online healthcare???

[Smallsteps]

So I have been seeing some commercials for a ED service called ROMAN that states you can just TEXT with a doctor(?) and then they will write a prescription for this company's ED program.
I also read an article with a doctor prescribing the PLAN B pill after only texts or chat with the patient.
Now I just cannot imagine this or other item prescribed by someone whom you have never seen and have no health history on the patient. I guess they are based on the honor system that the patient will tell you any item that could conflict with this medication.

I will wonder what happens if something really goes wrong? We can do ALOT of things online but I still think this is insane.

[disneysteve]

I have no idea how they get away with this. I think the same thing about the telemedicine services. You call or facetime and they treat you based on that. I think it's probably okay for something like a rash if they can see it pretty clearly but they also treat things that they can't possibly diagnose by video chat like strep throat. At my job, one of the quality metrics we track is treatment of strep. There has to be a positive strep test in order to prescribe an antibiotic. If the test is negative, no antibiotic. So how are they prescribing without any test at all? I guarantee they are grossly overprescribing antibiotics which is incredibly irresponsible. But even my insurance, which comes from my job, pushes their teledoc service (which directly competes with our urgent care services). It makes no sense at all.

[creditcardfree]

Basically it comes down to this, the pharmaceutical industry wants to get the drugs sold to the patient as quick as possible, it doesn't care about the consequences. Health is not the goal, only sales are.

[disneysteve]

Basically it comes down to this, the pharmaceutical industry wants to get the drugs sold to the patient as quick as possible, it doesn't care about the consequences. Health is not the goal, only sales are.

I don't see how this has anything to do with the pharma companies. They aren't the ones running these telemedicine services. They are run by doctors and hospital systems looking to boost income. And the insurance companies jump in because it reduces their costs.

I have absolutely no problem dispensing emergency contraception by phone/text. In fact, those products are already sold OTC so you don't even need a prescription to get them. You can just walk into your local CVS and buy them. ED drugs, however, do require medical evaluation. You should have an exam and some blood work done because there could be medical reasons for ED like high blood pressure or diabetes or low testosterone levels. So I think it's irresponsible to hand those out by phone.

[Smallsteps]

Disneysteve,
I thought you might weigh in on this.
Who are these DRs? what state are they licensed to practice in? wonder if details like background are provided.
How would this not be a conflict of interest only texting someone to sell 1 medication ( regardless of if another would be a better option) from the company they work for?


I too do not see how with all the possible side effects that someone would feel comfortable prescribing anything over a TEXT message not even a facetime/ skype meeting, almost as effective as people self diagnosing with WEB MD. Cannot imagine an insurance company offering Malpractice for text / phone doctoring.

If people ever took a moment to watch health related ads/ mostly by Pharma and Lawyers.
I really fear the crazy things out there the side effects and then in a very short time so many drugs are found to cause x,y and z so contact these digital ambulance chasers.

Particularly the recent commercial I saw for a diabetes drug that I remember had a happy jingle and was heavily advertised as little as a year ago .............is supposedly linked to and I quote " flesh eating genital infections" seriously?
what is the FDA letting on the market? Zero accountability so people should NOT feel safe with anything FDA approved.

I can only imagine the reality Doctors face trying to educate patients why some drug with a fun jingle and maybe a semi celeb promoting it IS NOT the answer for whatever the patient is dealing with.

[disneysteve]

Who are these DRs? what state are they licensed to practice in? wonder if details like background are provided.
How would this not be a conflict of interest only texting someone to sell 1 medication ( regardless of if another would be a better option) from the company they work for?

I'm not totally current on the laws but I believe doctors practicing telemedicine must be licensed in the state in which the patient lives. So I am licensed in NJ and can only handle telemedicine calls from patients in NJ.

I wouldn't think the doctors are only prescribing one specific medicine as there are several options. There's really no conflict of interest since the doctor doesn't work for the pharmaceutical company.

I too do not see how with all the possible side effects that someone would feel comfortable prescribing anything over a TEXT message not even a facetime/ skype meeting, almost as effective as people self diagnosing with WEB MD. Cannot imagine an insurance company offering Malpractice for text / phone doctoring.

And yet, it's very much a thing today. My health insurance includes access to Teladoc (teladoc.com). I've never used it and don't ever intend to use it and advise patients not to use it but it's there and lots of people do use it.

