Deductibles start over for everyone and I end up with a ton of last minute cancellations when people realize the cost. It is particularly bad right after the financial drain of Christmas and it gets worse each year as deductibles creep higher and higher and higher.
However, the holidays are great for spreading illnesses so with a 5-7 day incubation time, spending a week or two trying to fight things off…. Well, now is when people start to need an antibiotic prescription so those empty slots are put to good use.
Most of these patients never come in for a physical so I try to do that at the same time as their acute visit if I have the time as it saves them a copay and preventive care visits don’t go towards their deductibles.
I said all of that to say that yesterday I was doing one of these physicals on a patient who had come in for a sinus infection when she made a comment about how her employer now has the “benefit” of teledoc so she might not be coming in for this sort of thing again.
For those of you who don’t know, teledoc allows you to have a Skyped consult from your desk with a strange doctor somewhere far away.
What she doesn’t necessarily realize is that her employer is not doing this out of the kindness and goodness of their heart. Oh, no. If you see your doctor from your desk, you are not missing work. And a Skyped visit would be cheaper than an office visit so they are spending less money on you in the long run.
“What do you think of teledoc, Doc?” she asked casually.
I felt myself bristling.
Why did I feel the need to justify my role?
And then I realized, some of what I do probably could be done by Skype. Rashes for sure. Maybe some sinus infections. Diabetes check-ups to some degree. Blood pressure. Anxiety/depression sometimes. Gastroenteritis.
Not that it would be better by Skype. I pick up all kinds of stuff during office visits that you would not get by Skype. Like the new heart murmur. New swelling in the legs. The breast mass. Plus there is the relationship side of medicine. I really like that and I think a lot of patients do, too.
There are many, many things that cannot be done by Skype, though. Technology won’t let them listen to a heart or look in an ear yet.
So why do I feel so threatened?
Because it is coming. The technology is being used with robot doctors in rural ICUs.
Am I just the equivalent of a robot?
Some days it sure feels like it, I will admit.
I like my easy visit patients. They keep me sane. I don’t want to lose that to some yahoo behind a computer screen.
The worst thing, and I have to be honest with myself here, is that I look down on doctors who do teledoc work. They are selling out their profession! I also assume that they are not good physicians, that they are lacking in knowledge or personality and cannot hold down a job in the “real” world.
The other issue I have is based on a conversation I had with an acquaintance. He knew what I do for a living. He said, very loudly in a room full of people as he looked at me, “I love the teledoc! I use them all the time. I already know what I need. I can just tell them and they give it to me.”
Heaven help us. It is a brave new world and I will have to be dragged kicking and screaming toward it, I am afraid.