The Doctor Will See You … By Skype

Published April 9, 2013

As a possible preview of what awaits us in the United States under President Obama’s health care law, Great Britain’s government-run health care system, the National Health Service, is slashing nearly $4.5 billion from its budget by eliminating appointments with a doctor and instead treating patients via computer.

In addition, a new system of “virtual clinics” is being planned in which NHS doctors will connect with their patients via iPads and Skype. Some have warned this will put lives at risk by creating a two-tiered NHS in which the less technologically adept, particularly the elderly, would be left behind.

Devon Herrick, a senior fellow with the National Center for Policy Analysis, a public policy think tank located in Dallas, Texas, says the idea has both risks and potential rewards.

“Many consultations don’t require the physical presence of a doctor and patient face-to-face. Some of these could be conducted more efficiently—and conveniently—by phone, email, or online. However, this type of imitative needs to be driven by consumers, in consultation with their doctors, not bureaucrats trying to save money,” said Herrick.

Herrick says the key is in determining which patients require an in-office visit.

“Kaiser Permanente in Hawaii began offering electronic visits as a way for some patients in rural areas to avoid the arduous task of traveling to a physician on a different island. But, if done badly, patients in the United Kingdom could chat up a doctor for no valid reason, while other patients who really need an in-office examination are forced to consult with a doctor on Skype,” said Herrick.

Saving Time and Money

Dr. Alan Dappen of Vienna, Virginia uses emails and phone calls to diagnose and treat patients. He also does in-office visits and house calls from his Northern Virginia practice.

“I’ve been in this business model for 10 years. The reason I created this model is because health care today is not about providing health care but about medical billing,” said Dappen.

“I came up with this model after I remembered a study I read during my residency that concluded that 80 percent of all office visits to general practitioners were unnecessary. I don’t believe the number is necessarily that high, but if you analyze what the study says, then it means that if our patients could communicate with us by phone, then I could do other things like make house calls,” he explains.

Dappen says new technology dramatically reduces the need for office visits.

“The single most important question in health care today is: Why are you in the office? It makes no sense if you’re there for something that could be handled over the phone,” said Dappen.

“In my practice, the patient is billed by how long I spend with them on the phone; however, that does not preclude me from seeing them. They can get the care they need when they need it if I know them and they know me. I bill based on how much in services I provide. I’m less expensive than a plumber or mechanic, and during a typical interaction with a patient, about 60 percent of it can be done over the phone,” explained Dappen.

Information Quality Concerns

Dr. Roger Stark, a physician and health care policy analyst at the Washington Policy Center, expresses concern too many people currently use the Internet as a substitute for valid medical counsel.

“The Internet has become a terrific information tool,” said Stark. “That said, the quality of information has no checks and balances. Patients will be well-served if they use reputable websites and confirm information with their own health care providers. More and more providers are using email to answer simple patient questions, which frees up everyone’s time.”

Dappen says the problems can be mitigated with better communication.

“It’s all about the patient being able to communicate with the doctor. If they could just get in touch with the doctor and he could get paid appropriately for what he’s doing, then we can save health care. My model works because if I overcharge, then the patient fires me,” said Dappen.