The doctor won’t see you now

It’s the 21st century version of a house call: Pick up the telephone, recount your symptoms to a doctor and get your diagnosis and even a prescription in about 15 minutes.

Earlier this year, TelaDoc Medical Services, a Dallas-based company, began providing over-the-phone medical care, including prescriptions, 24 hours a day, seven days a week.

The company, which has treated 40,000 patients so far, is trying to appeal to two groups of people: those who don’t have the time to see a doctor and those who don’t have the money.

The controversial service fields calls from patients, then guarantees that one of its doctors will call the patient within three hours or the service is free. The doctor spends a few minutes collecting a patient’s medical history, then runs through symptoms as best as possible from afar. TelaDoc doctors can write prescriptions, except for controlled substances such as narcotics.

There’s little doubt the new service is filling a need. Waits in doctors’ offices have increased in recent years, studies show, and 45 million Americans are living without health insurance. More employees and their families are facing higher deductibles and co-payments for office visits -- which cost about $100 these days, compared with TelaDoc’s $35-a-call fee.

Doctors and other experts worry such barriers are causing a growing number of people to skip basic medical care, which can lead to serious -- and costly -- problems down the road.

“We’re not here to replace primary care physicians,” said Rocky Dhir, TelaDoc’s general counsel and spokesman. But “this is what consumers want. We can help them with 75% of reasons they go see a doctor.”

Nonetheless, a significant segment of the medical community remains deeply skeptical that doctors can adequately treat a patient they have never seen in person.

The American Academy of Family Physicians strongly opposes the idea. The American Medical Assn. has expressed concern that patients who get treated over the phone could get shortchanged, even harmed. The Medical Board of California asserts that TelaDoc may be violating state law by allowing doctors to treat patients by phone. A spokesperson said the board may open an investigation into the company’s operations.

Dr. David Goldstein, a physician and co-director of USC’s Pacific Center for Health Policy and Ethics, called the TelaDoc idea “totally unethical and inappropriate.”

He worries that physicians who do phone consultations can too easily miss critical information they might otherwise catch. “They don’t examine the patient,” Goldstein said. “What about the clinical benefit of looking at someone’s skin or their eyes or listening to their heart? This is laughable.”

Dhir, of TelaDoc, said the company believes it is operating legally in all 50 states, including California. The company has not received any reports of patients who have been harmed by a misdiagnosis, he said.

TelaDoc doctors treat only nonemergency medical issues such as allergies, respiratory infections and sprains. If a patient calls with a more serious medical issue, the doctor provides a referral to a local physician or an emergency room.

“This is no different than doctors who’ve treated people over the telephone for years,” Dhir said.

Melissa Smith of Granada Hills called TelaDoc last month to get a refill on her allergy medication. The 26-year-old customer service representative has a high-deductible, bare-bones health plan that restricts which doctors she can see.

A TelaDoc physician returned her call at work within an hour. He “asked me more questions than my regular doctor does,” Smith said. After a 15-minute conversation, he gave her a prescription refill. “This is pretty cool,” she said.

Just a few years ago, “telemedicine” -- over the phone or on the Internet -- appeared to be healthcare’s next big thing. A rash of companies and one-shop doctors rushed to offer such services, but many had trouble persuading patients that remote consultations were a good idea. Some states also cracked down, fearing patients might be hurt.

In 2002, Indianapolis-based MyDoc began offering Web-based consultations, but Illinois regulators ruled that the online practice violated the state law barring doctors from treating patients they hadn’t seen in person. The company has since ceased its Web operations.

Beyond the fee for each call, TelaDoc subscribers pay $18 to register and a monthly membership fee of $4.25 for an individual or $7 for a family. The company, which can be reached at (800) 835-2362, or (800) TELADOC, does not treat children younger than 12, and most insurers do not pay for the service. TelaDoc recommends its doctors do no more than four consultations an hour.

Any doctor treating a patient must have a medical license in the state that patient is in, so TelaDoc has contracts with doctors in every state.

Some states also require patients be seen in person. In such cases, the company sends a technician to meet the patient and check temperature, blood pressure and weight. Then the technician conducts a videotaped interview for the doctor to use to make a diagnosis.

Although the Medical Board clearly disagrees, TelaDoc’s lawyers say the company is abiding by California law. The disagreement ultimately comes down to what one considers a reasonable doctor-patient examination.

According to the state’s Business and Professions Code Section 2242(a), physicians must conduct “a good faith prior examination” before prescribing drugs, something the state Medical Board says TelaDoc does not do.

Peter Lee, president of the Pacific Business Group on Health, a nonprofit employer coalition representing 50 companies, said many companies could embrace a model like TelaDoc’s, especially if employers could ensure the quality of the doctors giving treatment and that patients follow up on the recommended care.

“The reality is that the way things work today, most people have to take two hours out of their day for a seven-minute visit,” said Lee. “That doesn’t make sense to employers or employees.”