Disrupting the doctor visit

This is the second of my posts from the recent Digital Health Summit at CES2015.

The first covered broader aspects of wearables, sensors and data collection, but in this one I want to explore how the traditional doctors visit is being disrupted, why it’s a good thing, and how it’s going to deliver long-term change to the way we access care for basic ailments.

The opportunity for disruption became clear in the very first session, when Tim Moore declared: ‘I detest everything about the current experience of visiting a doctors office.’

He wasn’t the only one, with plenty of other speakers all talking to the same issue. Pretty much every other aspect of our life has been made easier by apps and tech; we can do all of our banking without ever setting foot in a bank, we can buy pretty much anything we like from anywhere, we can book flights, order a taxi (or Uber, unless you are in Vegas where we were all desperate for an option other than the endless taxi queues). You name it, you can do it via an app or your smartphone.

The exception to this is your health, where the vast majority of doctors visits still require you to call the practice, schedule an appointment, travel to a surgery and sit in a waiting room full of sick people inhaling bugs that are likely to make you sicker than you were before you got there.

I know some surgeries are now offering the opportunity to book appointments online, but this is still the exception rather than the norm in Australia and only deals with one of the multiple pain points. You still have to get to the practice, and sit in the waiting room till your number comes up, which is rarely at the time that you originally booked.

Little wonder that Dr on Demand, co-founded by Dr Phil of TV fame, is growing at a phenomenal pace in the US. The concept is that after downloading an app, you book a consult with a doctor that occurs on average 2 minutes (yes 2 minutes) after you make the request, regardless of your geographic location. The consultation occurs via a HIPAA compliant video call from your PC or mobile device, with physicians able to treat 17 of the top 20 reasons people see a doctor. There is a charge of $40 for a 15minute consult, which is reimbursable under many US health plans (and not that far removed from the copay amount in Australia, particularly with the changes about to take place).

For me, and for many of the patients who use the service, the biggest advantage is that you don’t have to go anywhere. This not only saves your time, eliminating both travel  and waiting time, but it also means that if you are feeling lousy you can stay at home in bed in your pyjamas and still get medical advice and treatment. And if you need to see a doctor about something that isn’t actually making you feel awful, you don’t risk any exposure to those who should actually be at home in bed rather than coughing and spluttering their bugs across everyone else in the waiting room!

Doctors can prescribe medications (they don’t prescribe narcotics under any circumstances) and generate referrals if required. They don’t treat emergency cases, and if they feel the patient has an emergency issue will call 911 themselves and stay online until the responders get there.

Patients have the opportunity to rate the care they received after each experience, and doctors with consistently poor ratings are removed from the service. With only 20% of the doctors who apply to practice in this way making the cut, there is no shortage of enthusiastic physicians waiting to take their place.

The service is now expanding into mental health care, and Dr Phil believes it has the opportunity to deliver significant benefit to patients in this area. Regardless of whether there should be a stigma attached to mental illness, the reality is that many patients still don’t want it known that they are being treated for mental health conditions, and being seen in the waiting room can be an issue. With regular, ongoing treatment a real benefit here, removing access issues can also facilitate care. The difference to the regular Dr on Demand service is that appointments are scheduled with the same provider on an ongoing basis.

One of the great benefits that telemedicine delivers is equality of access. With geographic constraints removed, it means patients in the remotest regions (provided they still have internet access) are able to access high quality medical care without having to travel significant distances to do so, and this removal of a really significant barrier can only have a positive impact.

According to Dr Phil, Dr on Demand is a a runaway success for the same reason that the Dr Phil show has been a TV success story for the past 13 years; it proves common sense, usable information that people want in a format that is easy for them to access will always create a powerful disruptive force.

As Randy Parker, CEO of MDLIVE Inc stated, the consumer is now the Chief Medical Officer of their own home, and they expect the same kind of service in healthcare that they are able to get in all other aspects of their life. Doctors who continue to think that change won’t happen unless they want it to, I fear do so at their peril, with the real question being not how many patients want a different way, but how many don’t. That number is only going to get smaller as tech becomes more and more pervasive across all other walks of life.



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