Long Distance Diagnosis = Bad Idea
Nearly every day on the WebMD Ear, Nose, and Throat message board, I have to post the following disclaimer:
Usually, I do not know the particular demographics of the person posting, so many requests for an Internet diagnosis may come from naive teenagers, but I suspect not all of them. A diagnosis cannot be conclusively made without a detailed medical history (requires a dialogue of questions between the examiner and the patient), and that all-important hands-on examination. Some diagnoses are made entirely by the medical history, and some are purely visual, such as a dermatological (skin) condition. Vague descriptions just won't do it. And, even if I could diagnose the person, there is a very grey, legal area about treating someone who is not really one of my patients. (Besides, WebMD wouldn't let me for the reasons I stated here)
If I call my automobile mechanic and say that my engine is making this weird noise, and ask him what does he think it is, and if there is anything that I can do at home to fix it (since my car insurance does not pay for repairs). He will think I am absolutely crazy. This is not unlike many of the requests that I get on the Boards.
While I am very sympathetic about the cost of medical care, the fact that a person does not have insurance or the financial resources to seek proper medical care; does not change the situation one iota.
One time, I overheard another medical provider talking to a patient on the phone. Only hearing one side of the conversation, I quickly grasped the concept.
At the conclusion of the conversation, the doctor said that she can go on like that indefinitely until the person solves their own dilemma. She said if you keep restating that they have to come in, over and over again, and NOT offer them solutions, they will eventually solve it. For instance, if you tell them to take a taxi, they will say they have no money. If you tell them to get a neighbor, they will tell you that their neighbor is not home. In other words, it is always best to allow the person to solve their own logistical or financial problem; with a little prompting, of course. Medical providers do not lack compassion. They are just faced with their own logistical problems.
Medical providers help their patients financially all of the time. You may or may not notice it. Fees are adjusted or down-coded for patients who are paying cash or have no insurance. Pharmaceutical samples are often given, or medications are prescribed that are known to be inexpensive or available generically. Some providers simply write NO CHARGE on the fee tickets.
Attorneys charge for phone advice, but rarely do medical providers charge for lengthy consultations. I spend at least an hour or more of non-compensated time dealing with these issues. Phone medicine has the same limitations as Internet-based medicine, but the big difference is that these are your patients. You know their medical history. You can review their charts. And, you know them as people.
I get unsolicited junk e-mails every day offering me prescription drugs, such as Viagra via the Internet. Many state that their "doctor", after asking a few questions, will prescribe it for you. Granted, this sounds like a good job for a retired clinician, but really! Can a medical provider truly ascertain the medical risks of a person on the phone or Internet based on a few questions? I don't think so. This is really no different than the Golden Age of Medical Quackery.
I visited the Museum of Questionable Medical Devices a few years ago in Minneapolis. Among the impressive collections was a huge quackery machine, filled with lights and dials, and an antenna. This machine, according to the operator, was capable of diagnosing anyone via the airwaves. All you need to do is send in your money, along with your list of complaints. This information will be entered into the machine, which will pick up your waves. A diagnosis and treatment would be mailed back to you. As crazy as this sounds, this worthless machine generated the inventor quite an impressive income. A fool and his money soon part.
I have been providing health information and advice on the Internet for eight or nine years now. I suspect that I have answered ten thousand questions. I have helped many, and have frustrated some by posting my disclaimer. Hopefully, even reading the disclaimer will educate the naive and misinformed about the limitations of this educational service. Unfortunately, it is not possible to help everyone, at least in the way that they would like help. Now, if I had one of those machines....
Related Topics:
Technorati Tags: internet, medical advice
"Unfortunately, since I do not know anything about you, your medical history, or more importantly, have any way of examining you, it is not possible to determine the cause for your symptoms based solely on a brief description. There are just too many diagnostic considerations that cannot be sorted out via the Internet. You will need a hands-on medical examination for a proper diagnosis and treatment."
Usually, I do not know the particular demographics of the person posting, so many requests for an Internet diagnosis may come from naive teenagers, but I suspect not all of them. A diagnosis cannot be conclusively made without a detailed medical history (requires a dialogue of questions between the examiner and the patient), and that all-important hands-on examination. Some diagnoses are made entirely by the medical history, and some are purely visual, such as a dermatological (skin) condition. Vague descriptions just won't do it. And, even if I could diagnose the person, there is a very grey, legal area about treating someone who is not really one of my patients. (Besides, WebMD wouldn't let me for the reasons I stated here)
If I call my automobile mechanic and say that my engine is making this weird noise, and ask him what does he think it is, and if there is anything that I can do at home to fix it (since my car insurance does not pay for repairs). He will think I am absolutely crazy. This is not unlike many of the requests that I get on the Boards.
While I am very sympathetic about the cost of medical care, the fact that a person does not have insurance or the financial resources to seek proper medical care; does not change the situation one iota.
One time, I overheard another medical provider talking to a patient on the phone. Only hearing one side of the conversation, I quickly grasped the concept.
"I understand that you do not have transportation. I know it may be difficult for you to arrange to come in to the office, but I have to see you."
"Yes, I understand, but you still have to come it."
"Uh, huh, but you still have to be seen."
"Yes, you need to come in. Perhaps you can do that."
At the conclusion of the conversation, the doctor said that she can go on like that indefinitely until the person solves their own dilemma. She said if you keep restating that they have to come in, over and over again, and NOT offer them solutions, they will eventually solve it. For instance, if you tell them to take a taxi, they will say they have no money. If you tell them to get a neighbor, they will tell you that their neighbor is not home. In other words, it is always best to allow the person to solve their own logistical or financial problem; with a little prompting, of course. Medical providers do not lack compassion. They are just faced with their own logistical problems.
Medical providers help their patients financially all of the time. You may or may not notice it. Fees are adjusted or down-coded for patients who are paying cash or have no insurance. Pharmaceutical samples are often given, or medications are prescribed that are known to be inexpensive or available generically. Some providers simply write NO CHARGE on the fee tickets.
Attorneys charge for phone advice, but rarely do medical providers charge for lengthy consultations. I spend at least an hour or more of non-compensated time dealing with these issues. Phone medicine has the same limitations as Internet-based medicine, but the big difference is that these are your patients. You know their medical history. You can review their charts. And, you know them as people.
I get unsolicited junk e-mails every day offering me prescription drugs, such as Viagra via the Internet. Many state that their "doctor", after asking a few questions, will prescribe it for you. Granted, this sounds like a good job for a retired clinician, but really! Can a medical provider truly ascertain the medical risks of a person on the phone or Internet based on a few questions? I don't think so. This is really no different than the Golden Age of Medical Quackery.
I visited the Museum of Questionable Medical Devices a few years ago in Minneapolis. Among the impressive collections was a huge quackery machine, filled with lights and dials, and an antenna. This machine, according to the operator, was capable of diagnosing anyone via the airwaves. All you need to do is send in your money, along with your list of complaints. This information will be entered into the machine, which will pick up your waves. A diagnosis and treatment would be mailed back to you. As crazy as this sounds, this worthless machine generated the inventor quite an impressive income. A fool and his money soon part.
I have been providing health information and advice on the Internet for eight or nine years now. I suspect that I have answered ten thousand questions. I have helped many, and have frustrated some by posting my disclaimer. Hopefully, even reading the disclaimer will educate the naive and misinformed about the limitations of this educational service. Unfortunately, it is not possible to help everyone, at least in the way that they would like help. Now, if I had one of those machines....
Related Topics:
Technorati Tags: internet, medical advice
0 Comments:
Post a Comment