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Doctoring by Phone

How often do you get requests to do telemedicine? I get a few per month, all offering money (usually $20-$30 per call) for me to manage patients by phone. I’m not talking about Viagra or Vicodin mills, but places that cater to patients who either can’t or won’t see a doctor.

I always say no. In my mind, this is just another way to cheapen our profession, but I also have serious concerns about it.

Photo ©Alliance/Fotolia.com
    

There’s a lot to worry about when trying to treat patients without seeing them. Most migraines are migraines, but what if you can’t examine the patient? You might miss papilledema, or a reflex asymmetry, or other signs that something is amiss. The same could be said for routine lumbar pain or carpal tunnel syndrome.

I don’t mind handling the occasional phone call for an office patient I’m familiar with. And, of course, we all have to deal with cross-cover calls on nonpatients. But to try and do a full history and physical by phone? That doesn’t work for me.

I’m not deluding myself into believing that my refusal to participate will keep these things from happening. Hungry physicians willing to take the legal risks will be hired, and may end up costing me a few patients who would have otherwise come to my office. I’ve been told that I should participate in this sort of thing so at least I can shape the way it develops.

But my belief in my field makes me reluctant to compromise. I also have a family to provide for, and medicine is a risky enough undertaking as it is without adding more potential liability. And I just don’t believe you can provide a decent level of care solely by phone.

Knowingly doing an incomplete job is never a good idea, especially in medicine. And the people who use such services, as in everything else, get what they pay for.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. He has been a practicing neurologist since 1998 and in private practice since 2000.

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How often do you get requests to do telemedicine? I get a few per month, all offering money (usually $20-$30 per call) for me to manage patients by phone. I’m not talking about Viagra or Vicodin mills, but places that cater to patients who either can’t or won’t see a doctor.

I always say no. In my mind, this is just another way to cheapen our profession, but I also have serious concerns about it.

Photo ©Alliance/Fotolia.com
    

There’s a lot to worry about when trying to treat patients without seeing them. Most migraines are migraines, but what if you can’t examine the patient? You might miss papilledema, or a reflex asymmetry, or other signs that something is amiss. The same could be said for routine lumbar pain or carpal tunnel syndrome.

I don’t mind handling the occasional phone call for an office patient I’m familiar with. And, of course, we all have to deal with cross-cover calls on nonpatients. But to try and do a full history and physical by phone? That doesn’t work for me.

I’m not deluding myself into believing that my refusal to participate will keep these things from happening. Hungry physicians willing to take the legal risks will be hired, and may end up costing me a few patients who would have otherwise come to my office. I’ve been told that I should participate in this sort of thing so at least I can shape the way it develops.

But my belief in my field makes me reluctant to compromise. I also have a family to provide for, and medicine is a risky enough undertaking as it is without adding more potential liability. And I just don’t believe you can provide a decent level of care solely by phone.

Knowingly doing an incomplete job is never a good idea, especially in medicine. And the people who use such services, as in everything else, get what they pay for.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. He has been a practicing neurologist since 1998 and in private practice since 2000.

How often do you get requests to do telemedicine? I get a few per month, all offering money (usually $20-$30 per call) for me to manage patients by phone. I’m not talking about Viagra or Vicodin mills, but places that cater to patients who either can’t or won’t see a doctor.

I always say no. In my mind, this is just another way to cheapen our profession, but I also have serious concerns about it.

Photo ©Alliance/Fotolia.com
    

There’s a lot to worry about when trying to treat patients without seeing them. Most migraines are migraines, but what if you can’t examine the patient? You might miss papilledema, or a reflex asymmetry, or other signs that something is amiss. The same could be said for routine lumbar pain or carpal tunnel syndrome.

I don’t mind handling the occasional phone call for an office patient I’m familiar with. And, of course, we all have to deal with cross-cover calls on nonpatients. But to try and do a full history and physical by phone? That doesn’t work for me.

I’m not deluding myself into believing that my refusal to participate will keep these things from happening. Hungry physicians willing to take the legal risks will be hired, and may end up costing me a few patients who would have otherwise come to my office. I’ve been told that I should participate in this sort of thing so at least I can shape the way it develops.

But my belief in my field makes me reluctant to compromise. I also have a family to provide for, and medicine is a risky enough undertaking as it is without adding more potential liability. And I just don’t believe you can provide a decent level of care solely by phone.

Knowingly doing an incomplete job is never a good idea, especially in medicine. And the people who use such services, as in everything else, get what they pay for.

Dr. Block has a solo neurology private practice in Scottsdale, Ariz. He has been a practicing neurologist since 1998 and in private practice since 2000.

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