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Telephone doctors worry medical industry

/ Source: The Associated Press

Peter Beasley is a busy man who currently has no health insurance.

“To make an appointment and see a doctor, the whole process is very inconvenient,” he says.

Beasley is a customer of TelaDoc Medical Services, a setup that allows him to call an unknown doctor and get medicine prescribed sight unseen.

Within an hour or so of his call to an 800 number, he gets a call from a doctor who discusses his symptoms and will often write a prescription.

TelaDoc provides its members — which the company estimates at 30,000 — with access to a doctor 24 hours a day, seven days a week.

While members like Beasley praise the service as a convenient way to address nagging medical needs at odd hours, others in the health care industry say treating patients without seeing them in person is worrisome, perhaps dangerous. California’s medical board is investigating TelaDoc’s activities in that state.

TelaDoc chief executive Michael Gorton said the Dallas-based company is merely providing a needed service and is not meant to replace the family physician. The company began offering its services nationwide this year after an earlier test run.

“For the vast majority of Americans, being able to talk to a doctor in an hour is next to impossible,” Gorton said. “Our motto is we’re there when your normal doctor is not.”

Convenience questioned

TelaDoc subscribers are guaranteed to hear back from a doctor within three hours of their phone call. After paying a registration fee of $18 and completing a medical history, an individual subscriber pays $4.25 a month and a $35 fee per consultation.

Gorton said ailments range from urinary tract infections to strep throat to allergies.

But doctors’ groups and medical ethics experts question the notion of putting convenience first.

“Practicing medicine without seeing the patient is still a dangerous thing,” said Arthur Caplan, chairman of the department of medical ethics at the University of Pennsylvania. “From the doctor’s point of view, it’s not standard of care.”

Dr. Larry S. Fields, president of the American Academy of Family Physicians, said he doesn’t see the benefit of TelaDoc.

“As much as I’d like to put a positive spin on it, most patients can get to their family physicians just as quick by telephone,” he said.

Establishing a doctor-patient relationship should involve an office visit with a general exam and an ongoing plan for the patient’s long-term health, Fields said.

While the American Medical Association doesn’t have a specific policy on such services, there are some concerns for the patient, said AMA president Dr. Edward Hill. “Nothing we think can replace the face-to-face with a doctor.”

Gorton said that doctors with his network won’t hesitate to send patients to an emergency room if their symptoms warrant it. And he notes that many doctors have addressed the needs of unknown patients by handling after-hours phone calls for their colleagues.

He said that there are around 160-170 different medical licenses represented in 50 states with his service, which doesn’t treat children under the age of 12.

Five states — Virginia, Florida, Tennessee, Mississippi and South Carolina — require an examination, Gorton said. In those states, he said, patients get bloodwork and have their temperature and blood pressure checked to enable them to use TelaDoc.

Calif. investigates

The Medical Board of California has opened an investigation into the company. Spokeswoman Candis Cohen said that meeting the requirement of a good faith examination in California includes an in-person visit.

Gorton says he welcomes the scrutiny.

“We expect boards of medical examiners to look into what we’re doing and we expect to come out of it squeaky clean,” he said.

TelaDoc does not write prescriptions for controlled substances or narcotics. And uninsured patients with chronic medical conditions are limited in their use of the service, according to Gorton.

Beasley, 47, who is starting his own software company in Dallas, has had health insurance on and off for the past two years. He’s used TelaDoc for treatment of poison ivy and to get a prescription eye ointment.

“It’s certainly not the answer for anything life-threatening,” he said. “For people that don’t have health care or are in between jobs, I think it’s a great add-on.”