Dr. Howard Stark's office is quiet. Very quiet. No patients sit in his waiting room. No receptionist answers the telephone. Stark does not have a receptionist.
Instead, he and his assistant Michele Norris-Bell check e-mail alerts on handheld devices and — between seeing patients in person — on a desktop computer.
Stark has moved most of his practice, based in Washington, onto the Internet and he couldn't be happier. Since he started his Web-based service two years ago, he has received 14,000 e-mails.
And yet, he feels more like an old-fashioned family doctor in a small town than a modern, harried physician.
"That's 14,000 phone calls that we did not have to answer and that patients did not have to make," Stark said.
He does not charge for answering an e-mail. "You have to come in one time a year for an annual exam," Stark said.
The rest is free — prescription refills, quick questions about medication, even questions about unusual stings.
"What do I get? A picture of the scorpion that bit the patient in Belize," Stark laughed. "I said, 'it would have been better to send me a picture of your leg."'
He also gets updates on patients' personal lives.
"People say how impersonal e-mail is. No way. It is so personal because I can hear what is going on with the kids," Stark said in an interview at his otherwise ordinary office.
"It keeps me a lot closer to what is going on with my patients," he added. "I feel like I have taken 21st century medicine back to being more like the old-fashioned physician who knows how your family is doing."
Health experts, the U.S. government, labor unions, employers and average citizens all agree the U.S. health care system badly needs improvement.
Costs are soaring and yet the average physician, according to many estimates, spends only about 10 minutes with each patient.
Harried desk staff often double- and even triple-book each appointment slot to make optimal use of the doctor's time and to make sure the overheads are covered.
"They are seeing patients every 10 minutes and from 7 a.m. to 7 at night. They don't even have time to learn how to save time," Stark said.
"The medical profession is being pushed to the edge."
Not in Stark's office, where each patient is allocated at least half an hour per visit.
Stark rents two offices, a waiting room and two examination rooms from his two former partners. He employs only Norris-Bell — his rent includes the use of technicians to draw blood and do other specialized tasks.
He figures he saves at least $50,000 a year on staff costs alone.
Stark has some other advantages that other doctors lack — he does not accept any insurance, public or private, although he will help fill out the paperwork that allows patients to claim reimbursement from their insurers. That freed him up to go solo in his practice, and a few well-placed real estate investments allowed him to go part-time.
Using the Internet lets his patients proceed as if he were in the office full-time, however, Stark said.
The idea came to him while booking a flight.
"I was sitting here and making a seat assignment to go to Miami. And I said, 'why is it I can make a seat assignment four months in advance and my patients can't book a half-hour appointment?"' he said.
"I started thinking of other things that could be done online."
For instance, written instructions on how to prepare for a colonoscopy, general health tips, or information on Lyme disease.
Stark contacted a couple of friends with Internet experience and they designed DoctorsOnTheWeb (http://doctorsontheweb.net/), a site that lets any doctor do what he is doing. So far, three other doctors have signed up to use the site, he said.
The system works like a bank's Web site. To avoid putting confidential information in e-mails, patients work on a secure server. If Stark wants to contact them, they get an e-mail merely directing them to pick up a message at the password-protected site.
"A lot of my patients, their secretaries see their e-mails," Stark explained.
It allows patients to ask about their health as issues arise, instead of waiting for the annual exam. "If you have any questions, it's so nice to shoot an e-mail," Stark said.
He can direct patients to the emergency room, if appropriate, to see a specialist or set up an appointment for an examination. Stark stresses that he does not make medical decisions based on an e-mail.
But no one has to wait until business hours. "I'll refill your prescription from Barcelona," he said.
How about his lone assistant? Is she overworked?
"I love it. I love it. I love it," Norris-Bell said.