May 28, 2008 — -- With the days of routine doctors' house calls long gone, many patients have turned to telemedicine to get quick, convenient diagnoses.
While 30 million American said they have consulted their doctor via e-mail and another 70 million said they wish they could, only a third of doctors actually offer e-mail or telephone appointments, according to Manhattan Research, a market research and advisory firm for pharmaceutical and health care companies.
So many patients have turned to online resources to help pinpoint their problems.
Several online sites offer symptom checkers and access to medical experts — allowing patients to ask doctors for advice without ever meeting them face to face. But some critics question just how reliable such resources can be.
"Good Morning America" and "GMA" medical contributor Dr. Marie Savard decided to check some medical Web sites to see how they would advise a patient based on her stated symptoms.
First "GMA" took advantage of a free media trial at the subscription site Edocamerica.com. "GMA" asked for advice for one of Savard's patients, a 35-year-old woman with unexplained itching and fatigue.
Savard knew what was wrong with the patient. Edocamerica.com suggested the patient get blood tests to check for an underactive thyroid.
While the suggestion was reasonable, underactive thyroid was not the patient's problem.
Then "GMA" tried another site called LivePerson. The site posts doctors' pictures and credentials. Users pay by the minute or question for advice.
"It's totally, totally upsetting. It totally reduces medicine to piecemeal work," Savard said.
For $25, the LivePerson doctor also pointed to hypothyroidism. He suggested the woman get tested for diabetes, too.
Finally, "GMA" tried a site called Just Answer, where patients can get advice on what's ailing their cars as well as what's ailing their bodies. The price ranges from $9 to $30.
"I'm totally skeptical," Savard said before receiving the diagnosis.
In just 3½ minutes a doctor responded, "You are having an attack of acute urticaria." He didn't suggest the patient get checked for the skin allergy; rather he said she "had it."
Only when pressed did he mention other possibilities, such as liver and kidney disease.
Still, the doctor was incorrect. Figuring out Savard's patient's problem without the benefit of a physical exam could be difficult for any physician. A physical exam would have revealed her enlarged lymph nodes — a hallmark of a cancer called Hodgkin's disease.
LivePerson and Just Answer both said they are not responsible for the advice their experts give. All three Web sites said they are not intended to be substitutes for people's personal doctors. They all recommended testing, which would have resulted in a doctor's visit.
Savard's real-life patient kept asking her primary care physician to prescribe skin creams over the phone, and before she finally sat with Savard for an in-person appointment and second opinion.
"By her failing to go to her doctor's office and getting that hands on exam, she delayed that diagnosis many months," Savard said.
A much more common — and less controversial — practice is regular doctors who make telemedicine a part of their practice. Dr. Alan Dappen knows all his patients and requires them to see him for a face-t- face exam before treating them remotely.
"I'll see you seven days a week. If I have a doubt, you're coming to see me. If you have a doubt, you're coming to see me," he said.
"I have many cases in the past five years that my answering the phone resulted in a significant outcome difference for that person."
Dappen conducts half his visits by phone or e-mail. It's freed him up so he now can offer good, old-fashioned house calls.
Mary Padgett and her family are patients of Dappen who appreciate the convenience of telemedicine but enjoy the rapport that face-to-face interaction provides.
"I have a relationship with him. It's not just someone over the Internet or that I talk to on the phone. I actually know him and he knows everything about us," she said.
If you want to try telemedicine, keep in mind it's best for routine problems you've had before. Don't use it for any condition so pressing that you can't wait 24 hours for an answer.
To avoid back and forth, provide details, such as your pharmacy's phone number and convenient times for you to come in. Some insurance companies now pay for phone and e-mail visits, so try to get reimbursed. And if your symptoms don't go away, go to your doctor in person.