In full disclosure, I actually signed up with a telemedicine company several years ago (healthtap.com) when I was looking for alternatives to my practice (before I went into urgent care) but I have never actually "seen" a patient through the service.

If people ever took a moment to watch health related ads/ mostly by Pharma and Lawyers.
I really fear the crazy things out there the side effects and then in a very short time so many drugs are found to cause x,y and z so contact these digital ambulance chasers.

Particularly the recent commercial I saw for a diabetes drug that I remember had a happy jingle and was heavily advertised as little as a year ago .............is supposedly linked to and I quote " flesh eating genital infections" seriously?
what is the FDA letting on the market? Zero accountability so people should NOT feel safe with anything FDA approved.

I can only imagine the reality Doctors face trying to educate patients why some drug with a fun jingle and maybe a semi celeb promoting it IS NOT the answer for whatever the patient is dealing with.

You raise a couple of different issues here.

Direct to consumer (DTC) advertising of prescription medications and medical devices is a disaster. You can thank Congress for that. I'm sure they got millions and millions of dollars in money from the industry and pressure from the lobbyists to change those regulations so that the advertising was allowed, which is wasn't for a very long time prior to that.

As to the side effect warnings, blame the lawyers for that. Most of the side effects they mention are exceedingly rare, like occurring in a fraction of one percent of patients. When sales reps detail doctors in the office, they tell us the common side effects and also mention those rare side effects while making it clear what the incidence is. On the commercials, however, they just rattle off a list of potential side effects without regard to incidence. So "upset stomach" is mentioned in the same breath as "medullary thyroid cancer" even though one might occur in 15% of patients and the other occurs in 0.15% of patients.

As for your FDA comment, I completely disagree. I think the drug testing process is quite good. The reality, however, is that sometimes side effects show up once a drug is being used by millions of people that wasn't apparent when it was only being used by a few thousand in a study group. Those percentages come into play again. Let's say the studies are done on 5,000 patients over 5 years. If a certain issue only occurs in 0.1% of patients, only 5 people in the study group might get the problem, and possibly fewer than that or even none. Maybe the side effect doesn't show up until you've been on the medicine for multiple years. But release that med to the public and now there are 5 or 10 million people taking it. That 0.1% side effect starts showing up in thousands of people over the course of several years and they realize through post-marketing studies that there's a problem they weren't aware of.

[Radshaw8]

I am totally scared of it. If something goes wrong then you can't blame anyone.

[TexasHusker]

I used MDLive yesterday a.m. I have been congested for over a week, scheduled a telephonic appointment, and a doctor called me 20 minutes later. I was traveling and didn't have time to give half a day going to a doc in the box and filling out a bunch of forms. The doctor spent about 10 minutes with me and prescribed a generic antibiotic. Less than 48 hours later I am back home and feeling much better. The doctor also sent the notes to my primary care physician here at home for followup if needed. MDLive is free as part of my Christian Medi-share plan. I am a satisfied patient.

[disneysteve]

I used MDLive yesterday a.m. I have been congested for over a week, scheduled a telephonic appointment, and a doctor called me 20 minutes later. I was traveling and didn't have time to give half a day going to a doc in the box and filling out a bunch of forms. The doctor spent about 10 minutes with me and prescribed a generic antibiotic. Less than 48 hours later I am back home and feeling much better. MDLive is free as part of my Christian Medi-share plan. I am a satisfied patient.

I'm glad you're feeling better, but the reality is that these telemed services are greatly over-prescribing antibiotics which is a growing problem in medicine overall. Without a physical exam, it's really really difficult to determine if an antibiotic is actually indicated. I've had a number of patients tell me that they were prescribed an antibiotic for "strep throat" that way. Sorry but there is no possible way for a doc to diagnose strep via a phone call. The same goes for bronchitis. The vast majority of cases are viral but call one of these services and tell them you've got a bad cough and a few minutes later an antibiotic prescription is on its way to your pharmacy. It might satisfy patients but it is not good medical practice.

On the other hand, come into urgent care with a sore throat and we will take your temperature and examine you including looking in your throat and palpating for enlarged lymph nodes. Then we'll do a rapid strep test. If the test is negative, no antibiotic. Then we'll send off a culture as a confirmation and call you back in a couple of days with the result. But call the telemed folks and odds are good you'll get the antibiotic whether you need it or not.

