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Virtual Visits To Doctors Spreading

ScuttleMonkey posted more than 4 years ago | from the what-could-possibly-go-wrong dept.

215

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."

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215 comments

Slashvertisement (-1, Troll)

Anonymous Coward | more than 4 years ago | (#30516140)

There, said it. I AM SICK AND TIRED of this garbage.

Re:Slashvertisement (3, Funny)

Brian Gordon (987471) | more than 4 years ago | (#30516222)

Right, there's already a good free alternative: Yahoo Answers

Re:Slashvertisement (3, Funny)

Anonymous Coward | more than 4 years ago | (#30516256)

How is Babby formed?

How girl get pregnant?

(captcha : excavate)

Re:Slashvertisement (-1, Offtopic)

Anonymous Coward | more than 4 years ago | (#30516484)

Babbys are made when a boy stick his pee-pee in a girls butt and go pee. 9 months later stork brings you new babby.

"But why do momy and dady shut the door and then daddy jumps on mommy and does bad things to her because they both yell and bed make a lot of noise? I acidentaly saw it once and daddy told me to go away."

Because they love each other, kiddo. You'll find that parents do a lot of weird things when they love each other, like when Mommy has uncle Arnie come over when Daddy's gone, or when Mommy takes money from Daddy's wallet and then tells him that she dosen't know what happened to it. It's like magic!

"Why are baloons and milk spots in the back of dady's car and why does it smel like burned french fries and onions and dirty unnerwear and swimming pool water?"

Because he loves mommy, kiddo. A lot of strange and wonderful things happen when Mommies and Daddies get married and have kids. It's because of you that these magical, wonderful things are happening. Now that's enough questions for today, go take your Lithium.

Re:Slashvertisement (2, Funny)

Liquidrage (640463) | more than 4 years ago | (#30516434)

Can you show me where the "Prescribe Meds" button on Yahoo Answers is?

Re:Slashvertisement (1)

dr_labrat (15478) | more than 4 years ago | (#30516490)

One might hope that it is pretty close to the "auto euthanise" button.....

Nationwide, for anyone in Texas? (1)

FooAtWFU (699187) | more than 4 years ago | (#30516146)

It's like a whole 'nother country.

Re:Nationwide, for anyone in Texas? (0, Troll)

nedlohs (1335013) | more than 4 years ago | (#30516254)

The submitter/editor/whomever decided to run two paragraphs together for no apparent reason.

In context it's just saying that it is the first time such a service has been available anywhere in the nation without being restricted to a particular insurance plan. Since the same thing is already running in some states tied to insurance.

It is sloppy writing to start with made even worse summary.

Re:Nationwide, for anyone in Texas? (0)

Anonymous Coward | more than 4 years ago | (#30516400)

It's like a whole 'nother country.

Apparently it has its own interweb as well; http://www.webmd.com/ ? http://www.medhelp.org/ ? http://various.others.etc ?

Re:Nationwide, for anyone in Texas? (5, Funny)

Shakrai (717556) | more than 4 years ago | (#30516738)

It's like a whole 'nother country.

Actually I have a funny story about that. I called Dell once upon a time to get a warranty replacement for a power supply that had gone up in smoke. My company has a support agreement with them and is supposed to receive priority support from Americans. Somehow I wound up in the queue talking to the morons from New Delhi. That went something like this:

Heavy Indian Accent: Thank you so much for calling Dell, my name is "Bob" (yeah, I bet it is buddy....), how many I assist you?
Me: *sigh* (well, might as well give it a shot) "Yeah, I have a bad power supply here and I need to get a replacement for it."
Tech Guy: Yes, yes, I am understanding that you have a bad power supply. Please insert the system diagnostics CD into the CD-ROM drive.
Me: I can't do that. When I plug the system in sparks come out of the back.
Tech Guy: Yes, yes, I am understanding your problem, please insert the system diagnostics CD into the CD-ROM drive.
Me: No, you don't understand, I can't plug the system in, the power supply failed.
Tech Guy: Please insert the system diagnostics CD into the CD-ROM drive.
Me: (trying different tack) I can't get the CD-ROM drive to open.
Tech Guy: Yes, I understand, is the computer plugged into the wall outlet?
Me: (back to square one) No, sparks will come out of it.
Tech Guy: Please insert the system diagnostics CD into the CD-ROM drive.
Me: *click*

So I call them back and go through the same exact menu system. Somehow I wind up with an American this time. He had the thickest Texan drawl that I've ever heard in my life.

Tech Guy: Thanks for calling Dell, my name is John, how may I help you?
Me: John, are you in the United States?
John: No sir! I'm in Texas.

Needless to say I knew I had somebody on the phone that I could do business with ;)

Amazingly enough he didn't ask me to use the system diagnostics CD either. I don't know how he was able to troubleshoot my "sparks are coming out of the back of it" problem without the assistance of the system diagnostics CD, but somehow he managed.....

Re:Nationwide, for anyone in Texas? (0)

Anonymous Coward | more than 4 years ago | (#30516866)

Me: I can't do that. When I plug the system in sparks come out of the back.

No, no, you're jumping ahead. You sit back and relax and tell them "oh, no! my CD drive won't open! what ever, shall I do?" Then you'll start a troubleshooting session where he tries to get you to plug the computer in and turn it on, and when he gets to 'plug it in', pretend to do so, and then start yelling "Oh, no! Sparks and smoke! The computer is trying to kill me! I had to unplug it!"

Or luck out and get to talk to Texas.

Re:Nationwide, for anyone in Texas? (3, Interesting)

jcr (53032) | more than 4 years ago | (#30516898)

Dell Support is a business-school case study in how cutting corners and trying to save costs can piss away tens of billions of dollars of shareholders' equity. There was a time when Dell support was as good or better than the average in their industry.

