The Doctor Will Take Your Call--on 900 Line : Health: On-call physicians will answer your questions but won’t diagnose your ills. Still, critics remain leery, fearing such services may discourage patients from seeking medical care.

This, it seems, is the Phone Age.

If you want to hear from Hulk Hogan and take the Hulkster’s wrestling challenge, dial up 1-900-454-HULK.

Lonely and want to listen to a throaty woman named Bev? Call 1-900-BEV-XXXX.

But if you have a bellyache or a bad rash at 2:30 in the morning, would you call a Dial-a-Doc?

Plenty have; they’ve reached out and touched real-life, licensed practicing physicians on call 24 hours a day.

The first such service, Doctors By Phone, has been on line for nearly a year. Since then, the New York-based 900 number has fielded thousands of calls at $3 per minute from people around the country seeking guidance on everything from croupy coughs to sexually transmitted diseases.

It also has fielded criticism from some medical ethicists, physicians and consumer groups leery of such services’ limitations.

No matter. For a lot of people either unable or unwilling to get hold of their primary health-care professional for basic medical information, dialing up remote, faceless doctors has its allure.

“People call us again and again,” says Dr. Vandana Mathur, an attending physician at New York University who has worked off hours for Doctors By Phone since its inception last April. “Patients are intelligent, they want answers. They have a lot of questions about things that aren’t always easy to find.”

Typical calls, Mathur says, run along these lines: “I was just put on a medication, can I drink alcohol with it?” Or, “I’m three months’ pregnant and going on a boat trip, can I take Dramamine?”

One caller told the doctor about a sexual encounter, wanting to know what his risk of AIDS would be. Another wanted to know whether sarsaparilla had been linked to cancer. (It hasn’t.)

“This is about teaching patients,” Mathur says. “On the phone, we have time to really explain things to them. We give information, but we don’t diagnose.”

Ah, the dreaded D word. To admit to actually diagnosing callers is to sit on the whoopee cushion of telecommunicative doctoring. Critics say responsible diagnosis can take place only after a face-to-face physical examination, not after a few minutes on a 900 line.

Doctors By Phone founder Dr. Thomas Kovachevich, a Manhattan osteopath and adjunct professor of family medicine at Chicago Osteopathic Medical Center, says his phone doctors do not diagnose--they simply dole out information upon which callers can make informed decisions.

“We’re reluctant even to give advice,” Kovachevich says. “The scope of this service is more explanatory, as opposed to saying, ‘Take two aspirin and go to bed.’ We help people arrive at a decision (about) what options make sense for them.

“(Callers) know they are on the telephone, that we can’t provide diagnosis over the phone.”

Still, critics of remote-control medicine point to a vague line separating diagnosis from seemingly generic medical information.

“If you call them up with a medical problem and they give you information, even that is diagnosis by another name,” says Richard Kessel, executive director of the New York State Consumer Protection Board. “If you have a pain somewhere and they tell you to see a doctor, they are still giving you advice.

“Any time someone gives medical advice over the phone for a fee, it creates problems. They can’t examine you, they don’t know your medical history. It raises major ethical and medical questions. I believe it’s a very dangerous thing.”

Arthur Caplan, director of the Center for Biomedical Ethics at the University of Minnesota, does not categorically reject the concept of phone doctors. But, he adds, “It’s almost impossible for a doctor to say anything (to a caller) without at least a hunch about a situation. You would be awfully hard-pressed to give information out without some diagnosis.

“Diagnosis gets them into ethics problems with their peers.”

Those, of course, would be other, more conventional physicians, who prefer treating their patients, if not always in person, at least within their own area code.

Criticism of pay-per-call medical advice lines--and critics are plentiful--centers not only on their inability to fully assess a caller’s condition and medical history but also on their perceived disruption of the traditional doctor-patient relationship.

“There are important qualities in that relationship that come through encounters over time,” says Thomas Murray, director of the Center for Biomedical Ethics at Case Western Reserve University in Cleveland. “It would be a major loss, in many ways, if that didn’t exist. Substituting that would be unhealthy.”

Hold the phone, says Kovachevich.

“Most of our callers have physicians,” he says. “We’re not replacing them. We just go over whatever may be bothering (the callers) day or night. We provide information so they can sort it out in their own minds. . . . We’re not a substitute for seeing a physician. As doctors, we don’t want to replace ourselves.”

