Tag Archives: Technology and Health Care

Emailing your Doctor

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House Calls from the Carrboro Citizen 01.19.12

Dear HOUSE Calls, I took a picture of my partner’s wound on his leg and emailed it to his doctor and asked what we should do. He prescribed an antibiotic. Is this the wave of the future? Can doctors bill for this type of consultation?
This is a hot topic. There are issues of billing, communication, correct diagnosis, liability and access. There are business models for this. There are insurance codes for telephone consultation. These are usually reimbursed at very low levels and by very few insurance companies. In our medical system, physicians make a living by seeing patients. There are capitated or single-payer systems where physicians make money for not seeing patients. Those systems have other challenges, but would make this sort of consultation quite reasonable from a financial perspective. This is no different from telephone medicine. We generally feel if a problem can be managed in about a minute or so, a telephone call is a reasonable approach. But if a patient needs 15 minutes of our time, a visit is important to us from a scheduling and financial perspective. Regarding communication, telephone medicine is generally preferable to email medicine for making a diagnosis. Two-way communication is much better this way, and we can detect discomfort or distress that is hard to pick up by email. For quick questions, email avoids phone tag. In this case, we would want to know: Is the wound warm? Is there any pus? Is the leg swollen, painful? Any fever? These questions help us to make the correct diagnosis. In this case, and many cases, a picture is worth a thousand words, but to see and touch the wound is worth 10,000 more. What if it is not infected? What if the antibiotic is unnecessary and your partner has a severe reaction? The treating physician has the same liability for delay in diagnosis or misdiagnosis in the event of a complication. On the upside, we all believe that access to care should be convenient and affordable but with careful attention to quality. This type of consultation is so easy in this day and age. We should note that we are especially fond of this type of consultation in conjunction with further dialogue and an office visit. Perhaps you get a picture of that rash at its worst and come in the next day for an office visit. Many of these issues are not new, and we have been dealing with the same issues in regards to the telephone for a long time. The challenges and opportunities are evolving.

Swimming & Weight; Technology & Medicine

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House Calls from the Carrboro Citizen 01.12.12

Dear HOUSE Calls, I like to swim for exercise. A doctor told me that if I really want to lose weight, swimming is not the answer. Is this true?
What probably matters most is how hard you work – not what kind of exercise you do. It is easy to swim without pushing yourself and not as easy to jog without pushing yourself. In addition, when jogging, you have the added resistance of gravity, which is mostly eliminated in the water. To lose weight, we recommend 30-60 minutes of moderate to vigorous exercise six days per week. That means you need to elevate your heart rate to 70-80 percent of your maximum heart rate (220-age=maximum heart rate, so if you are 40, 80 percent of your maximum is 144 beats per minute). The other thing you can do in the pool is learn how to swim better, using more muscles and thereby increasing your workload. Depending on how good of a swimmer you are, you may want to consider a few lessons. Also, vary your workout routine. Try other strokes to improve the workout. Swimming is great for you and your muscles, but you might need to work a little harder and smarter to get the results you want. Also, consider cross training.
Dear HOUSE Calls, In what ways do you see the use of technology in your everyday practice as being a benefit or barrier to your ability to do your job?
The most important way technology facilitates medical practice is by enhancing communication. We have better access than ever before to new information and to records such as documents from hospitals and medical consultations. Our patients increasingly have better access to information about their health from their personal physicians and from the Internet. Technology opens up new channels of communication. This is mostly good. However, not all communication is good communication, and it is important not to use technology to supplant face-to-face communication, but rather to enhance it. Like wise, not all information that we read is good information, and the increased access to information has increased the importance of sorting good information from bad information. Some people also worry that doctors now bury their noses in computers during visits. We feel like those same doctors were likely to bury their noses in charts, so this is probably not a new issue, just a variation on an old issue.