The Online Doctor : A Good Use of Your Health Care Dollar?

by Marla Walters on 13 February 2010 8 comments
Photo: PC Doctor

My husband was building a shed last week. I went out to see how it was coming, and noticed he seemed distracted about something. He said his calf was sore, as though he had a pulled muscle. As the soreness got worse, he finally stopped to look at his leg, and there was a spot of blood right where the soreness was. He felt it, and there was something there, which he assumed was a splinter. He scratched at it, and something came off. He wondered if a treated-lumber sliver could have such an effect on his leg. Before too long, there was a grape-sized swelling under the small wound. He decided that he had better come inside and put some ice on it. I felt it, and under the grape-sized swelling there was a larger hard area, as though his calf muscle were flexed, even when relaxed.

He’s not one for complaining about pain, so I was a little concerned. It was just strange enough that we thought about seeking medical advice. A call to our family doctor confirmed my fear: too late for him to come in, that day. If it became even worse, we were directed to go to our local emergency room. Unfortunately, our local ER is one of the busiest in the state, so he wasn’t crazy about that idea. The Urgent Care clinics tend to be expensive and are not close by. Then he had an idea: trying an online doctor, which he had read about in a flyer from our health care provider.

Had he had any difficulty breathing, severe pain, or the like, this would not have been an option. But for a small wound, we decided to give it a try. Should you? Here is what we learned during his “appointment.”

1. Since we live in a remote area, the visit was actually covered by our insurance. After our co-pay, the cost came to only $10. The visit system, coincidentally, allowed for a ten minute “visit.”

2. It took a while to sign up and log on. Stupidly, I began to sign up with my own information, only to realize that it needed to be under my husband’s own login name and password. So, I ended up setting up both accounts. When you are a little bit stressed-out, it’s not a good time to go through this process.

3. Have your credit card ready, if you are using a site that charges for this service. I also was instructed to enter our doctor’s name and pharmacy. Make sure the site is legitimate, secure, and safe. Never give out your credit card number unless you have that assurance.

4. Our system had a tutorial. I should have watched, before. As it was, we decided to wing it — which was probably not the best method. (Is it, ever?)

5. Duh — a webcam could have and should have been used.

6. We had two choices: an online internist, or an online family practitioner. We selected “family practitioner,” only to be told the family practitioner was not available, but that the internist, Dr. Unpronounceable, could answer our questions. Okay ...

7. Bedside manner ain’t so hot, online. Here’s a sample of the chat:

Doctor: Good afternoon. (At a dollar a minute, “Hi,” would have been fine.)

Husband, pecking at laptop: Hello.

(Pause. Longer pause. We look at each other. Shouldn’t somebody be typing something? Does he ask what is wrong, or do we offer? Is he playing chess with someone at the other end?)

Husband jumps in: About a half-hour ago, I noticed that my leg was bleeding and now it is very swollen. I have applied ice and taken ibuprofen. My wife checked for a splinter, as I was building a shed, so I thought maybe a piece of wood poked me, but she cannot see anything.

(Pause. Husband notes we are now at a remaining 7 minutes, 37 seconds, for the appointment. What happens if we run over?)

(More looking at each other. Maybe we really should have done the tutorial. I’m wondering how many patients he is dealing with right now. And then:)

Doctor: Sounds like a contusion.

Husband: Is there anything I should be doing?

Doctor: Ice the swelling and take ibuprofen.

Husband: Done. Anything else?

(Pause. Meanwhile, we are down to about two minutes.)

Doctor.: Come in and see us tomorrow.

(Huh? We don’t even know where he is.)

Husband: I have an appointment to see my family doctor, tomorrow.

(Pause. Then, seeing that time was running low, anyway:)

Husband: Okay. Thanks. Bye.

ARTICLE CONTINUES BELOW

(He closed the window, but a moment later it popped back up.)

Doctor: Have a great afternoon.

I happen to own a Dorland’s Medical Dictionary, which defines “contusion” as “an injury of a part without a break in the skin with subcutaneous hemorrhage. Called also bruise.” Hmm. Maybe tomorrow it’d be a bruise, but at that point, the skin was definitely broken. Had we had a webcam hooked up, I’d have felt better about the diagnosis.

After another thirty minutes or so, the hard swelling seemed to have gone down, a little bit. We decided to stay put and continue periodically applying ice, and taking ibuprofen as directed, washed down with a couple of beers. The swelling was much improved the next morning. A full week later, though, his leg is still store.

