TIME: Almanac 1993/TIME Almanac 1993.iso/time/072291/0722350.000

Text File | 1992-08-28 | 5.8 KB | 121 lines

                                                                                MEDICINE, Page 54

Reach Out and Cure Someone


A new 900 number offers medical advice by phone, but can it
replace a family physician's personal touch?

By ANDREW PURVIS


    Ah, the conveniences of the electronic age! At a time
when everything from diaper and sushi deliveries to kinky
romantic trysts can be had with a few touch tones, yet another
novel entry has arrived in this vibrant market-by-wire. Why
spend hours traveling to the doctor's office, leafing through
out-of-date magazines, waiting for the healer to spare a moment
of precious, not to mention expensive time, when one can now get
instant medical gratification over the phone? Why not simply
dial a doc?

    That is the proposition being promoted on freeway
billboards, along train platforms and in newspapers around New
York City this summer. The ads tout a unique new 900-number
service called Doctors by Phone, which provides professional
medical advice for $3 a minute. Similar campaigns are scheduled
to appear next month in Los Angeles, Miami and Chicago, among
other cities. But the program has already drawn fierce
criticism. Says Philip Boyle, an ethicist at the Hastings Center
in Briarcliff Manor, N.Y.: "There is just no substitute for the
clinical encounter. They are selling something that they cannot
provide."

    The service certainly could soothe a sore spot. American
physicians are notoriously hard to reach, leaving thousands of
patients frustrated by their inability to get answers to basic
medical questions. In addition, asserts Dr. Thomas Kovachevich,
49, founder of Doctors by Phone, patients often hesitate to
bother their busy doctors with problems that seem too trivial
or embarrassing. Kovachevich, an adjunct assistant professor of
family medicine at the Chicago Osteopathic Medical Center,
points to a class of relatively simple medical queries that can
be addressed quickly and effectively over the telephone. These
range from deciding which specialist to consult to interpreting
blood tests and probing the obscure side effects of a particular
medication. More ticklish questions may be easier to ask of an
anonymous voice. Some of the more common problems raised in the
thousands of calls received during the past month: "The condom
broke. Do I need an AIDS test?" Not necessarily. "I can't
perform sexually. Could it be related to my medication?" Yes,
depending on the drug.

    Since 900 numbers are perhaps better known for
personalized horoscopes and phone sex than serious subjects like
medical care, Kovachevich has taken pains to underscore the
respectability of his operation. To avoid obvious conflicts of
interest, he does not allow his doctors to see the patients they
talk to (all referrals are made to the New York County Medical
Society), and his staff cannot prescribe medications over the
phone. Such caution is also a hedge against malpractice suits.
Although the service is fully insured, some courts have been
critical of care delivered by telephone.

    Most of the 80 physicians taking calls are recent
graduates of leading medical schools in the New York City area,
usually hospital residents still in training, most of them
seeking extra income to pay off student loans. A few of the
doctors are retired. The pay is comparable with that offered to
entry-level emergency room attendants (about $40 an hour), and
the work, some feel, is more rewarding. Says Dr. Neil Stollman,
28, a senior resident in internal medicine at
Columbia-Presbyterian Medical Center who has manned the phones
on and off for Kovachevich since June: "In the emergency room,
I would often get this kind of call. Just a simple question. But
meanwhile two people are dying. I just didn't have time to talk.
This gives me the opportunity to focus on a patient."
Kovachevich predicts a new era of "information doctors" who
specialize in caring for people by wire alone.

    Critics of remote-control medicine say communicating by
phone may be a reasonable way to diagnose a problem with a car,
but not to understand the intricacies of human disease. Dr.
Daniel Isaacman, a pediatrician at Pittsburgh's Childrens
Hospital who has examined the question of remote diagnosis,
cites a study in which 61 emergency-room doctors were contacted
by phone and presented with the same hypothetical patient, a
baby boy with a 102 degrees fever. For a child under two months,
such a fever can signal a life-threatening infection. Nearly 30%
of doctors responding did not ask the child's age and so failed
to recommend that the youngster even come in for an exam.
Richard Kessel, executive director of New York State's Consumer
Protection Board, which is looking into the service, notes that
patients may be spending money on what they think is a final
answer, when "many will still have to go to a doctor and pay
additional bills." Kovachevich says that about 75% of calls are
indeed referred to other doctors.

    A serious concern of physicians is that if 900 services
catch on, they will deter patients from establishing a rapport
with their family doctor and cause them to miss out on vital
ongoing preventive advice. "A cornerstone of good medical care
is continuity and getting to know a patient as an individual,"
explains Isaacman. "This service is going to discourage that
kind of care and encourage patients to seek a quick, temporary
fix."

    Several medical societies, including the American Medical
Association, are studying the 900 idea, but they have yet to
come to any conclusions about its usefulness or safety. For now,
it seems, patients would be wise to think carefully before
dialing -- and get a stopwatch. At $3 a minute, or $180 an hour,
the bill itself could trigger cardiac symptoms too grave for any
phone doctor to resolve.