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Continued: On-screen doctor visits are the new house call

  • Article by: ALLIE SHAH , Star Tribune
  • Last update: April 7, 2014 - 3:13 PM

As a participant in a pilot program through the Mayo Clinic’s Center for Innovation, Bomgaars skipped the routine office visits with her doctor and instead used her smartphone and other tools provided by the Mayo to self-monitor. The ability to video chat with her doctor gave her peace of mind throughout her pregnancy, she said, especially since she travels a lot. “Hands down, it allowed the flexibility in my lifestyle,” she said. “I was really comfortable with it.”

She now is the mother of two children under the age of 2, and said she would consider trying apps like Doctor on Demand for doctor visits for her kids.

Doctor on Demand co-founder Adam Jackson said the app, backed by TV personality Dr. Phil and his son, Jay McGraw, is not releasing numbers yet of how many people have used the service. But he did say the majority of cases are resolved during the video consultation.

Still, not everyone is rushing to embrace the video doctor exam.

For four years, HealthPartners has offered its online medical clinic called Virtuwell, which doesn’t have a video component. Instead, patients complete a questionnaire, then are connected with a nurse practitioner who can answer questions. Kevin Palattao, who developed HealthPartners’ 24-hour online tool, said that adding video doesn’t radically change the way patients and doctors interact. It’s just another “entry point into a similar experience.”

Video limitations

The looming question for virtual appointments is whether patients receive the same quality of care as when they see a doctor in person.

Video chatting doesn’t allow the doctor to touch the patient’s neck, for example, to feel if the lymph nodes are swollen when investigating complaints of a sore throat. They worry that doctors may not be getting all the information needed to render a proper diagnosis.

Linda Macdonald Glenn is a professor of medical ethics at Albany Medical Center in New York and at California State University. On the whole, she sees great potential in video visits, but she has concerns, too. She wondered: Can a patient’s privacy truly be ensured when discussing personal medical information by video?

Another issue is the potential for medical malpractice if the patient isn’t aware or doesn’t reveal something. “In a video interview of the patient, the patient may just present certain things,” she said. “In an office visit, the doctor may be able to pick up other clues — behavior, interactions, symptoms — that the patient may not themselves be picking up on.”

Olson agreed that there are limits to what he can do during his Doctor on Demand visits. Cases in which the patient reports abdominal pain, for example, are very difficult to assess remotely, he said.

“You have to actually press on a patient’s abdomen” to know how bad it is, he said. In those cases he immediately refers patients to an emergency room. Chest pain is another one. “I remember one patient called me and he had a hard time breathing and he was in his mid-50s. His wife was saying he has a history of heart problems. I said he needs to go to the nearest emergency department.”

Yet Olson, who also works as an ER doctor, mainly at Windom Area Hospital, thinks video visits work well for urgent-care situations and they help ease the burden on the busy health care system.

“Right now access to care is a big thing,” he said. “And this is allowing more immediate access to care.”

 

Allie Shah • 612-673-4488





 

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