More thoughts on the future of virtual medicine

I’ve written before about using e-mail to communicate with your doctor. My own personal physician does this for all of his patients who wish to participate, and it allows me to do things like ask him simple questions or get refills on my prescriptions. It works well for those kinds of things and saves both of us time and the frustration of playing telephone-tag. Of course he knows me already and I know him, and he sees me in the flesh at least once each year. Many pediatricians now have websites for their office practices and use them to distribute information to the parents of their patients as well as for e-mail.

Is there any way this kind of virtual medicine could work if there were no pre-existing relationship between doctor and patient? Could a doctor dispense useful advice without ever having seen the patient? The answer would depend upon the problem, of course — I would be leery of diagnosing and treating, say, pneumonia over the internet. But what about other things? Could an online exchange between a patient and a doctor be used to, for example, schedule an x-ray of a swollen, painful arm? The patient would still need to see the non-virtual doctor, but could this kind of practice save time and streamline the process? And what if the exchange was not by e-mail, but in real time?

A new company is trying to establish just such a system. Called American Well, it aims to offer not e-mail exchanges, but real-time conversations between patient and physician. I have no idea if this will work out, but I could see a system in which a pediatric practice with several pediatricians would assign one of them to spend chunks of time interacting with parents of children in their practice, using either instant messaging between doctor and patient or perhaps even a sort of internet chat room for general discussion with several patients. If this were linked to the scheduling system of the practice, tests could be arranged and follow-up appointments easily made. As a pediatric intensivist I can’t see my practice being changed by this brave new virtual medical world, at least for now. But who knows what’s coming.