In fact, Kovachevich’s part-time staff consists of 70 physicians, all of whom practice medicine in the New York City area. They are paid an hourly rate of $40 and do not refer callers to their own or anyone else’s private practice. All referrals are made to the caller’s local medical society.

Kovachevich seems miffed and mystified by those wary of his electronic brainchild. He says the need for his service boils down to a few rudimentary facts: People have medical woes and worries at all hours of the day and sometimes they can’t reach their doctor; Doctors By Phone is only a resource.

What if a troubled mother calls in the middle of the night about a sick baby?

“We have to deal with it,” Kovachevich says. “If she answers ‘yes’ to a first set of questions, then she is told to go to an emergency room. If she answers ‘no,’ she is asked another set of questions. If she answers ‘yes’ to any of those, she is told to be seen by a doctor within 16 to 24 hours.”

One advantage of the 900 number, according to Mathur, is that some callers feel more comfortable discussing ticklish subjects with a long-distance doctor.

“We get a lot of skewed kind of calling,” she says. “Questions about sexually transmitted disease and AIDS questions. They can ask questions in great detail and remain anonymous.”

Kovachevich adds that his phone doctors often encourage callers to follow up with their physicians.

He concedes, however, that some patrons call in obvious attempts to avoid a visit to the doctor’s office. But even that is legitimate in some cases, he says: “Nobody wants to see a physician for no reason.”

Michael Cane of Huntington Beach, an attorney who operates a 900 number for legal advice, says he once called Doctors By Phone after he developed pain in his jaw during a trip to Florida.

“I was ready to find a dentist there,” he says. “But I called Kovachevich’s line and a doctor told me, ‘Naw, wait until you get home in a few days.’ It calmed me down. Turned out to be sinuses.”

All of which raises obvious questions, however, regarding instances where phone doctors may be incorrect. What if Cane’s jaw problem had been more serious? What if waiting had caused adverse effects on an undetected condition?

Could he have sued Doctors By Phone?

“Anybody can sue for any reason,” Cane says. “But I’ve seen no litigation regarding any live professional (900) lines.”

Kovachevich says his service, which has no written or verbal disclaimer, has had no lawsuits in its first year. Although it has been reported that he carries liability insurance, Kovachevich brushes aside such questions. He says only: “Some people sue you because you have good insurance.”

Caplan has reservations about medical advice phone lines and what he calls “the vague area of liability.”

“If you get bad advice,” he says, “I’m not sure how responsible phone-line operators are for what they say.”

Informed that Doctors By Phone had not been sued, Caplan responded: “Just wait. If they are doing their jobs, they’ll get into legal action.”

Also in question, at least by some, is the economic viability of medical advice 900 numbers. Although Kovachevich says Doctors By Phone’s business is steady, a handful of others have gone on line and off in a few months.

Doctors TeleCare, a 900 number based in Irvine, opened for business in July and closed down in November.

“It didn’t work because people didn’t call,” says Dr. Bryn Henderson, the service’s co-founder. “It didn’t make money.”

Henderson blames Doctors TeleCare’s failure, in part, on the public’s perception of 900 numbers. “There’s a stigma with them,” he says. “There’s a credibility problem.”

But Pharmacy Question? Ask The Pharmacist, a North Carolina-based 900 line that handles inquiries about over-the-counter and prescription drugs, has generated enough $1.95-a-minute calls in 14 months to warrant expansion.

“We’ve gotten thousands of calls,” says Mary Lynn Bell, founder of Ask The Pharmacist, which has 17 pharmacists on staff full time. “Most of the calls come from New York, California and North Carolina. But we’ve gotten them from everywhere.”

Bell’s service has benefited from a strong endorsement from the American Pharmaceutical Assn. “We see it as a positive thing,” says Melanie Privette, an APA spokeswoman in Washington. “They are there to enhance the role of the pharmacist. We encourage that kind of interaction.”

Medical advice lines saw a more cautious pronouncement from the American Medical Assn. a few months ago. Included in that statement was the following:

“Although telephone services can only provide limited medical services, they can be a useful complement to more comprehensive services, if used properly. . . .

“It is also important that safeguards be in place to ensure that callers do not incur large bills inadvertently or without understanding the billing system.”

The translation? Go ahead and call the phone doctors from the comfort of your family-room couch, but keep in touch with your regular doctor.

And keep an eye on the clock.