Virtual Visits To Doctors Spreading

tresho writes to tell us that virtual doctors visits seem to be on the rise. A new service, most recently deployed in Texas, from "NowClinic" is allowing doctors to make virtual house calls and prescribe anything short of controlled substances. "For $45, anyone in Texas can use NowClinic, whether or not they are insured, by visiting NowClinic.com. Doctors hold 10-minute appointments and can file prescriptions, except for controlled substances. Eventually they will be able to view patients’ medical histories if they are available. The introduction of NowClinic will be the first time that online care has been available nationwide, regardless of insurance coverage."

Finally moving into the "public sector"

[ubrgeek]

A dozen years ago I was a reporter in the Texas Panhandle and the Texas Department of Criminal Justice used "telemedicine" extensively. Interesting to see them finally moving it to the general population (no pun intended.) IIR, the patients/inmates were of mixed opinion on it, but the remote doctors seemed to prefer it ;)

I am a med student, and I am horrified

[tpjunkie]

This is a bad idea. No, this is a TERRIBLE idea. With a virtual doctors visit you are missing out on a very important component of data collection leading to a diagnosis; the physical exam. Without ascultation, you are missing out on a ton of information about a patient's cardiovascular, gastrointestinal and pulmonary systems. Without physical contact, you cannot perform any kind of neurological or musculor skeletal exam, or even really determine a patient's mental status, especially if you are using just a instant messenger style window for communication. I think it is highly irresponsible and certainly opens up a practitioner to a lot of liability to be diagnosing and prescribing meds in such a manner. As a doctor, I'd say this is not for me. And as a patient, moreso.

Re:Don't worry about the quality, feel the cost

[fuzzyfuzzyfungus]

When they say "controlled", in this context, they mean something distinct from "by prescription only".

You have over-the-counter drugs, which you can purchase freely(unless, like Sudafed, they've been caught up in the War on Drugs(tm) in which case you still don't need a prescription; but you will face a hassle).

Then you have prescription drugs, which you'll need a doctor's OK to buy, and you'll only be able to get from a pharmacist.

Then you have "controlled" substances, which are generally prescription; but are also of interest to the DEA, generally because they are either exciting narcotic painkillers, or amphetamines, or suchlike. Those tend to have additional restrictions in terms of how much can be supplied per unit time(ie. 1 month supply only, vs. 3 month supply) and doctors are more likely to face investigation if they are perceived to be oversupplying the stuff.

Then, of course, there are "dietary supplements" which are subject to almost no regulation whatsoever.

Re:Don't worry about the quality, feel the cost

[icebrain]

Disclaimer: I worked in a pharmacy for a while.

As I remember it, the "controlled substances" were broken down into a couple different categories. Class IV drugs were things like percocet and other narcotic painkillers. They had some abuse potential but were still fairly common. You could get refills, but there were generally limits on quantity dispensed and (IIRC) you couldn't transfer them. These were stocked with the rest of the "regular" prescription drugs.

Class III drugs were more controlled for whatever reason. We still kept them stocked on the regular shelves too.

Class II drugs were the real heavy stuff, like methadone and adderall/ritalin. Those were kept locked up in a safe, and we had a continuing inventory sheet where we kept track of exactly how many were in stock. No refills on these suckers. I think this also included things like morphine and such that weren't stocked in a retail pharmacy but would be issued at a hospital, for example.

Class I drugs were illegal--cocaine, meth, pot, etc.

There were also special ones that got treated just like Class II (at least the locked-up and inventory part) because they had a high theft potential, like Viagra. That was a company policy, though, not an FDA/DEA requirement. I think there were also Class V drugs (can't remember what was special about them), and I think Class VI was "ordinary" prescription drugs.

You'd be amazed how many people would do things like claim their pills were "stolen" or try to change the quantity on the prescription. Usually it just took a phone call to the issuing doctor to confirm a bogus story before we called the cops. I helped take down a couple prescription fakers and a check fraud guy :)

Re:I am a med student, and I am horrified

[aleph]

Are you serious? More than $100? A visit to a non-bulk billing [wikipedia.org] Doctor here in Aus will usually set you back $40-60. Typically you get ~$30 back from Medicare, but that's the rate for a 15-20m consult. Random person from street can rock up for that, no government subsidy involved.