Using Online Medical Consults
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Using Online Medical Consults

Image for online medical consulting “I find emailing easier than phoning,” says Kurt Soutendijk, a patient of TienaHealth in Texas. “I don’t like leaving voice mail messages.”

Soutendijk is one of many patients who uses MyDocOnline to ask for prescription refills and changes in his medications.

“You have time to think about what you want to say,” he says. However, when his son came down with a sore throat, he used common sense and scheduled an office visit, so the doctor could look at and culture his son’s throat. What are online medical consults? When is the right time to use them? Here’s some information that may help.

What Are Online Consults?

An online consult is a secure website that allows you to communicate with your doctor via email. Unlike a standard email account, an online consult is password protected. Therefore, your privacy will be protected also.

When to Use Online Consults

If you have an ongoing medical condition, online consults are an ideal way of updating your doctor about how you’re doing or how you responded to a new medication. They can also be useful if you need to clarify any advice you received during an office visit or if you have general health questions but don’t need to see your doctor for an exam. Some doctors and hospitals will even offer second opinions or advice to patients they have not seen online.

However, this practice is controversial. Without an exam, your doctor could miss something important. The American Medical Association (AMA) is just one organization that advises doctors not to treat unseen patients. The state of Illinois even considers the practice illegal. Nonetheless, some very prestigious healthcare providers (for example Cleveland Clinic) offer online evaluations to patients they have not seen “in person”.

“A lot of what can be done with an online visit is what can be done with a phone call, with a nurse in between,” said Sue Milam, spokesperson for MyDocOnline. “We think this is a more efficient and better documented way to handle events.”

Pain specialist Lynne Carr Columbus, DO, in Palm Harbor, FL, is one of more than 90,000 doctors using the Medem network. She requires patients on powerful pain pills to check in monthly. Stable patients can alternate between in-person and electronic visits. She also has the ability to review patients’ pain diaries and drug use online and can make suggestions if necessary.

Bear in mind that if you choose to use an online medical consult, you should keep your messages to your doctor clear and concise. Don’t ramble. Instead, take the time to organize your thoughts. Remember any email you send will become part of your medical record.

When Not to Use Online Consults

If you have a new medical problem that needs to be diagnosed, an office visit is probably still your best bet. That way your doctor can perform a physical exam and ask additional questions.

You should also never use an online consult if you have a medical emergency and need a quick answer. Difficulty breathing, bleeding, or severe abdominal pain all warrant immediate, personal medical attention.

MyDocOnline uses a template system with a series of questions. If you click on anything that might indicate a serious problem, you will be instructed to call 9-1-1 or a doctor immediately.

You should also avoid using online medical consults for sensitive subjects, such as mental health, drug abuse, or HIV status. Although these websites are secure, privacy is always a concern.

With the current proliferation of services it may be very difficult to be sure that the services provided are high quality, or even legitimate. Seeking internet-based consultation from recognized sources such as well-known clinics or medical universities can help ensure that any information received is accurate.

Fees

Some practices will charge an annual fee for online consults. However, more often, the doctor will be the one to decide whether or not to charge for the service. Scheduling appointments and clearing up billing questions incur no costs, and many doctors waive online fees for drug refills as well.

Answers to clinical questions however, often require payment. A survey by Medem found the average fee for online medical consults was $25, approximately the same cost as an office visit copayment. Questions about an ongoing condition and/or medications are also usually considered billable, and as yet, only a handful of insurance companies cover online consult costs. However, several large companies are considering it.

While standard insurance usually will not pay for online services, patients with a medical flexible spending account often may submit online consult bills for payment. Although Soutendijk’s doctor has not charged for email advice, the busy computer programmer would be willing to pay.

“It’s quicker than going to an office,” Soutendijk said. “You have to drive there, wait, and who knows if the doctor is behind or not. This way you submit it and when he has a free moment, he can look at it.”

Benefits

Both patients and doctors enjoy the convenience of online consults. In a survey conducted by the University of California, Berkeley and Stanford University for RelayHealth, a provider of such services, 78% of patients considered online messaging more convenient than telephoning.

Well-educated, web-savvy people seem to be the most comfortable with online consults, says Milam. Often users are busy professionals who do not want to miss time from work waiting to see the doctor.

But they are not the only ones. Online medical consults may solve transportation problems for older adults or people who cannot drive. In fact, the majority of Dr. Columbus’s online patients are older and include a 90-year-old.

A MyDocOnline survey indicates that some people would change their healthcare providers solely for access to an online medical consult. At Medem.com people can search for subscribing doctors by specialty.

Offering email messaging has certainly brought Dr. Columbus new patients.

“I think it’s a nice adjunct to any practice and can’t understand why anyone would not use it,” Dr. Columbus concludes. “I’ve found it very beneficial.”

CANADIAN RESOURCES:

Canadian Family Physician
http://www.cfpc.ca/cfp/

Health Canada
http://www.hc-sc.gc.ca/index_e.html

References:

Adler KG. Web portals in primary care: an evaluation of patient readiness and willingness to pay for online services. J Med Internet Res. 2006 Oct 26;8(4):e26.

eRisk working group for healthcare: guidelines for online communication, November 2002. Medem website. Available at: http://www.medem.com/phy/phy_eriskguidelines.cfm. Accessed January 8, 2004.

Guidelines for physician-patient electronic communications. American Medical Association website. Available at: http://www.ama-assn.org/ama/pub/category/2386.html. Accessed January 8, 2004.

Online patient-provider communication tools: an overview (November 2003). California HealthCare Foundation website. Available at: http://www.chcf.org/topics/view.cfm?itemid=21600. Accessed January 8, 2004.

webVisit® study facts. RelayHealth website. Available at: http://www.relayhealth.com/rh/general/news/studyFacts.aspx. Accessed January 8, 2004.

Umefjord G, Sandström H, Malker H, Petersson G. Medical text-based consultations on the Internet: a 4-year study. Int J Med Inform. 2008 Feb;77(2):114-21. Epub 2007 Feb 20.



Last reviewed July 2008 by Lawrence Frisch, MD, MPH

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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