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Wednesday, January 8, 2014

A Doctor's New Year's Resolution


I’ve quit doing telemedicine.

Organizations like Dial-a-Doc or Teladoc or 1-800-MD pay doctors to answer phone calls. Sitting at home, we can earn $40 for a conversation that lasts a few minutes. It seems like easy money, and I’ve had many satisfying experiences answering questions, helping with minor illnesses, assuring callers that something that seems ominous is not ominous, or sending them for urgent medical care if they needed it.

What spoils the experience is that nearly half of these callers are suffering a respiratory infection: cough, sore throat, congestion, “sinus,” “bronchitis.” Since their doctors routinely prescribe antibiotics, these callers know what they need. Phoning saves a trip to the office. What a convenience!

When, after discussing their symptoms, I give my diagnosis and explain how to help, many are puzzled. When, in answer to their hints, I assure them that antibiotics don’t help, most remember their manners, but they don’t believe me. Some point out that their doctor takes their illness more seriously. A few question my competence or suspect they’ve fallen for another internet scam (“Are you a real doctor?.... What am I paying this money for?!!...).

When guests at my hotels phone, respiratory infections are also the leading complaint. But phone calls to me are free, and I spend a good deal of time answering questions and giving advice. By the time guests agree to a housecall, they understand that I genuinely want to help and that I know my business. If they don’t understand, I direct them to another source of care. If you follow this blog you know that this tactic occasionally fails with unhappy consequences for everyone concerned.   

Telemedicine guidelines forbid doctors from prescribing narcotics and tranquilizers but say nothing about antibiotics which are far more toxic. If you join one of these services and want an antibiotic but have the bad luck to reach a doctor like me, simply thank him, hang up, call again, and tell whoever answers that you want a different doctor. That should work.

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