-jcr

Re:Nationwide, for anyone in Texas? (3, Funny)

Shakrai (717556) | more than 4 years ago | (#30516958)

The business support people are very good in my experience. I've had issues with Windows Server that Microsoft couldn't figure out but there was always some Dell guy at Level 3 that could come up with a solution. Figure that one out.

The consumer support group sucks donkey balls. It absolutely amazes me that I can buy a Lenovo (Chinese company) off the shelf and get an American on the phone but if I buy a Dell (American company) off the shelf I wind up talking to New Delhi. WTF is wrong with that picture?

Maybe we should all welcome our Chinese overlords, because apparently they can afford to pay us to work for them.....

Re:Nationwide, for anyone in Texas? (2, Funny)

EvanED (569694) | more than 4 years ago | (#30516970)

Hell, I remember when Dell was ranked at the top of customer service ratings in PC magazines.

Re:Nationwide, for anyone in Texas? (3, Funny)

NoKaOi (1415755) | more than 4 years ago | (#30517262)

You remember PC magazines? Is that what they had before web sites? You must be old.

Prescriptions (1)

Rob Riggs (6418) | more than 4 years ago | (#30516188)

Hell, most online pharmacies will find you a doctor to prescribe non-controlled substances!

Re:Prescriptions (1)

mcgrew (92797) | more than 4 years ago | (#30517136)

If it's not a controlled substance you can prescribe it for yourself. What's the point? I don't need a doctor to buy aspirin or cold medicine. If I need an antibiotic I need a real visit to a real doctor.

Lawsuits galore? (1, Insightful)

MMC Monster (602931) | more than 4 years ago | (#30516232)

It sounds like a good idea.

I hope the physicians are covered by some sort of indemnity so that they won't be sued for something that they cannot possibly figure out via a video phone and 10 minutes. Otherwise you'll see doctors figure out that it's just not worth the risk.

As a physician, I'll be happy to participate in something like this so long as my exposure to lawsuits is limited.

Re:Lawsuits galore? (1)

mdarksbane (587589) | more than 4 years ago | (#30516336)

Yeah, it sounds like it'd be great as long as everyone can sign something that they realize this isn't a full examination and there's a limit to what the doctor can do ( and of course, a fair number of the answers from this should be "come in to the office").

I bet there are a ton of standard issues that can be resolved with a quick Q&A and a couple webcam pics of the effected areas. And I know that I've personally had a fair number of minor medical issues that I never get looked at because I don't think they're worth wasting the time (mine or my doctor's) of an office visit.

Re:Lawsuits galore? (0)

Anonymous Coward | more than 4 years ago | (#30516932)

Yup, sounds like it would be a great idea as long as only the CEO of United Health Care has to undergo this kind of "medical examination".

Re:Lawsuits galore? (3, Insightful)

nomadic (141991) | more than 4 years ago | (#30516344)

I hope the physicians are covered by some sort of indemnity so that they won't be sued for something that they cannot possibly figure out via a video phone and 10 minutes. Otherwise you'll see doctors figure out that it's just not worth the risk. As a physician, I'll be happy to participate in something like this so long as my exposure to lawsuits is limited.

As a lawyer, I'd hope that if a doctor risks harming a patient by practicing through video phone, then maybe they shouldn't practice through videophone.

Re:Lawsuits galore? (2, Funny)

natehoy (1608657) | more than 4 years ago | (#30516572)

As a patient, and it pains me deeply to say this... I'd have to agree with a lawyer.

There. I said it. I agree with a lawyer on something. I'm going to hell now.

But seriously, we use our insurance company's "dial-a-nurse" service and it works well if you have some idea of what is wrong with you and just want some "best practices" advice, like "I have either a cold or the flu, can you help me determine which it is, and what symptoms I would indicate that I should see my doctor as opposed to drinking plenty of fluids and staying home?"

I can see a service like this being useful for other minor ailments that are relatively easy to diagnose based on clear symptoms, but that require medications that need a prescription. I'd hope that any doctor who was concerned about it being "maybe this or maybe that" wouldn't just take a guess (or render a medical opinion beyond their training) and hide behind some special immunity from lawsuit. But that doesn't mean I'd want to extend that immunity. If you're unsure of your diagnosis because you can't get enough information, the correct answer would be "I cannot help you, proceed to an in-person clinic in your area, this will be a no-charge courtesy call, 'kthanksbye!"

I'm not saying that a service like this would be useless, but if a good relatively confident diagnosis is not practical, the answer is to refer the patient to an in-person diagnosis, NOT to protect the doctor from indemnity if they made a diagnosis based on insufficient data because the tools they chose to use couldn't give them the data they needed.

Of course, that argument also leads down the slippery slope of requiring an MRI for a splinter removal as a lawsuit-prevention device, but any doctor who chooses to use "telediagnosis" should be aware of the limits of the technology and adjust their confidence in their diagnosis accordingly.

Re:Lawsuits galore? (1)

Idiomatick (976696) | more than 4 years ago | (#30516374)

More worrying perhaps than lawsuits galore is the health risks. If this gained popularity I think we'll see a lot of people skipping going to the clinic so they can do this. And pretty much anything not common and obvious will be misdiagnosed or impossible to diagnose. If you were going to be limiting diagnosis to simple things over voice then a simple app could take place pretty easily and likely do a better job. It could work like 20 questions for maladies. (So long as it doesn't do guessing)

When combined with your point it is a bit scary. The doctors participating will be those with nothing to lose(can't hold clients), idiots(willing to risk lawsuits) or the dishonest(if they are too closely linked to pharmacies). So we'll have shitty doctors with no tools, and little information giving out drugs and diagnosing people. Yikes.

Re:Lawsuits galore? (1)

LockeOnLogic (723968) | more than 4 years ago | (#30516568)

Regardless of any indemnity, a clever tort lawyer has got you at the very least with strict liability.

Also disciplinary hearings (1)

Mastodon (757726) | more than 4 years ago | (#30516826)

Depending on your state, your medical board may not approve.

