appreciate if their ailment is embarrassing. It’s inexpensive – less than $50
for a typical consult, says Doctor on Demand. But as Crenshaw knows, it’s
no replacement for your regular doctor, who knows you and can usually
discern something that’s out of the ordinary. Telemedicine services are great
for coughs, colds, rashes, suspected urinary tract infections and the like,
but they have their limits.
“I had a lady who was over 50, had been losing weight, had not seen a
doctor in YEARS,” Crenshaw said. “She was very concerned because she
didn’t have much of an appetite. Once I got that history, I told her, ‘It’s
really difficult to pinpoint exactly what the issue is. You’ve never had a
mammogram, and you’re 10 years late on getting your colonoscopy. You
need to see a doctor in person.’”
Crenshaw started with Teladoc in November, when she was switching
from a clinic in Pelham to the one in Albany. Her new employer would
need a few months for the process of hiring a new physician, which
included thoroughly checking her credentials, background and references,
plus her orientation. She didn’t want her skills to get rusty, so she jumped
into virtual medicine.
A few practical nuts and bolts:
• Telemedicine companies screen their physicians thoroughly. Hers
required that doctors be board-certified, something that not all
companies do.
• She gets paid per consult.
• Her consults can last up to 15 minutes, but typically they’re
between five and seven minutes.
• Physicians get extensive training in the art of assessing a virtual
patient with modules, courses and quizzes online.
• Patients are asked to evaluate her after each consult.
• Medical directors periodically review her charts and evaluate her
performance.
• She doesn’t have to be a computer wizard. If something goes wrong
with the video, she has the patient’s phone number and can call.
STILL A LONG WAY TO GO
Some states – such as Florida – are approaching telemedicine with
great caution.
Yes, it’s true that if Brittany Crenshaw lived in Florida instead of
Georgia, she could still consult with telemedicine patients for Doctor
on Demand. Those direct-to-consumer rules are pretty simple: No
matter which state she lives in, she can consult with patients as long as
she’s licensed in the state where those patients live.
Beyond that, though, the rules of telemedicine are largely unsettled
in Florida.
For the past four years, Florida legislators have been working to
establish guidelines. The biggest challenges, said Dean John P. Fogarty,
are: Who has the capacity to pick up the extra work of monitoring
these patients long-distance? What type of medical records system do
you need? And how does a doctor get reimbursed?
“Everyone’s concerned about making sure that this is done in the right
situations,” Fogarty said, “and that it actually improves outcomes.”
A statewide Telehealth Advisory Council – which includes Michael
Smith from the College of Medicine – will submit a report to
the governor and legislative leaders by Oct. 31. More legislation
involving telemedicine is expected next year. Will it succeed where its
predecessors failed? Stay tuned.
What it boils down to, she says, is just another way to put a patient’s
mind at ease.
She remembers one Doctor on Demand patient who’d had a physical that
same day. His regular doctor had ordered an EKG, and the patient had a
copy in his hand. Across the top he’d seen wording that he interpreted to
mean “abnormal” – and by this time it was too late to call his doctor.
“He was scared to death,” Crenshaw recalled. “I asked: ‘Are you having
chest pain? Are you having any shortness of breath? Anything like that?’
No. He felt like he was pretty healthy. I had him take a picture of his EKG
and send it to me. It was normal! He just needed a doctor to tell him that.”
And he found one.
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