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, September 30, 2014

New App-Pager

I saw an ad on the subway today for a new app called, "Pager". You download the app, input your info, and then you can report any symptoms you might be having, and get a doctor to make a house call within 2 hours.

That's right! The new innovation in medicine is house calls.

The app was designed by the same people who brought you Uber, the taxi summoning app. Which makes sense. In case you're interested, and I must say I'm intensely interested in this, here's a Wall Street Journal article about Pager from back in May.

But today was the first ad I'd seen for it, and I ride the subway every day.

I did the instant chat thing with Michelle from Pager when I checked out the site, because I was curious about a few things. Here are the screen shots:

Okay, so it's not foolproof, but they do have some way of addressing safety concerns.

I asked about safety because I remember my doctor making house calls when I was a kid, but this was someone with whom my family and I had a long-established relationship. Not a stranger.

I asked about Gyn just to be challenging. And I asked about Psych to see what they would say, and if I could potentially work there one day. Not that that's my current plan, but I do think this is a much more promising venue than telemedicine. These are real medical visits, with real physical exams. Wounds can be sutured, school physicals dealt with, flu shots given, labs ordered and followed up, prescriptions written.

I was thinking about this in comparison with Urgent Care centers, and for reasons I  can't really justify, I prefer this system. I somehow have the sense that if I walk into an urgent care center, I'll end up dealing with someone who has less training and knowledge than I do, and I'll be frustrated and walk out. I'm not sure why a doctor working for Pager would be any different, except that, at least according to the WSJ article, doctors do this to supplement their incomes, and to avoid the frustration of working at insurance based clinics. Somehow that seems more reasonable, or at least more in line with my approach. But I'd be interested to hear other people's thoughts.

Pager is $50 for a call or text that does not require in-person follow up, $199 for a weekday house call, and $299 for a weekend/evening house call. I believe it's only available in Manhattan, currently. I'm also not sure what the time limit is for a house call. Pager will provide you with appropriate bills to submit to insurance.

The site seemed reasonably responsible in weeding out emergencies, which was reassuring. It also seemed really suitable for someone visiting NYC and staying in a hotel.

Is this the future of medicine? Surely not the future of Psychiatry-house calls are kinda off limits for the way I practice. But Pager has an option for telemedicine, so maybe it could be tele-psychiatry, with an option for in-person follow-up if necessary. Sounds confusing, but better than run-of-the-mill distance psychiatry.

I did download the app. It required my name (false), email, cell number, and photograph, which it claims to need. It requires a credit card to set up an appointment, but not for plain old registration. I entered my office location, but I couldn't figure out how to access a list of local doctors without entering my current symptoms. Maybe I'll try that out.


  1. I heard of a similar service called MD On Call, but they mostly used NPs with MD backup. They went out of business. I don't know whether that's a reflection of poor management or the underlying business model.

    What kind of urgent care centers are you talking about? In the Boston-area the urgent care center I went to, they had an MD. I still got sick enough to need an ER the next day.

    What they are marketing around here now are urgent-care facilities which are staffed by board-certified ER docs. The co-pays are lower for these visits than a trip to the ER is, and they claim that they can manage broken bones and dehydration.

    I don't exactly know when you are supposed to go there. I recently had a bad episode of epistaxis which resulted in 4 trips to the ER. The last 2 could have been saved if the ER doc I saw the 2nd time had paged the ENT like my PCP asked him to do. I had really bad nausea and vomiting because I was on my 2nd rhinorocket, and both times the nurse at my PCP's office told me to go to the ER and NOT the urgent care center.

    Which is to say that I am not sure what these urgent care centers are for and what they are supposed to do that an after-hours appointment at a practice affiliated with my doctor's hospital can't do. And if I need the extra services that the fancier urgent care centers offer, should I be at an ER?

    1. I've never been to an urgent care center, so I'm not sure exactly how they function, but they're all over NYC, and there are ads for them on bus stops, etc. I think they can deal with minor traumas, like a small wound that needs suturing. I have this idea that if you develop a UTI over the weekend, you can go in and get a prescription for bactrim without spending hours and lots of money in an ER. And I'm not sure who staffs them, either.
      I'm pretty sure one of their appeals has to do with the fact that you can wait weeks for a non-urgent visit to your PMD in NYC, even if you're paying out of pocket.
      But mostly, I'm guessing that you can either wait for your PMD if something's non-emergent, or go to the ER if it is.