Per TFA, the Texas board seems to have a problem with it if doctor and patient have never met in person.

Self operation (1)

geeper (883542) | more than 4 years ago | (#30516240)

Hi, is this NowClinic? Yes, I'd like to inquire about your special for the self-vasectomy.

Re:Self operation (1)

bagboy (630125) | more than 4 years ago | (#30516418)

Simple - get married...

Re:Self operation (1)

natehoy (1608657) | more than 4 years ago | (#30516604)

Hold a firecracker, lit with an 8-second fuse, in your left hand and count to ten on your fingers. One finger per second. If you need both hands, you can temporarily place the firecracker between your legs while you finish the count.

$45 please. Please be sure to pay up BEFORE you perform the operation.

Re:Self operation (1)

Monkeedude1212 (1560403) | more than 4 years ago | (#30517084)

I'm more concerned about all the people who want to do an over the internet Full Physical. I'm not really into that Goatse stuff.

Virtual Medical License (1)

StikyPad (445176) | more than 4 years ago | (#30516242)

Doesn't a "virtual doctor visit" necessarily imply that there are virtual doctors? If so, please send me a check for $45 and proceed to http://www-ai.ijs.si/eliza/eliza.html [www-ai.ijs.si]

Thanks.

Re:Virtual Medical License (1)

Idiomatick (976696) | more than 4 years ago | (#30516438)

That thing is possessed or something. I said something but it came out as a keycode and confused the bot. So I said "I'm sorry for the bad input" and this is what displayed:

...
You: i need a blowjob
Eliza: What would it mean to you if you got a blowjob?

Is it trying to subconsciously mess with me?

Re:Virtual Medical License (1)

chromas (1085949) | more than 4 years ago | (#30517062)

I'm sorry but Slashdot will not allow me to send a Unicode check nor its reasonable approximation, the root symbol. Therefore, please accept the attached Unicode point reference in its stead. Thank you.

U+2713

Re:Virtual Medical License (1)

mcgrew (92797) | more than 4 years ago | (#30517176)

Maybe it's Janeaway's holographic Johnnycab doctor?

let me be the first to say (1, Offtopic)

nimbius (983462) | more than 4 years ago | (#30516268)

grabbin' pills!

Re:let me be the first to say (1, Troll)

Lordrashmi (167121) | more than 4 years ago | (#30517006)

Sad the mods don't get a L4D reference.

Re:let me be the first to say (0)

Monkeedude1212 (1560403) | more than 4 years ago | (#30517064)

Or if they do, it's just not funny.

Re:let me be the first to say (2, Insightful)

mcgrew (92797) | more than 4 years ago | (#30517252)

That's the danger of a joke comment. If the mods don't get it, or if you fail at being funny, you lose karma, but if you succeed you still don't gain any.

If you see "the comedian" in somebody's achievements page, it's a sure sign they're not a karma whore.

Paying cash always helps (1)

demonlapin (527802) | more than 4 years ago | (#30516270)

If you call around asking doctors' offices if they'll see you for $45 cash at the time of service for an uncomplicated visit, you will not have to make many calls before you have a taker. This is already an option, "whether or not they are insured".

Re:Paying cash always helps (0, Offtopic)

RingDev (879105) | more than 4 years ago | (#30516632)

A scheduled office visit with a Physician's Assistant at my local clinic costs $125 cash. And he's not even a doctor!

-Rick

Re:Paying cash always helps (1)

lastchance_000 (847415) | more than 4 years ago | (#30516778)

At the base I spent most of my time at in the USAF, there were a number of doctors and 2 PA's on the hospital staff. Both the PA's started as medical corpsman in Vietnam. You definitely wanted to be seen by them over most of the doctors.

Re:Paying cash always helps (0, Redundant)

Shakrai (717556) | more than 4 years ago | (#30516796)

A scheduled office visit with a Physician's Assistant at my local clinic costs $125 cash. And he's not even a doctor!

At my old clinic is cost the same to see a PA, a nurse practitioner or an actual MD. Figure that one out.

Re:Paying cash always helps (2, Insightful)

Hatta (162192) | more than 4 years ago | (#30516872)

Chances are, you're getting the same quality treatment no matter which you see. Most of what a doctor sees is really pretty routine and can be handled by a nurse or PA just fine.

Re:Paying cash always helps (1)

Shakrai (717556) | more than 4 years ago | (#30517000)

I'm not comfortable entrusting my body to someone with two years of schooling and no experience. I don't have a problem seeing the nurse practitioner but I won't see a PA. That's where I draw the line.

Of course I did one better and found an actual doctor in private practice who doesn't staff PAs at all. I always know I'm going to see an MD when I go to visit him.

Re:Paying cash always helps (1)

natehoy (1608657) | more than 4 years ago | (#30516692)

This does seem rather expensive for a "dial-a-doc" service. The insurance company I use provides free "dial-a-nurse" services, charging $45 to add prescription capabilities seems a little pricey.

But, of course, $45 for a guaranteed ten minutes of access to an actual MD is probably well worth it. I've been with my current doctor for 6 years now, and I've met her once when one of the RNs wanted to do an in-office biopsy (and she observed while a med student did the actual cutting and stitching). All other business I've done with the office has been with a nurse.

The actual doctor rarely gets involved for an "uncomplicated" visit, so you probably WOULD get a lot of takers for $45 to spend 15 minutes with a nurse/practitioner.

Re:Paying cash always helps (1)

Urza9814 (883915) | more than 4 years ago | (#30517234)

Strange. Whenever I go to see my doctor I _always_ actually see my doctor for at least 10 minutes....

Finally moving into the "public sector" (2, Informative)

ubrgeek (679399) | more than 4 years ago | (#30516272)

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 ;)

Virtual Visits To Virtual Doctors In A (0)

Anonymous Coward | more than 4 years ago | (#30516282)

virtually non-existent U.S.A.

Have a weekend.

