Monday, August 9, 2010

The Many Costs of Seeing a Doctor

An interesting article in the Baltimore Sun describes a new set of websites in England by which people can answer a questionnaire and receive a prescription without ever seeing the doctor.  This is not for patients with an established relationship to have a follow-up--this can be for people who literally have never met the physician before.

It is interesting to me that most of the medical professionals who are quoted in the article talk about this being useful for people who don't have access are who are in areas without easy access--or they don't like it at all.  While I am not a physician, I believe I would still tend to focus on at least trying to get to an urgent care center (if one of those is accessible) rather than using this type of service.  I tend to agree with whoever wrote the headline for the article--"if you don't have the time just click here" and would assume that many people who will use this service will be busy individuals who feel they don't have the time to both with going to see a physician in person if the issue can be taken care of over the internet.

When assessing something like this, we would simply have to hope that the questionnaire has enough points at which patients are directed to stop and go to see a physician that patients do not end up trading convenience against safety.   What risks to patient safety are we willing to experience to get faster care?  At the societal level?  At the individual level?  What if we have a serious shortage of physicians if payments to physicians really are cut as steeply as suggested under health care reform?  Hypothetically, the duration of the delay without access to this type of service could lead to a need for this type of service and it would really just be trading off one type of risk to safety (delayed care) with another type of risk to safety (care via the net).

Also, I would hate to think of the implications of any security failure if people are sending pictures of rashes, etc. over the web.  Yes, I once posted some pictures of my (then) 4 year old's foot which was infected, but I'm not sure what other body parts I would (or would not) be willing to send for fear of security issues.  That raises a whole different set of cost and benefit tradeoffs.


  1. There are many costs attached while going to meet a doctor. You have discussed a new thing to us.

  2. Glad to hear that. We have to think about the time costs as well as the money costs and the risks we take depending on how we choose to interact with a physician.

  3. Physicians are skilled and trained observers, the onlinemethod does not only prevent the doctor from doing the very essential physical examination but also deprive him from multiple non verbal ques that are most of the times very helpful in diagnosing a patient.. i have to say that i believe this is a very unsafe practice and it is ok if it ends up with a consultation and a feedback.. but having prescription also is a very big risk that can not be balanced by any other forms of benifits.

  4. I like Omniyat's point about non-verbal cues. I would bet that even with best efforts to use video-conferencing it would still not be the same.