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Telemedicine Starts with the Doctor's Voice

Scott Mace, for HealthLeaders Media, August 7, 2012

"Believe me, you could put every patient on amoxicillin, which costs about a buck, and doesn't work on anybody, or you can really thoughtfully try and treat them. And if these individuals weren't signed up with telemedicine, they wouldn't get care, because they wouldn't have a place to go.""

Some consults are triage-like in nature, with Gordon simply giving advice. A fuller consult allows him to both advise patients and prescribe medications, although "not controlled substances, no Level 2, but anything below that," he says.

Gordon recounts the time a teenager's mom called, concerned about an outbreak of mono that had gone through her 16-year-old son's volleyball team. The son was showing symptoms of what could have been mono. He advised her to take her son in for an in-person checkup to rule out other serious possibilities such as a ruptured spleen.

"That was a very good call by that lady to call us, and it changed the whole way she was going to approach it, because she wasn't going to take him to the pediatrician," Gordon says. "She thought it was just completely and totally unnecessary. That's where we kind of are making the difference, because we're able to direct patients in the direction they need to go."

Talking to Gordon, I got a palpable sense of the highly disruptive nature of such simple telemedicine to the existing way healthcare is practiced in this country. Gordon presumes the woman has good hospitals where she lives, but for whatever reason, she chooses to call this service instead. And even though the doctor could not see the boy or his mother, it  was an absolutely respectful relationship between doctor and patient.

I ask Gordon if he thinks it's a healthier experience than going to one of those pop-up retail urgent care clinics.

"While most of them are staffed by nurse practitioners and physician assistants who are very good, it's very sterile and not warm," he says. "I'll be perfectly honest with you, the physician extenders are as disinterested as a general practitioner in the office trying to see 35 patients in a day.

"At least on the telephone, for whatever period of time that a consult takes place, both people are focusing on each other, and it's just very rare. I came of age in a different time. By the time I got out of medical school, the whole practice and orientation emphasis had changed, and it just gets worse every day in that regard."

Today's business models of patient-as-consumer or doctor-as-marketer just creates different levels of entry and different barriers, and it really doesn't serve the patient as well, Gordon says.

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