Yours In Moscow,
K. Trout

Good idea (2, Interesting)

RudyValencia (728937) | more than 4 years ago | (#30516312)

This sounds like a good idea.

A lot of the immigrants from Mexico and Somalia that have settled here (northern Colorado) could use this. We have a local clinic that is always so busy that you have to call first thing in the morning to get an appointment. I'd think that if they did offer this service, it'd be a big help.

Its nice to see (2, Interesting)

djfuq (1151563) | more than 4 years ago | (#30516328)

Its nice to see the medical industry take steps to modernize finally.

Problems with visiting the doctor in person:

If you are sick you have to make an appointment - and wait. If you cant wait and you need answers you go to the ER (bad for many reasons)

If you are sick you have to drive to the doctor when the appointment comes, or get a ride or ride public transit and share the germs etc (bad for many reasons)

When you get to the doctors office, you wait with other sick people. (spread the germs - bad on many levels)

You speak to 2 people before you speak to the doctor (cost of receptionist, cost of nurse, miscommunication possible)

Skipping all of those steps may be a good idea for things where physical testing etc isn't needed.

Anonymous Coward (-1, Offtopic)

Anonymous Coward | more than 4 years ago | (#30516330)

Hi. Just checkin your comment feature.

Don't worry about the quality, feel the cost (3, Insightful)

MosesJones (55544) | more than 4 years ago | (#30516334)

Seriously is this a good thing?

In the UK we have a service "NHS Direct" which is effectively a triage service which tells you whether you need to go to a doctor. Its in no way shape or form a replacement for a direct doctors appointment its just there to filter out cases that aren't overly serious or are serious enough to need an emergency visit. This service is staffed by nurses and its pretty good and does help with people who are concerned about medical issues.

The idea of someone prescribing drugs via this sort of service is just insane. It would be smarter to delegate prescriptions, or at least re-issuing prescriptions, to pharmacists who will at least see the patient. Or are we going to a world where you don't see the doctor and you get your drugs shipped direct so you never ever see anyone with any sort of medical training who can just briefly add a sanity check to the whole thing.

Its hard to imagine a better example as to why the US system is completely and utterly fucked than this being considered a good thing.

Re:Don't worry about the quality, feel the cost (1)

CannonballHead (842625) | more than 4 years ago | (#30516492)

Its hard to imagine a better example as to why the US system

Just wait. Plenty more examples in years to come if things continue to go the way they are going. :)

Re:Don't worry about the quality, feel the cost (0)

Anonymous Coward | more than 4 years ago | (#30516662)

Just wait for the lawsuits for when something is misdiagnosed.

Re:Don't worry about the quality, feel the cost (1)

ceoyoyo (59147) | more than 4 years ago | (#30516502)

I don't think this amounts to anything that much different. The online doctor's visit will likely almost always boil down to some variation on:

1) You've got a cold. Get plenty of rest and fluids and take an aspirin. If it doesn't get better in 5-7 days, go see a doctor in person.

2) You've got something I can't diagnose over the Internet. You need to make an appointment to go see a doctor in person.

So like you said, triage. Except in the US it has to be a doctor who does it, because nobody would settle for a nurse.

The prescribing seems to be a bit of a red herring. Maybe the definitions are different in the US, but if the drug is not controlled, couldn't you just buy it without a prescription anyway? The only reason for having a prescription would be to get it covered under a drug plan.

Re:Don't worry about the quality, feel the cost (1)

shrimppesto (766285) | more than 4 years ago | (#30516600)

prescription drugs = drugs you have to have a prescription to get

controlled substances = drugs determined to have significant abuse potential, and therefore subject to certain prescribing rules by the DEA (e.g. no refills, can't phone it into the pharmacy, some states require triplicate prescription paper, etc.) examples of controlled substances include narcotics, amphetamines, etc.

not every prescription drug is a controlled substance. in fact, most are not.

Re:Don't worry about the quality, feel the cost (1)

Shakrai (717556) | more than 4 years ago | (#30516902)

not every prescription drug is a controlled substance. in fact, most are not.

My favorite "prescription drug" has to be the 800mg ibuprofen and 800mg aetaminophen tablets. You could get the exact same effect by buying Advil or Tylenol and taking four of them, but we are going to make it a prescription drug anyway.......

Re:Don't worry about the quality, feel the cost (1)

ColdWetDog (752185) | more than 4 years ago | (#30517204)

My favorite "prescription drug" has to be the 800mg ibuprofen and 800mg aetaminophen tablets. You could get the exact same effect by buying Advil or Tylenol and taking four of them, but we are going to make it a prescription drug anyway.......

Nobody said the system makes sense. You can buy Primatine mist over the counter. Pure ephidrine. Dangerous. Doctors don't use it. Albuterol is much safer, it's prescription. Up until recently the only antihistamine you could buy OTC was benadryl - actually a fairly dangerous drug. Only in the past couple of years have Claritan (loritadine) and others which are much less sedating made it OTC.

That said, there is some logic behind the 'prescription strength' version of ibuprofen. If you take a couple of 'extra' 200 mg tablets (the OTC dose) then you're less likely to get into trouble compared with a couple of extra of the 800 mg prescription dose. Yes, if you were operating with half-a-brain, you'd understand the dosing limits, but as a rule, one does not expect the public to be able to do much more than breath and show the clerk the VISA card.

Of course, each country is different. I remember a sign in a Mexican Pharmacia extolling the virtues of IV dopamine (a seriously potent drug used to keep critically ill people alive when their blood pressures drop) which was available OTC. I have no idea what it was really used for....

Re:Don't worry about the quality, feel the cost (2, Informative)

fuzzyfuzzyfungus (1223518) | more than 4 years ago | (#30516618)

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 (2, Informative)

icebrain (944107) | more than 4 years ago | (#30516886)

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:Don't worry about the quality, feel the cost (1)

mea37 (1201159) | more than 4 years ago | (#30516718)

Uh, actually, a lot of people do settle for nurses to do triage. My insurance offers me a phone number where I can reach a nurse at any time of day or night to determine if I have a medical concern that needs a doctor's attention.

