Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Tuesday, July 1, 2014

Virtual Care Physician

I got the following email:

Become a HealthTap+ Prime Virtual Care Doctor
HealthTap+ and HealthTap+ Medical Group, PC. have partnered to create a healthier, happier world—one person at a time.
As a Prime Doctor with HealthTap+ Medical Group, you have freedom to shape your own lifestyle. Boost your income and practice medicine remotely from wherever you wish (at home, in your office, even a vacation home) using your own equipment to provide Virtual Consults via video, audio, and text using HealthTap+ Prime, the next-generation platform for delivering care online and onto mobile devices.
You’ll have the ability to provide quality services that keep patients coming back, attract exceptional peers in the medical profession, and help create the future of healthcare by demonstrating what’s possible when people have immediate access to trusted doctors.
We are looking for Board Certified physicians (MD and DO) who possess the skills or knowledge of a primary care physician.
As a Prime Doctor you will receive the following benefits:
  • Boost your income (earn up to $180/hr)
  • Care for patients anytime and anywhere most convenient for you
  • Work free of administrative hassles, overhead, or additional costs
  • Join an elite group of thought leaders to revolutionize personal health
Take a minute to sign up here:
Shifts are selected on a first-come, first-served basis!
This is an independent contractor position with HealthTap+ Medical Group, PC for Virtual Consults via HealthTap+ Prime.

I googled "healthtap prime", and one link took me to a review on Reidbord's Reflections, Steven Reidbord's blog. The original HealthTap model seems to be a double social network, where anyone with the app, or on their site, can ask a medical question, and get an answer, from a doctor, for free, pretty quickly. So there's the network of "askers", and the network of doctors. 

As Dr. Reidbord notes, it would work better as a knowledge-base model, rather than a social network. But there are fun features like "Tap Tips", which seem to be unsolicited pearls. You can look things up by topic, and you can set up a feed. For doctors, there's something called the "virtual practice", which allows you to advertise yourself, schedule appointments, and offer an individualized app to your patients. And there are little perks and awards, "Best doctor in Hoboken" based on some rating system. Also for doctors, there are all kinds of disclaimers like, "see your doctor if..."

I clicked the link to Dr Reidbord's page on HealthTap, to see what kinds of questions came up. Some simple things, like, "Is ECT effective for depression?" There seems to be a one word answer, "Very", followed by a brief explanation: Electroconvulsive therapy (ECT) has one of the highest success rates of any treatment for depression. But because it involves anesthesia and other risks, it is reserved for severe conditions that do not respond to less intensive treatments.

There are a lot of "maybe" kinds of questions: "Does risperidone work right away?", "Any tips for anxiety?", "Best antidepressant?". Some specific questions, "Can I take beta-blockers and paxil?", and some I wouldn't know what to do with, "Why can't I sleep at night?". 

Dr. Reidbord's answers are impressive. First of all, they're limited to 400 characters. He manages to know when to answer directly, when to say, Maybe, when to say, You might want to see your doctor, and when to say, See your doctor. I don't think I'd be able to navigate those shoals. (If you're reading this, Dr. Reidbord, kudos).

I decided to try HealthTap from the patient's perspective, so I signed up for an account under a false name and date of birth, and an email I rarely use. The UI of the app is pretty good. I glanced through some questions, and many were along the lines of, "How can I lose 40 pounds in 1 year?" The answers were decent-eat healthily, drink water, get sleep, exercise-but many grandmothers could give you the same answer, and I got the impression that most of it was common sense. There were some reviews from users who are grateful for having access to doctors, rather than someone crazy online. But for a lot of the questions, I didn't think it would be that misleading or confusing to google. 

I decided to post a question. One question I saw was about sodas, whether they're unhealthy, including sugar free and club soda. One answer mentioned tooth decay. I drink a lot of club soda, so I started to wonder, is it adversely affecting my teeth. Now, I'm sure I could have looked this up myself. But I asked, "Is club soda bad for me?" I got two answers within a couple minutes, both of which said club soda was fine, as long as it's not in excess. And one answer mentioned teeth. I "thanked" one of the responders-I supposed it's like "liking". I was pleased that my question was vague and didn't include what I really wanted to know, but I still got the answer I was looking for.