Since then, discussions with our neighbors and others suggest that the small wound, swelling, and soreness were most likely caused by a centipede sting, rather than a splinter. In their book, Hawaii, The Big Island Revealed, authors Andrew Doughty and Harriet Friedman write about centipedes: “If you get stung, even by a baby (centipede), the pain can range from a bad bee sting to a bad gunshot wound. Some local doctors say the only cure is to stay drunk for three days.” My husband points to this as support for washing his ibuprofens down with beer. He also notes that pretty much everything he did, by instinct, turned out to have been correct.

So, would I use an online doctor, again? I’d answer that with a qualified “yes.” For minor injuries, or medical questions, why not? I could ask questions from the convenience of my laptop and the comfort of my couch. Naturally, if I suspected a broken bone, or had any chest pain or breathing difficulties, I wouldn’t crack open a laptop. I would call 911. I certainly wouldn’t recommend it to my father, who types with two fingers. With a ten-minute time allowance, he’d barely get his question out.

In retrospect, though, the time to experiment is not when you are mildly stressed. I may even spend another $10 and “practice” with a non-emergent question, just to have the hang of it. A co-worker, after hearing my story, pointed out another great function: being able to get a prescription issued a lot faster. Finally, Husband skipped the follow-up visit to our family doctor, as the soreness and swelling were much improved the next day.

So thank you, Dr. UnP. Though you probably did not diagnose the problem correctly from afar, and did not suggest treatment that had not already occurred to us, it was reassuring to have a physician answer in a way that indicated the problem was nothing to panic about. The quality of our evening was much great than had we spent it at the emergency room, and in the end, he was spared a trip to the doctor.

To sum up: if you’re going to try this, get the hang of it before you get into a stressful situation. If you are able, use a webcam. If you are truly in an emergency situation, don’t turn to your computer, call 911.

And try not to bleed on the keyboard.

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Guest's picture

I don't know--sounds like a waste of money to me.

Guest's picture
spaces

I don't think that $10 to learn a fancy word for "bruise" is a good use of money. Especially when your spouse patently did not have a contusion! I'm not sure how one could find a clearly incorrect diagnosis comforting.

Rather, the entire scenario seems quite reckless, a waste of $10 and a waste of the $50-$100 real cost that was paid by medical insurance.

Marla Walters's picture

I can see both your points.  Something I neglected to mention was that this service was actually promoted by our insurance company to use, as an option.  We just received thank-you letters from our insurance company for trying the service out.  Since writing this post, a friend in California told me about a program called Tele-Nurse, which also uses a web cam and computer.  In her words, " . . . and it works very well."  So, I guess, I am still open to the idea, even though there were cons.  Thanks both, David and Spaces, for chiming in. 

 

Guest's picture
Alan S

Depending on when/how the 10 minute timer starts, you may be able to save a precious minute by doing some preparation. Right before you start the timer, take 60 seconds and type up your initial information and question in a text file/Word document/email/etc. Then, when the 10 minute timer and chat begins, copy and paste the pre-typed message into the chat.

Guest's picture
spaces

Just ... Be careful. Data about respiration, blood pressure, pulse, etc. can be terribly important, and aren't the kind of items most people are equipped to assess on their own. And they can't be checked over the internet.

Marla Walters's picture

Alan, wish I had thought of your suggestion.  What a great idea!

Spaces, you are right - there was no way for us to measure BP, etc., from home.  If his breathing had been odd, I'd have just called 911. 

One other advantage of using this system was that my husband's EMR was in the system.  I wonder now if the pauses in the chat were when the doc was actually doing a quick records review for allergies, etc.

Thanks much for your good comments.  -M.

Guest's picture
jim

We have access to a free 24 hr nurse phone line via our health insurance plan. I'd use that in these situations. I've used them before and they are generally knowledgeable and helpful, perfect for minor health problems or simple questions. If anything is really concerning the'll suggest you go to a local doctor or emergency room.

"Some local doctors say the only cure is to stay drunk for three days." Now thats my kind of doctor!

Guest's picture
Guest

Seems like you would do almost we well with a bit of internet research. There are sites that tell you when it is important to get medical attention immediately. ... for example symptoms that might indicate stroke or heart attack. Most ailments can wait, and usually goes away on their own. In these cases, I have found that simple Internet research tells me what things I might try to ease symptoms.

In the olden days, before Internet, I referred to my family medical volume, which had pages of diagnostic flow charts. Although I was often unable to diagnose from these charts, the did tell me when it was important to call a doctor if I had certain symptoms.