Re:Don't worry about the quality, feel the cost (1)

stefanlasiewski (63134) | more than 4 years ago | (#30517334)

Except in the US it has to be a doctor who does it, because nobody would settle for a nurse.

Blue Shield/Blue Cross of California and Kaiser Permanente both have a nurse available on the phone, 24/7. I've used it a couple times and it worked out well... many simple things can be diagnosed over the phone with a simple questionnaire. If not, they'll tell you to come and see the doctor, often with a priority appointment the next morning.

Re:Don't worry about the quality, feel the cost (1)

dr_labrat (15478) | more than 4 years ago | (#30516566)

Not just the UK...

France has a very good system for this, apparently.

My personal experience with NHS Direct was actually (all things considered) pretty damn good. Mind you I am a strong proponent of the NHS, despite its neglect over the past decade, Its still a valid and potent solution, and one which I am grateful for! And have been a lot throughout my life!

Driving a motorbike, having a son, and an accident prone girlfriend makes you very happy that a relatively small proportion of your income goes to those fellas!

Re:Don't worry about the quality, feel the cost (1)

Registered Coward v2 (447531) | more than 4 years ago | (#30516754)

Seriously is this a good thing?

In the UK we have a service "NHS Direct" which is effectively a triage service which tells you whether you need to go to a doctor. Its in no way shape or form a replacement for a direct doctors appointment its just there to filter out cases that aren't overly serious or are serious enough to need an emergency visit. This service is staffed by nurses and its pretty good and does help with people who are concerned about medical issues.

The idea of someone prescribing drugs via this sort of service is just insane. It would be smarter to delegate prescriptions, or at least re-issuing prescriptions, to pharmacists who will at least see the patient. Or are we going to a world where you don't see the doctor and you get your drugs shipped direct so you never ever see anyone with any sort of medical training who can just briefly add a sanity check to the whole thing.

Its hard to imagine a better example as to why the US system is completely and utterly fucked than this being considered a good thing.

I agree - better to staff a clinic with a Physician / Nurse Practitioner and Nurses who confer with an MD, even virtually to ensure quality of care. A PA/NP is quite capable of delivering primary care (or even specialty care) in a safe and cost effective manner; but there is no real substitute for being seen where they can detect subtle things, that may get unnoticed otherwise, which might indicate a more serious or additional problem.

Now, followup visits or routine test results can often be handled virtually (or even by email); but there is no real substitute for a real examination.

Re:Don't worry about the quality, feel the cost (1)

natehoy (1608657) | more than 4 years ago | (#30516820)

Yeah, the addition of "can issue prescriptions" does make it a little scary. I would hope that any qualified doctor would reserve their actual diagnosis for easy and obvious cases ("what, the over-the-counter hayfever medications aren't working for you? OK, let me send you a scrip for Claritin-whatever_letter_they_are_at_now").

But, of course, that means that the utility of such a service is limited. It's rather expensive for 10 minutes with someone who is either horribly overqualified to diagnose your condition in-person or horribly under-equipped to diagnose something they ARE qualified to diagnose because they can't get enough information. If I need to try out an asthma med or help with the diagnosis of athlete's foot or hayfever, any trained nurse can do that for me. If I need something more complicated, a doctor might be hard-pressed to diagnose it accurately over a webcam.

It's especially expensive if you have to pay for a referral to an in-person doc, unless the $45 includes the office visit if one becomes necessary.

Re:Don't worry about the quality, feel the cost (1)

ColdWetDog (752185) | more than 4 years ago | (#30517278)

But, of course, that means that the utility of such a service is limited.

Yeah, I'm trying to figure out why this is supposedly a big deal (I am an MD). Sure, for a lot minor things, you don't need to see the doctor. You don't likely need to do anything at all. So self help books / web sites, nurse triage programs and Ouija boards would work well. For the things you would typically prescribe drugs for, you would likely want at least a cursory physical exam.

While TFA disses the physical exam portion of the classical doctor's visit (the rant about 'laying of the hands') the fact is that a quick look at the relevant organ system along with some routine vital signs (Blood Pressure, pulse, temp) really go a long way towards making a diagnosis. Now, you could easily come up with a little machine that would give you the vital signs at home, and I think that some chronic-care by email / Internet programs use these to good effect, but using just a crappy videocam seems pretty limited.

Re:Don't worry about the quality, feel the cost (0)

Anonymous Coward | more than 4 years ago | (#30517012)

This is America, where everything can be fixed if you just find the right drug! Hyperactive kids? Stressed out? Feeling sad? Have a headache? A cold? A runny nose? A small scrape? Not having any problems at all? It can all be fixed thanks to the wonders of drugs!

Hippies never grew out of drugs, they just changed the type they use and decided the next generation could use the same thing.

Say goodbye (1)

Azghoul (25786) | more than 4 years ago | (#30516470)

Say goodbye to this type of innovation if things continue down the pathetic road we're on. Thanks, politicians!

Why the hell should I have to take time out of my day to go sit in a doc's office for a hour, for a 30 second consult, to get my prescription meds? If I can do it from the privacy of my own home, and the doc already has access to my charts, why not?

Re:Say goodbye (1)

Xtravar (725372) | more than 4 years ago | (#30516714)

Nice try making this political, but those terrible politicians recently passed a law that requires health care IT to improve. It's called the HITECH act. So you may not be getting innovations and improvements the way you'd prefer, but you'll be getting them nonetheless.