(By the way, does anyone know the difference between seltzer and club soda?)

Then I decided to try a difficult question, "What is the proof that DSM-5 diagnosis criteria are accurate." I got one answer, 43 minutes later:

"History. These codes are compiled by the symptoms of millions of patients. The diagnostic codes are created around a constellation of symptoms by doing it this way the risk of mis diagnosis is lessened. A patient is not diagnosed by one symptom but a series of them adding up to a diagnostic criteria"

You can decide if that answers my question.

The responder is an Aesthetic Medicine doctor "known for" (one of the app features) acne, botox, laser tattoo removal, thermage, body contouring, being knowledgeable,...

I should mention that the club soda question was answered by a Pain Medicine doctor, and a Clinical Psychologist, who was the one who wrote about teeth. 

There also seems to be a way to get faster answers from doctors for $0.99. I haven't tried that yet.

I checked out the link in the email to sign up to be a Virtual Care Physician. There was a video with words like "delighted". Everyone had some sort of laptop, ipad or mobile device, and was happily tapping away. One doctor was demonstrating to her patient, on a Skype-like system, something about neck pain. At least, that's what it looked like.

Apparently, malpractice insurance is included with the virtual care position. 

Is this the future of medicine? The talking heads on the video seemed very pleased that patients could have 24/7 access to doctors, without visiting an ER. 

I read an article in New York Magazine, a few weeks ago, about the future of health insurance. It described a new insurance, available now in NYC, called, Oscar. It's a techy, startup operation, with subway ads like, "Finally, health insurance that won't make your head explode. And if it does, you're covered." The techy part seems to include health profiles for users, and the ability to get medical care quickly and easily:

He gave an example: A few weeks earlier, he’d felt some rawness in his throat that he was worried might be strep. Using his Oscar iPhone app, he put in a request with his doctor, who phoned him back in 15 minutes. The doctor, Kushner recalled, “asked me to stand in front of a mirror and look at the back of my throat. Did I have white spots on the back of my throat? I did. He said, ‘I’m going to prescribe you Amoxicillin.’ ” (Oscar has stressed that the call feature is not intended for ongoing care nor major ­medical conditions. “We’re not going to treat diabetes by phone,” Nazemi told me.)

So the virtual phenomenon is not exclusive to HealthTap. 

I was pretty surprised that I was being contacted for a primary care job. Technically, I'm qualified, but I wouldn't recommend myself for primary care. I was also surprised that they're restricting the initial virtual push to primary care. Psychotherapy seems much better suited. 

I'm gonna break it down now. And I'm gonna include both the patient's and the doctor's perspectives.

24/7 access
immediate response to questions
answers from actual doctors
good UI
tools for doctors to get new patients and make access easier for current patients
way for doctors to make some extra money
challenge of writing succinct answers
social network atmosphere and tropes

no physical exams
doctors viewed as experts outside their primary fields
over-prescribing of antibiotics
medicine practiced in a way that could be construed as irresponsible, and at the very least has unforeseeable consequences.

1 comment:

  1. Hi. Thanks for checking out my review, my HealthTap page, etc. I've enjoyed providing those free, 400 character answers, although my interest has waned after tackling about 650 of them (yes really), and I don't do it very often anymore. I was an early adopter at Health Tap and by now have no problem tailoring my responses to fit the space limits. I agree that the quality of answers varies a lot, especially if the question is controversial and can't fairly be answered in 400 characters (e.g., your DSM question).

    The "Prime" feature — actual doctor-patient encounters online — caught my eye due to my interest in the pros and cons of online psychotherapy, which I've blogged about before. As you note, Health Tap is rolling this out for primary care only. It mystifies and troubles me that they market this "opportunity" so aggressively to non-primary care docs, who for the most part have no business attempting any such thing. (I'd be an awful primary-care doc, online or otherwise). Not to mention that the lack of physical exams ought to be a deal-breaker in many instances.

    Health Tap didn't invent online doctor-patient encounters, and they won't be the last. I'm not sure where they're going as a company. I find the TipTaps, awards, competitions, and such irritating, but still find it fun to log on now and then, and answer a few questions for free.