by Tom Wilemon, The Tennessean
Doctors are tossing aside their stethoscopes and sitting down in
front of computer screens or simply picking up phones in the expanding
practice of remote medicine.
Insurers have been encouraging people to embrace the concept by directing them to services such as Teladoc,
which offers both telephone and Internet consultations with physicians.
Now, telemedicine is entering the direct-to-consumer realm. Beginning
today, Tennesseans can dial up a doctor for a $50 flat fee.
Apogee Physicians, a company that has been providing doctor staffing in hospitals, has launched Apogee Doctor on Call.
Its doctors will pick up the phone and offer remote consultation from
their homes when they're not on hospital duty. The lines will be
answered 24 hours a day, seven days a week.
Tennessee is the pilot
state for the new service offered by the Arizona-based company. Dr.
Peter Purrington, an Apogee physician based in Clarksville, Tenn., said
many residents of this largely rural state do not have easy access to
"This is really a great opportunity to bridge that gap," he said.
will prescribe drugs for minor infections and other ailments after
patients verbally report their medical histories and current
medications. If a patient calls with symptoms of a sinus infection, the
doctor can put in a prescription order at the patient's pharmacy,
If the symptoms sound like a possible heart
attack, the doctor will advise the caller to dial 911. And there are
limits to what medications can be prescribed. No narcotics or any other
kind of happy pills. Viagra isn't on the authorized list.
Trend bothers some
Even with these limitations, some doctors worry about the trend.
Mohamad Sidani, a professor with Meharry Medical College, said the
symptoms of sinus infection can sometimes mimic something much more
"If a patient calls me and says they are having a sore
throat, headache and fever, it can be a wide range of possibilities,"
Sidani said. "It can be a simple viral infection, which doesn't even
need a physician to cure. It can cure on its own. It can be bacterial
tonsillitis, which needs antibiotics. And it can be a severe condition
Face-to-face interaction is crucial for adequate
diagnosis, Sidani said. The only scenario in which he would consider
practicing remote medicine would be with a nurse interacting with the
patient and relaying information to him.
"If it is over the phone,
I won't be able to see that patient's face," he said. "It can tell a
lot about whether he is in severe pain or distressed or not. And the way
he is moving. Body language is very important."
said the service Apogee just launched is not meant to replace
face-to-face encounters between doctors and patients. It's an
opportunity for people to talk to a licensed, board-certified doctor in
the middle of the night when an emergency room visit may not be
necessary, he said.
They can see their regular doctors for follow-up care, he said.
it's also another way for people to have the convenience of meeting a
medical need without committing to a primary care physician - a practice
that could cause chronic conditions to go undiagnosed. Retail pharmacy
clinics are another work-around used by busy people who won't take the
time to establish a relationship with a doctor.
companies are directing people to services like Teladoc, they also
encourage them to get annual physicals and be tested for chronic
conditions such as diabetes or risky conditions such as elevated
Purrington said Apogee doctors do not intend
to function as primary care physicians and will advise the people who
call to follow up with their doctors.
Tennessee was chosen as the
pilot site for more than one reason. The company already had providers
in place, he said, because of 12 doctor-staffing contracts with
Tennessee hospitals. Also, Tennessee is a hub for the health care
industry, where new entrepreneurial endeavors can become successful.