Look at whose backing this (3, Insightful)

LockeOnLogic (723968) | more than 4 years ago | (#30516478)

OptumHealth, a division of UnitedHealth Group, the nation’s largest health insurer, plans to offer NowClinic

When the devil hands me a gift I'm wary of opening it...

tubgirL (-1, Offtopic)

Anonymous Coward | more than 4 years ago | (#30516496)

maintained that too I thought it was my OEpenBSD wanker Theo obvious that there create, manufacture at this point AMERICA) might be Lizard - In other

I am a med student, and I am horrified (4, Informative)

tpjunkie (911544) | more than 4 years ago | (#30516516)

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:I am a med student, and I am horrified (2, Funny)

alrudd1287 (1288914) | more than 4 years ago | (#30516794)

dude- whatever. if this stuff is actually needed, the person over the net will say GO TO A DOCTOR. This sounds like a GREAT idea from a cost-savings perspective, which is the only one that matters here. Often, patients go in for an appointment with a drug in mind that they just need a script for. Like if i have poison ivy, i need steroids because in the past the topical stuff hasn't worked. If I don't get it the first time then i'll have to go in a 2nd time... costing me or my insurance something like 150$ each. clearly an online person could save alot of money here

Re:I am a med student, and I am horrified (1)

BlueBoxSW.com (745855) | more than 4 years ago | (#30516892)

Uhm. Maybe the doctors you go to work like they do on House, but for the rest of us, the deal is simple: You get 10 minutes of a doctor's expertise and you pay a least 100 bucks. No references will be consulted, not too many notes will be taken. No follow up is guaranteed unless there's a charge to go with it.

This is the same business model Hookers use, and we're sick of it.

The medical industry here in the US is pathetic. We spend the most pre capita, 2-3 times what most industrialized nations spend, and have the life span of a third-world country. Our system was built by lobbyists looking out for Doctors and the Pharma industry. Almost no one is looking out for the patients.

We need better access to information so we can help ourselves. We need portable electronic records that we can view and amend without the assistance of a doctor (gain or lose weight? Sprain your ankle? Put it in there.). We need a proactive electronic model of our health that looks for trends and potential upcoming issues (Want to know the likelyhood of developing diabetes based on you age, weight, and history? It'll tell you. Having symptoms related to a kidney problem? Let's schedule you an appointment.). We need access to "tier-1" doctors such as the one in the article for a reasonable cost, and escalation should there be a need for it.

Re:I am a med student, and I am horrified (1)

Prefader (1072814) | more than 4 years ago | (#30517174)

. . . and have the life span of a third-world country.

Ahhh, no . . . This [wikipedia.org] seems to indicate that you've got a case of proportionitis. I'm writing you a prescription to Reality . . . make sure you take the whole thing, ok?

ascultation (0)

Anonymous Coward | more than 4 years ago | (#30517102)

Get with the times, doctor, we're up to unicocultation now.

Re:I am a med student, and I am horrified (1)

shrimppesto (766285) | more than 4 years ago | (#30517148)

To be fair, there are a significant number of conditions seen in the primary care setting for which the physical exam is of little or no value. Many conditions are diagnosed by the clinical interview alone. A responsible way to run this virtual clinic thing would be to treat only this set of conditions over the internet, and bring the rest into the clinic for an exam. Whether this is actually what takes place is another story.

For patients who have an established relationship with a primary care doctor, virtual clinics can be a valuable adjuvant in managing many chronic medical conditions between visits. This is particularly valuable in conditions for which some level of self-testing is available at home (e.g. hypertension, diabetes, chronic congestive heart failure). Incorporating the virtual clinic model into chronic disease management can even improve the management of such conditions beyond what can be achieved through regular face-to-face doctor visits. Telemanagement programs have long had success keeping CHF [congestive heart failure] patients out of the hospital, and moving such programs from the phone to the internet is a reasonable next step for computer-savvy patients.

Unfortunately, most acute conditions that are seen in the ER are a bit more serious, and tend to require some level of physical exam for proper diagnosis. Additionally, the management of most chronic medical conditions also requires some level of examination at regular intervals. If the goal of expanding access to primary care is to provide better chronic disease prevention/management and relieve ER crowding, the virtual clinic is unlikely to achieve those goals without coexisting access to face-to-face primary care. For this reason, while virtual clinics can (and will) become an important adjuvant in primary care, they cannot replace an established relationship with a primary care doctor.

Can you order me some Viagra without seeing me? (0)

Anonymous Coward | more than 4 years ago | (#30517196)

Really, that's all that's important.

Re:I am a med student, and I am horrified (0)

Anonymous Coward | more than 4 years ago | (#30517226)

Just to get something out of the way first:

I am a med student[...]
As a doctor,

You're not a doctor. You're a med student. One of the first things you should have had beaten into your head as a med or law student is that you are not either a doctor or a lawyer until you've completed the programme of learning and training.

This aside, you are completely right. There is a lot of "I don't want to wait 30 minutes going to an appointment!" in this thread - if such people cannot spend 30 minutes on their health, but are happy to idle time away on Slashdot, they are bringing on their own demise.

Re:I am a med student, and I am horrified (1)

physicsphairy (720718) | more than 4 years ago | (#30517254)

Yes, well, do you need to need to perform a neurological and skeletal exam to re-fill someone's acne medication?

Obviously there are some things this works well for and others that it doesn't. I don't see why you automatically assume this will be used for the latter. Presumably a doctor is conscious of the holes in the information obtained this way and thus if able to state if he requires a personal visit.

On that note, you are also assuming you have the given patient at your mercy. The truth is a lot of people simply do not visit the doctor unless they can no longer help doing so. For all its possible deficiencies, a cheap, fast, unobtrusive examination process that people will actually use is a million times better than no examination at all.

I would be quite interested... (1)

fuzzyfuzzyfungus (1223518) | more than 4 years ago | (#30516518)

To see how effective this is as a diagnostic mechanism(and I don't mean some bullshit anecdote/contra-anecdote thing, I mean a genuinely rigorous study).

On the one hand, there are definitely lots of conditions that can be diagnosed, with fair accuracy, by basically asking the patient questions and traversing a decision tree. Heck, that slice of the population(and it is a large one) could probably be handled by an expert system no more complex than the one that makes calling most support lines an exercise in pain.

