Take two aspirin and E-MAIL me in the morning

Online 'clinics' offer patients care, convenience and control

June 07, 1999|By Michael Stroh | Michael Stroh,SUN STAFF

Off a desolate stretch of Route 4 in northern Calvert County, in a white dormered building sandwiched between a baseball field and an auto repair shop, a half-dozen physicians at computer screens are making virtual house calls to people they've never met -- and probably won't hear from again.

Welcome to America's Doctor, one of a growing number of online "clinics" that are changing the face of American medicine. Their lure: physicians who answer medical questions directly and -- in some cases -- diagnose patients and issue prescriptions.

Thousands of medical consumers, frustrated by the assembly-line pace of managed care and doctors who are too busy to chat about their health concerns, are turning to America's Doctor, as well as sites such as CyberDocs ("Where the doctor is always in") and WebMD ("Pay an office visit to the future of health care").

"People are saying, 'I want my doctor to spend more time with me,' " says Dr. David Stern, an assistant professor at the University of Michigan Medical School. "I think they're not getting the attention they need, they want, they deserve."

The online clinic is just one example of the Internet's impact on the traditional relationship between doctor and patient. From online support groups to cyberpharmacies to the use of e-mail between patients and doctors, medicine has taken to cyberspace.

"The role of the patient is shifting from someone who just passively follows doctors' orders to people taking charge of their own health care," says Dr. Tom Ferguson, editor of The Ferguson Report in Austin, Texas, which monitors the online health-care industry.

Dr. Andre Gvozden sits at the epicenter of the revolution. It's 8 p.m., and the Millersville pediatrician listens to a background of jazz and clacking keyboards while the questions roll in.

"How many liters of water should I drink per day?"

"What can you tell me about pin worms?"

"What causes memory inconsistencies?"

Gvozden, wearing braces on his teeth and a brilliant blue tie showing children holding hands, says he's seen it all.

Once a man logged on complaining of chest pain. Suspecting a heart attack, Gvozden told him to log off and call 911.

He hears from people who have no health insurance. From teens with sensitive sex questions they're too embarrassed to ask anyone face to face. From people who wonder whether massaging squirrel brains into their children's gums will ease their teething pain.

Those clacking keyboards are the sweet sound of vindication to Dr. Scott Rifkin, a Baltimore native who launched the service last fall on America Online, then on the Web a few months later. At the time, critics doubted whether anyone would stop by. They were wrong.

The America's Doctor Web site gets 500,000 visitors a month, Rifkin says. While not all visitors step into the virtual waiting room -- support groups and a medical reference library are big draws -- there's enough demand for face-to-face medical chat to keep the company scrambling for physicians. The service employs about 100 doctors in a variety of specialties.

"We could use twice that number," says Dale Hutchins, who operates the call center.

Its doctors see about 16 patients an hour on line, typically two or three at a time by clicking between "chat" windows. On rare occasions, Hutchins says, the virtual waiting room has been so packed that visitors have waited as long as two hours to see a doctor.

It's unclear how online clinics will survive financially. America's Doctor hopes to make money through contracts with local hospitals that sponsor the clinic as a "branded" Web service. Others hope to make money by charging patients directly, or through related businesses such as online pharmacies.

State regulators are watching online clinics closely because laws prohibit doctors from practicing in states where they're not licensed.

To deal with those restrictions, America's Doctor warns visitors that none of its doctors "will enter into a physician-patient relationship" or "engage in any conduct that involves the practice of medicine."

As a further precaution, patient and doctor are cloaked in anonymity -- the only information visitors provide is their ZIP code. Physicians are assigned at random, so visitors never know whether they'll get the same doctor twice.

"We don't try to diagnose. We don't prescribe drugs," Rifkin emphasizes.

Cheryl Wyatt, a mother of two who runs a day-care center out of her home in Shawnee, Kan., doesn't mind the limitations. "If you call the doctor's office with silly questions," Wyatt says, "they can get a little bit irritated after a while."

Wyatt turned to America's Doctor when she hit age 40. She wondered whether she should take vitamins, wanted to know more about attention deficit disorder after her son was diagnosed with it, and asked about a child in her day-care center who had a bump on his back that she feared might be from chicken pox.

"It's just nice to hear them say, 'If it was chicken pox it would be more than one bump,'" she said.

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