The Lost Angeles Times recently reported more about these online consults.

Doctor visits in the United States have surged 20% in the last five years to more than 1.2 billion visits annually, according to the Centers for Disease Control and Prevention. Even as the population ages, the number of doctors is falling across the country, and experts predict that office wait times will increase in the coming years.

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“People can wait a long time to get in to see their primary-care doctor and longer for a specialist. . . . To have immediate access is huge,” said Dr. Melissa Welch, Aetna’s Northern California medical director.

Insurance companies apparently opened up and expanded coverage to these web-based services, according to the same article.

…Aetna Inc., the nation’s largest insurer, and Cigna Corp. have agreed to reimburse doctors for online visits. Other large insurers are expected to follow, experts say.

The question is, what are the limits to this type of consults? Would it be like the telephone calls made by patients sometimes—clarification of dosages, lost scripts, refills, checking in for the response or non-response to the initial medications, etc.?

These new online services, which typically cost the same as a regular office visit, are aimed primarily at those who already have a doctor.

The virtual visits are considered best for follow-up consultations and treatment for minor ailments such as colds and sore throats.

But some specialists, including cardiologists and gynecologists, also see these e-mail tete-a-tetes as ideal for periodic checkups that don’t require in-person visits.

Are there regulations we can follow or refer to specific to online consultation lying around or about to be made after this initial period? Ethical issues for one. Quality of care versus the volume is another—the assurance that quality is not compromised to address patient volume and cost issues.

Harvard University health care economist, David Cutler, says it is good.

“Paying doctors to do more patient care over the Internet is a small but important step in a good direction,”

“It increases patient access and could significantly improve their satisfaction.”

Financial journalist, health care analyst, and author Maggie Mahar, in her post, The Downside of Virtual Medicine, has a fine point.

Another question mark is the assumption that online consultations will replace in-person visits. I’m not so sure about this. Just as plausible is the notion that online consultation ends up making more patients pay twice: once for the Internet powwow and then again for a face-to-face visit should it be necessary. And who decides if the visit is necessary? Why, the doctors who can price Internet consultation at their own discretion, of course.

She raised many more important dimensions of concern regarding this arrival. This should facilitate further discussion and further exploration on how this novel avenue works best and be another potential extra hand in addressing issues of patient care and health care cost.

And in this discussion, I opine it is fair to leave a physician’s patient (and case) management decisions in the practitioner’s realm. No one wants insurance-like dictates on how a physician does her work. The patient, on the other hand, has every right to have a choice and a say on how he complies (or not) with his physician’s approach to his care. A common ground has to be reached in order to make sure it is a fair avenue for everyone. I’m very positive that this advantage of technology can be very helpful and is definitely not our enemy.

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My apologies for changing course in today’s post. I will share about Dr. Stark in my next post.

Related—Media In Medicine: More Than Mending The Broken

Upcoming—more about Media In Medicine.