However, when you go to see the doctor, there are also a number of signs that the doctor looks for that a (cheap, nasty, web)camera isn't going to capture. Really shitty cameras aren't even going to let you see if the patient is flushed, pale, or an odd yellowish color. Even the nicest camera isn't going to tell you what the patient's breath smells like, or allow you to palpate some gland that may or may not be inflamed.

That's the real trick. While diagnosis, in the sense of traversing a decision tree based on symptom data, might very well be amenable to substantial automation(it might even be better as well as cheaper: computers don't get tired, don't suffer lapses of memory, and don't form snap social judgements based on primitive primate instincts); gathering the symptom data is going to be pretty tricky without good old fashioned face time. Suitably trained humans are really good at picking up social cues while talking with the patient, as well as the routine(but difficult to do with robots) work of taking temperatures, palpating organs, swabbing throats, and the like.

Whether or not this service is a good thing, it seems to me, will depend largely on one (empirically testable) point: There are conditions that are easy to diagnose over video chat. There are conditions that are hard to diagnose over video chat. How many conditions look easy to diagnose over video chat; but are actually something else entirely? If, 90% of the time, the doctor can say "Yeah, colds suck, sleep it off and get lots of fluids" or "Sounds like strep, fill this prescription and take as directed" and the other 10% say "Christ, man, get yourself to an ER right the fuck yesterday!" then this should save a lot of time and money. If, though, they can't usefully distinguish between these two categories, there will be trouble.

More generally, since humans are so good at gathering data face to face, I would be very curious to see an experiment with an alternate model: Instead of having patients see real, MD, doctors over video conferencing, what about having patients see, in person, cheaper nurse/tech types, who would be supported by a mixture of diagnostic software and teleconference with doctors? Still cheaper than seeing a doctor in person; but also allows a large number of common/safe tests, examinations, and sampling procedures to be done in person.

Re:I would be quite interested... (1)

berashith (222128) | more than 4 years ago | (#30516896)

Your example of "sounds like strep" is exactly where something like this can fail. Strep requires antibiotics , and those are bad for us all if used incorrectly. A test is required for verification.

Your final alternate model is dead on , and in fact my wife's work has this exact scenario... and she loves it. She works at a school, so there is already a nurse on campus. She can arrange a doctor visit without having to take time off work, and she will see the nurse who has a video conference with a real doctor. The trained nurse can handle the personal bits and the testing and offer suggestions to the doctor.

non-controlled substances (0)

Anonymous Coward | more than 4 years ago | (#30516524)

Aren't all prescription medications "controlled"?

Prescriptions for non-controlled substances? (1)

swb (14022) | more than 4 years ago | (#30516574)

What would be the point? Aren't all medications that require prescriptions before dispensing "controlled" substances, or are we talking about Schedule II only?

Or will they write "prescriptions" for overpriced formulations like Ibuprofen 800 (just take 4 of the over the counter 200s)?

I like the idea of telemedicine, I think it holds a lot of promise for reducing costs and increasing access (both in terms of speed and breadth of access), but it sucks we have to let our moronic prohibitionist mentality get in the way.

Re:Prescriptions for non-controlled substances? (1)

Ellis D. Tripp (755736) | more than 4 years ago | (#30516638)

I would assume that they mean anything in Schedules II through V of the controlled substances act.

Lots of drugs are "Rx only", but that doesn't make them "controlled substances" in the legal definition.

Yet another prescription mill (1)

hwyhobo (1420503) | more than 4 years ago | (#30516594)

This is simply taking it to another level. Why make a pretense of actual examination when one can write a prescription serving as a bandaid to mask symptoms sight unseen and move on to the next "patient"? That's what most doctors do today anyway, except they go through a 5 minute theater of taking your vital signs.

This may be a good step, however, if it results in computers one day diagnosing patients. They will possess vast medical knowledge and will actually attempt to correlate multiple symptoms. Today most doctors seem utterly incapable of not only telling a cause from effect, but also of looking systemically at more than one symptom at a time. If anyone, god forbid, has a complex issue, most will diagnose it as 5 unrelated issues, and will treat them separately, at best helping none, and usually making it worse.

So for now, let's cut the pretense, and one day let's move to a system that may help patients instead of just separating sick people from their money.

Precisely! (1)

maillemaker (924053) | more than 4 years ago | (#30516982)

>Why make a pretense of actual examination when one can write a prescription serving as a bandaid
>to mask symptoms sight unseen and move on to the next "patient"? That's what most doctors do today
>anyway, except they go through a 5 minute theater of taking your vital signs.

This is why I think this telemedicine is a great idea. Since the doctor examination is theater anyway, why not just run down the symptom checklist and guess at a prescription just like they do in doctor's offices anyway!

Most of the time I have gone to the doctor when I was sick they did not bother with blood work - they just prescribed some medicine to treat my symptoms. In the few cases where they did order blood work, I was well on my own by the time the blood work came back.

Hopefully the time is coming when you can go to your local drug store and get an instant blood test done by a machine, and then call up one of these tele-doctors to have the right medicine prescribed. Hell, maybe a computer will do the analysis and cut the doctor out of the loop entirely.

Re:Yet another prescription mill (1)

RingDev (879105) | more than 4 years ago | (#30517330)

Sure, some people will be idiots looking for prescriptions. But think of the number of people who every year show up at doctors' offices and emergency rooms across the country because they have cold/flu symptoms. How many millions of doctor visits can you filter out with T1 support every year?

Imagine if every user incident was immediately sent to a developer. Even if the incident was that the user didn't have their PC plugged in. It wastes the developer's time, it could have been handled much faster by a T1 support person, and it would have left more time for the developer to focus on critical issues that are beyond the scope of T1 support.