[TexasHusker]

I think a personal visit to the doctor is always best. My wife had the same crud and actually did go to her doctor while i was gone and it was bronchitis. But when you are on the road and you're sick, teledoc is an attractive alternative. I rarely take an antibiotic - perhaps every few years, and I assume the one they prescribed is far down the totem pole from the big guns they pull out when you're REALLY sick. I am no doctor, but unknowingly taking a low-level AB once every few years when you had a virus instead of a bacterial infection is of little long term consequence, I would think. If you did that frequently you might find yourself AB resistant to the point that nothing might work at all. But I could be way wrong on that.

[disneysteve]

I am no doctor, but unknowingly taking a low-level AB once every few years when you had a virus instead of a bacterial infection is of little long term consequence, I would think.

I think that's probably true, though taking any medicine is never risk-free. I see patients fairly often who had an allergic reaction to an antibiotic, even one they've taken several times in the past. Or maybe they had an interaction with another medication they are on. Or they got diarrhea or developed a yeast infection as a result of taking the antibiotic. So you never really want to take something you don't truly need.

I certainly won't pretend that I never prescribe antibiotics that probably aren't necessary, but I guarantee I do it far less than the teledocs do, because I actually examine the patients, including sometimes doing diagnostic testing to confirm what's going on - a strep test for a sore throat, an x-ray for a bad cough, a flu test.

Our insurance (which is through our hospital system) includes Teladoc access and they periodically send out a mailing touting their services. It drives us nuts because it's all of the stuff that we treat every day in Urgent Care. They are cannibalizing their own business by doing that. Sure, if you're out of town and there's no urgent care center nearby, go for it. It's certainly better than ignoring your symptoms. Or it's late at night and nothing is open, that's fine too. But if you can, go see someone in person.

[TexasHusker]

I think that's probably true, though taking any medicine is never risk-free. I see patients fairly often who had an allergic reaction to an antibiotic, even one they've taken several times in the past. Or maybe they had an interaction with another medication they are on. Or they got diarrhea or developed a yeast infection as a result of taking the antibiotic. So you never really want to take something you don't truly need.

I certainly won't pretend that I never prescribe antibiotics that probably aren't necessary, but I guarantee I do it far less than the teledocs do, because I actually examine the patients, including sometimes doing diagnostic testing to confirm what's going on - a strep test for a sore throat, an x-ray for a bad cough, a flu test.

Our insurance (which is through our hospital system) includes Teladoc access and they periodically send out a mailing touting their services. It drives us nuts because it's all of the stuff that we treat every day in Urgent Care. They are cannibalizing their own business by doing that. Sure, if you're out of town and there's no urgent care center nearby, go for it. It's certainly better than ignoring your symptoms. Or it's late at night and nothing is open, that's fine too. But if you can, go see someone in person.

agreed 100%. For me, I was in a rural area and I had a ton of stuff to get done. There was a clinic within a few miles, but the idea of going down there, waiting around with a bunch of coughing and hacking folks, filling out paperwork, blah blah blah, I was just willing to take the risk.

[Mjenn]

We have this included in our national health care coverage and I have found it helpful for 1) renewing prescriptions for my chronic illness -- have to do this annually and can sometimes be annoying to take off work just for this and 2) getting meds if I have an infection the I am prone to -- usually I can control these without antibiotics, but occasionally it needs antibiotics. The few times I've gone to the health center they have prescribed me meds and taken a test as well that confirmed diagnosis later on. It is again helpful as I don't need to take time off work.

That said, there have been studies that show that this service has increased the amount of antibiotics being prescribed here significantly -- due to exactly what Steve described. Most health clinics here are quite conservative with antibiotics but the online services dole them out far more frequently.

Our local government has some trouble with these as they charge about the same amount as a clinic. Right now we can choose to use a variety of these apps and have them covered by our national health insurance, but I'm thinking there may be a crack down on this. Alternatively, our health clinic has also started offering more appointments via telephone and online. However I have complained about this as I get an appointment for a telephone call at 4:30 and set aside time to take that call only to learn that the call will come 'at 4:30 or later ' and then it is really inconvenient due to meetings, picking up kids, life, etc.