Details of how this will work are in an article by Tom Pullar-Strecker which I spotted in the Dominion Post on Saturday, 17 January.
In summary, it’s a joint venture between a Waitemata mobile GP service Third Age Health and a private equity firm Hatch Equity. It will cost $99 a month plus minimum $59 per 15-minute video-consultation. Home/office visits will cost $199 or $299 after hours. They are hoping to qualify for capitation funding and to have patients use Doctor2Go as their official primary healthcare provider.
I would imagine there are high-earning patients who will jump at this model. But I am sceptical on whether it will be good for their health.
For some consultations it won’t matter. For example, if they have a home blood pressure monitor, their blood pressure medications could be managed in a video consultation. Their doctor would be able to discuss medication benefits and side effects, alcohol intake and exercise.
Weigh-ins and antibiotics
I’d still want to get them in once a year for a weigh-in, and have their height formally measured once – I know from experience that the patient’s estimation and the actual measurement can be wildly mismatched.
But some consultations would be impossible – a patient might well have the expectation that they could request an antibiotic prescription for their chest infection, but it would in my opinion be reprehensible to do so without physical examination. So that’s $199 for a house call.
The chap on Waiheke Island who features on the Doctor2Go website video would presumably be referred to an accident and medical clinic as Doctor2Go does not have a physical clinic. Or offered a $800 house call.
Hopefully they have made some provision for continuity of care.
Inherent risks of virtual treatment
The Medical Council Statement on Telehealth (June 2013) states, “You should be aware of its limits and ensure that you do not attempt to provide a service which puts patient safety at risk. In particular, you need to be aware of the inherent risks in providing treatment when a physical examination of the patient is not possible.”
Communication is the heart of a consultation, and it is simply better face to face. I can see my menopausal patient break out into a sweat, I can feel when a pause is just a pause or when it is a plea to notice a question struggling to get out, I can make a connection with my patient that will stand us both in good stead for their ongoing care.
I see parents interacting with their children, I see the elderly festinating across the waiting room. Patients tell me things I suspect they would not if they were sitting in their office talking to my image on a screen.
The Doctor2Go website also suggests they will be providing a service for “you and your family”.
I’m hard pushed to think of a consultation for a child which doesn’t require examination. Even the paracetamol for teething needs a body weight, and the behavioural problems are demonstrated as they swing off the sink and help themselves to the tongue depressors. They’d need to subcontract the immunisations, assuming high-flying corporates have their children immunised.
A problem of focus
The website video is worth watching for its lurching focus – the patient is in focus, then the beach behind him, then the patient, then the beach. I imagine this is artistic, but I wonder if I can squeeze some symbolism from it. It may seem the patient is the focus, but is he?
The high-flying corporates may think they are getting a good service. They are getting the service they want, but possibly not the service they need.
I can see that this could be sooner and more convenient for some, and it may provide part of the care our patients deserve, but as an adjunct to a real world relationship rather than replacing face-to-face consultations.
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Autor(en)/Author(s): Emma Dunning
Quelle/Source: New Zealand Doctor Online, 04.02.2015
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