last century, most professionals discovered that face-to-face meetings with clients werent always necessaryor even desirable. Lawyers, accountants, engineers, architects and scores of other professional service providers discovered the phone. Then they discovered email. Then video conferencing.
But not doctors. Most doctors today communicate with their patients the same way the Greek physician Galen did 2,000 years ago: one on one, in person.
Why is that?
One reason is unwise legislation. Another is resistance to change by the American Medical Association and state medical societies. A third reason is Medicare, whose payment practices tend to be copied by most employers and private insurers. But the biggest problem is that rank-and-file doctors have been unwilling to step into the modern age.
Thanks to the most recent legislative session, Texas became the last state in the union to allow doctors to consult by phone with patients they have never met. And that only came about after a long, hard struggle.
Take the case of Teladoc, a Dallas-based firm that provides telephone consultations to nearly 11 million patients nationwide. Say you are on a business trip and your allergy prescription runs out. You put in a call to Teladoc, and within 30 minutes you get a call back from a doctor who has access to your medical records. After a brief consultation, the doctor prescribes the medication you need.
Teladoc estimates that one-third of physician consultations dont require the doctor to be physically present. Further, a typical phone consultation costs about $40 to $50, compared with $130 for a family doctor visit or $1,500 for a trip to the emergency room.
Great service? You would think so. But the Texas Medical Board (acting like a wholly owned subsidiary of the Texas Medical Association) tried to put Teladoc out of business and might have succeeded had the company not spent six years in a protracted court battle.
Telemedicine doesnt just lower costs. It has the potential to save lives.
Suppose you are a patient in an intensive care ward in southern Minnesota or in parts of Iowa and Wisconsin. There is a chance that your vital signs are not being monitored by the staff of the hospital you are in. Instead, they could be monitored by the clinical staff of the Mayo Clinic, miles away. The Mayo Clinics eICU (electronic intensive care unit) currently monitors 73 beds in remote locations.
Mayo provides expertise that is generally not available in local community hospitals. How a stroke is treated and how quickly it is treated have a huge impact on patient recovery. With telemedicine, patients get access to the best that Mayo has to offer.
So who could be against this? The American Medical Association for one. The federal government for another. The official position of the AMA is that doctors must be physically present in order to deliver appropriate care. For the most part, Medicare payment policies follow AMA guidelines.
Technology is on its way, whether organized medicine likes it or not. Patients in 14 states can now download an app made by a Silicon Valley firm called Lemonaid Health. Customers fill out a questionnaire on eight simple health concerns, including sinusitis, birth control and acid reflex. These are reviewed by a doctor who can write a prescriptionall for a fee of $15.
Health Tap, another startup company, offers an artificial intelligence product that allows patients to submit their symptoms and then get options on what to do next. Like an Uber for health care, the company connects patients to 107,000 doctors who are willing to answer general health questions.
A third California company makes a $200 iPhone attachment that operates like an otoscope. Parents can use it to look inside their childs ear, take a photo, send it to a doctor-on-demand and, for $49, get a diagnosispotentially saving an expensive trip to the emergency room.
A brand-new world awaits us. Patients are ahead of most doctors in getting us there.