Heck, my wife has a vitamin B12 deficiency. She can feel certain symptoms act up when her B12 starts getting low. If she could just go down to clinic and get a B12 test, she could schedule an appointment for a shot. Unfortunately, our insurance will only cover the test if it is recommended by a doctor. So in order to get the shot, we have to deal with a doctors appointment to get the lab referral, then the lab, then an appointment for the shot, then a follow up.

Each of those appointments are billed at $125, and the lab appointment is even more. And we pay a $25 co-pay on every one of them. Over $500 ($100 after insurance) to cover a $0.20 shot. Cutting the referral and follow up appointments to 10 minute virtual visits (which is already longer than we actually see the doc in person) drops that to $390+ and saves us 2 trips across town.

-Rick

Virtual doctors (1)

dvh.tosomja (1235032) | more than 4 years ago | (#30516626)

I assume these virtual doctors cure only virtual diseases.

I can see this coming a mile away (1, Insightful)

Anonymous Coward | more than 4 years ago | (#30516668)

America will shortly have a large influx of Docs from China doing virtual visits. This will be another form of outsourcing. the difference is that when docs screws up and kills someone, there will not be lawsuits. Instead, China will say that the doc did not have right to practice medicine even if they had been embraced by the Chinese gov. for the last 20 years.

The good news on this, will be that now, more professionals will re-think through what is happening with regard to the outsourcing back to China. I am just waiting for politicians to be outsourced. They will be just as corrupt, but at least will cost America less.

Better than no visit at all... (3, Insightful)

ravenscar (1662985) | more than 4 years ago | (#30516724)

Most commenters have only mentioned that a web diagnosis is likely to be inferior to an in-person diagnosis. I generally agree with that statement.
What I feel people are failing to catch is that a web diagnosis, conducted by a qualified individual is better than no diagnosis at all.
How many people skip or put off doctor visits because they don't have the desire or time to block 2+ hours of their day for a 5 minute visit with a doctor? How many others can't afford $150+ for a visit? Now that you're thinking about those numbers consider how many people miss out the on the potential benefits of an early diagnosis.
If this service can expand access to medical care and encourage more people to seek care when they need it I think it could have significant benefits. I think it also has the potential to limit unnecessary doctor/ER visits.
As long as the doctors stay within the bounds of what they can really do on the web I think there is upside potential in this model.

Re:Better than no visit at all... (0)

Anonymous Coward | more than 4 years ago | (#30517020)

How many people skip or put off doctor visits because they don't have the desire or time to block 2+ hours of their day for a 5 minute visit with a doctor?

Very few. In fact you might be the only one.

This is just unethical (0)

Anonymous Coward | more than 4 years ago | (#30516772)

There is no way in hell that a doctor can accurately and safely prescribe medicine after a 10 minute virtual visit with a patient, especially without a medical history or records of any kind. This is nothing more than a scheme to make money off of hypochondriacs and those who are uninsured.

$9.95 per minute (0)

Anonymous Coward | more than 4 years ago | (#30516834)

10 minutes?! Shit, I am sold! Here in BFE Indiana, you are lucky to get 30 seconds of your doctor's time for $65 and that is after waiting in the waiting room for two hours. Physical exam? You might get a whole minute of your doctor's time if they actually listen to your chest, look at your throat, nose, ears... Usually, it is just the 30 second "what hurts? Oh. Okay..take this OR, more commonly, it is a viral thing...drink plenty of fluids, rest, call me next week."

Why allow 10 minutes? Completely unnecessary! This online crap should only take a minute, not 10 and should be billed at $9.95/minute (limit of one minute to be enforced under ObamaCare). $600 an hour from the beach in the Bahamas is plenty...hell, make it a beach in a country without an extradition treaty and you can skip medical school! And you never need to go face to face with the contagious...how AWESOME is that?! Another Mai Tai please!

I smell... (0)

Anonymous Coward | more than 4 years ago | (#30516876)

...a lawsuit in the making.

Prescriptions are.... (1)

mtmra70 (964928) | more than 4 years ago | (#30516952)

Prescriptions are controlled substances...otherwise you wouldn't need a prescription to get them!

Re:Prescriptions are.... (1)

maxfresh (1435479) | more than 4 years ago | (#30517180)

That's not correct. Not all prescription medications are controlled substances. Controlled substances are a subset of prescription medications that have a high potential for abuse, such as narcotics, for example. They are specified in the Controlled Substances Act, and are regulated by the DEA. Controlled substances have much tighter controls placed on their prescriptions than other prescription drugs, such as limits on the number of pills that can be prescribed at one time, the number of refills permitted, requiring the use of special prescription forms, etc. In addition, prescriptions written for controlled substances are monitored, and prescribers can face investigation if they appear to be over prescribing them.

I have a bad feeling about this (0)

Anonymous Coward | more than 4 years ago | (#30517034)

So the company is setup in texas but where are the doctors? I have a bad feeling that you are actually calling doctors in india.

Virtual Doctors Visits - Look Out (1)

twmcneil (942300) | more than 4 years ago | (#30517096)

Next stop India. "Is there anything else I can help you with today?"

Offshore Outsourcing, Its not Just for IT Anymore (1)

CodeBuster (516420) | more than 4 years ago | (#30517266)

Is it just me or does this sound like code for offshore outsourcing of doctors? If the doctor doesn't have to actually see you in person then the next logical question is: Does it matter where the doctor is physically located? If the answer to that is 'no' then you can bet your bottom dollar (or rupee if you prefer) that you 'personal physician' will be some video conference station linked to some 'doctor center' in India. Of course, most American senior citizens have a hard enough time understanding Indian accented English when the get 'outsourced to India' for phone tech support so just imagine how they will feel when their doctor is outsourced too as a 'cost saving' measure. The outsourcing of front line medical services (it is already being done with back office tasks like reading x-rays) may become the next big battleground issue in the offshoring debate; the demand is there, cost is the issue in health care, and the tech makes it possible or at least plausible.
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