Blue Cross doctors to treat patients online
Thursday, September 2nd, 2004 at 3:23 pm
From the Florida Times-Union:
Some doctors will be making house calls — online — under a new program from Blue Cross and Blue Shield of Florida. The Jacksonville-based health insurer is launching the first program in the state to reimburse physicians for online medical consultations.
Patients will be able to confer with doctors on non-urgent matters, receive lab results, request prescription refills, schedule appointments and request referrals.Under the Blue Cross program, patients and physicians must have an existing relationship and both agree to communicate online. To access their physician, a patient logs in and is prompted to answer a series of questions or fill in the blank about their current health, medications, symptoms and other concerns. The doctor must respond within eight to 12 hours in order to be paid. Patients pay for the online consultation as they would for a standard office visit under their plan.
Personally, I love electronic communication, and think it's great. (Note weblog). Emailing results to patients, appointment reminders and the like definately make things easier and more streamlined. But patient logs in and is prompted to answer a series of questions or fill in the blank about their current health, medications, symptoms and other concerns??? I mean for this, you really don't need the doctor at all. You could just write a program where the patient inputs their symptoms and the computer spits out a diagnosis and recommended treatment. Is that where we are going with this? Not that I am worried about job security, as I doubt, at least in my lifetime, that you could ever run a code with a mouse (EM), or repair intrabdominal bleeding due to a GSW (Trauma — and yes, they have robots doing surgery now, but there is still a physician somewhere in the world controlling that robot.) I just think that patients still prefer the human touch of someone actually caring for them, which is something no computer could ever do. And no matter how well programmed, I don't think it could match a clinician's good medical judgement. Not to mention the lack of a physical exam. I know that in the US there is less and less emphasis placed on good physical diagnosis skills with the increasing reliance on technology, but not to have an exam at all?
What do you all think? Is such an online program acceptable for routine matters, such as medication refills, or would you be satisfied using it to explain your symptoms and obtain a diagnosis transmitted to you on your computer screen?
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Gabi Says:
Anyways, I don’t think you can really teach someone ethics. You either have them, or you don’t.
No way would such a thing fly with me. Like you said, emailing test results and appointment reminders is great, but if you want electronic dx, go to WebMD or something. There is SO MUCH lost if you don’t actually see the patient and at least do a rudimentary physical exam. At some point since I started the paramedic program, I suddenly developed a clincal judgement ability. All it takes is 30 seconds to assess whether or not a patient is *really* sick, but those 30 seconds are so crucial. I’ve gotten plenty of tough-old-men patients (as I”m sure you have too) who claim it’s “just a little chest pain, probably indigestion”, yet they have that awful gray pallor of impending doom. And that’s something critical that would be missed without face-to-face contact. Even smaller sxs would be affected, cause a lot of people don’t realize that little things (fatigue, bruising, etc.) can signal disease, so they might not input them into the computer.
Yeah, I agree with the whole “clinical assessment/judgement” thing. When I worked in the ER, usually I was one of the first people to see the patients. The nurses were usually backed up seeing patients, so they asked me for my clinical judgement (scary). Patients were either sick (gonna die in the next 10 min) or not sick (can sit on the stretcher for a few hours without decrement). In EM, with backlog measured in hours, this is essential. The face-to-face contact is definately key, as you can gain so much info just by looking/touching the patient.