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Uber for doctor housecalls

Your smartphone can summon the doctor to make a house call. I'll tell you if it'll fly in Canada.
  Doctors who make house calls may seem like a thing of the past. But in the States they're making a comeback - thanks to smartphones and a new service that summons a doctor in the same way that the on-demand car service Uber hails a ride.

As reported last week in the New York Times, there are several of these services available south of the border.  They have names like Heal, Doctor on Demand, Pager and Teladoc.  They all work fairly similarly.  You download the company's app on your smartphone and enter the reason for your visit, your address and other information.  In the case of Heal, you enter your credit card information, request a doctor, and one arrives at your door within 20 to 60 minutes. With some services, you have a videoconference via smartphone to screen out patients who are better off going to the hospital.  The doctor arrives with a medical assistant and equipment - some of which is much more high tech than the doctor bag I got in med school.

The service you get depends in part on what's in the doctor's gadget back.  In general, they can take vital signs.  Some can take a picture of your child's eardrum to see if it's infected.  Some can do an ECG to check your heart.  In general, services like Heal are designed to diagnose and treat relatively minor things like sore throat and pneumonia.  If you have a cut, they might come with the equipment to stitch it up.  If you need to see a specialist, Heal can arrange an appointment with one of the specialists it has on its roster. The Spruce app lets you send pictures of your rash to a dermatologist.

The cost of these house call services varies.  Heal charges a flat fee of $99 to summon a doctor.  Pager - a service available only in New York City - charges $50 for a first-time home visit, $200 for each subsequent visit, and $100 for a physical.  Doctor-on-Demand - a service based in San Francisco that offers virtual house calls only - charges $40 for a video visit with a doctor or a pediatrician.

Anecdotally, services like these are popular with mothers who work and who can't afford to take time of work to bring their kids to the office.  One patient spotted a skin rash while waiting at an airport for a flight. He said he got a diagnosis in minutes. Testimonials on the various company websites say they like the convenience.  One happy patient said it beat going to an urgent care center.  More than a few said they  used the service to get a refill on their prescription.  Some said they got to see a doctor within an hour; if they'd waited to see their own GP, it would have taken days.  Younger customers like the fact that a house call doctor can be summoned using a smartphone.  But remember, young people don't need doctors all that much anyway. 

Profitable or not, the business appears to be growing.  Heal launched in Los Angeles and then went to San Francisco.  The company says it will expand to more than a dozen major cities across the US later this year.  Curbside Care operates in Philadelphia.

  These modern takes on house call service have their share of critics. There are legitimate concerns about security. If the system can be hacked, then personal information might get out there.  Critics say apps like Heal and Pager are no substitute for a family doctor or nurse practitioner who has known you for years.  Fair enough.  But 
  you could say the same thing about patients who receive their care at random from urgent care centers.

Some critics worry more about virtual house calls than they do an app that summons a live MD to your home.  Last month, the Texas Medical Board - the people who license doctors in Texas - issued an edict requiring doctors to establish and demonstrate a relationship with patients before giving a diagnosis and prescribing treatment. As reported in the New York Times, the Board ruled that questions and answers exchanged via email, texting, chats or smartphone are inadequate to the doctor patient relationship.

I doubt this will go like gangbusters in Canada. We have companies like MedVisit that do house calls and nothing else. What we don't have so far are house call services activated by apps. In 2013, a Vancouver start up called began offering people in British Columbia (with valid provincial health coverage) video appointments with a doctor via computer, smartphone or tablet.  The company said it was filling a need: a 2012 study by the Canadian Institute for Health Information said one in three Canadians have trouble getting a doctor's appointment.  According to the web site, as of 2014, more than 20,000 Canadians had signed up.  That's a drop in the bucket. 

In Canada, we aren't encouraged to be innovators of health. Hospitals and doctors in the system are terrified of breaching the security of patient data. If I were to guess, I'd say the likeliest place to see the Uber of house call services in this country is at for profit so-called concierge clinics that offer increased access to the doctor for a price.

And that's a shame.  I think the dusty old health care system in Canada could do with some new ideas and a bit more risk taking.

- This blog entry contains corrected information on the Spruce app.


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