White Coat, Black Art

Dr. Uber Will See You Now

(or will she?)
Should we be able to get a doctor's appointment as easily as an Uber car? (QUIQUE GARCIA/AFP/Getty Images)

My mind was just blown away because I had never had the opportunity to video conference with a doctor from my own home.- Kimberly Strain, patient

It's 2015.

You can use your smart phone to get what you want, when you want, where you want: rides, lunch, a haircut, dry cleaning, an oil change and lots more.

And now, if you just happen to live in British Columbia, you can conjure up a doctor too.

Dr. Vim Hofmeyr spends two hours a week manning a virtual clinic for his patients.

Equinoxe Virtual Clinic is one of Canada's first forays into patient-driven video-based doctor appointments. Brian talks to one of the first MDs to climb on board is Horseshoe Bay GP Dr. Vim Hofmeyr. He loves the ability to reach out to his patients who might not be able to make it into his office.

Patient Kimberly Strain lives in Abbotsford, BC and uses Equinoxe. She likes the convenience of having a doctor's appointment when and where she wants it. She also likes having access to her doctor's notes from her appointment, as well as the convenience of having her prescriptions automatically emailed to her local pharmacy.

I fill my cup of coffee, go to my virtual room which has a laptop, earphones and a laptop.... I click on an "accept" button. Two seconds later I have an audio/visual of my patient wherever he or she might find themselves and we will conduct a virtual visit.- Dr. Vim Hofmeyr

Rural and remote Canada has half the doctors it needs. Given how sparsely populated our country is, the uberization of health care seems logical.

But it isn't happening on a large scale. Keep in mind - this isn't telemedicine: a two-way video-conferencing service pioneered in Canada that puts patients and doctors in remote areas in contact with urban specialists and hospitals. Telemedicine is a niche service controlled by doctors. What Vim Hofmeyr does is a consumer-friendly option accessed by patients that puts a doctor right in your living room.

So far, BC is the only province that has created a code so that doctors gets paid a standard fee to see you at the virtual clinic instead of insisting that you come to the one made of bricks and mortars.

The US is ahead of the curve; it has a plethora of Uber-like services with catchy names like Heal, Doctor on Demand, and Pager.  Some see patients virtually for around $50; others summon a doctor or a nurse to your place for something closer to $200.

Many of our patients, be they single moms who have family obligations or university students who are literally in the classroom just can't make it to the traditional model of health care and this is just another tool in the tool kit.- Dr. David Gratzer

The service provided depends on what's in the doctor's black bag.  Some can do an ECG to check your heart. Some can stitch up a cut. In the virtual realm, the Spruce app lets you send a photo of a skin rash to a board-certified dermatologist for an almost instant diagnosis.

Dr. Vim Hofmeyr tells White Coat, Black Art that one of the hurdles to virtual care is that doctors are reluctant to do e-visits because they can't lay their hands on the patient.

But if the patient has a mental health problem such as anxiety or depression, that becomes irrelevant. Dr. David Gratzer is a psychiatrist; Faiza Khalid-Khan is a social worker.  Both see patients in the flesh at The Scarborough Hospital in Toronto.  They've created an internet-based cognitive behavioural therapy or CBT.  CBT is a well-established structured treatment that teaches patients how to solve problems and by helping them get rid of negative thoughts.

Gratzer and Khalid-Khan recently co-authored a paper published in the Canadian Medical Association Journal in which they presented evidence that their Internet CBT or e-Therapy, as they like to call it,  was effective in patients with mild to moderate depression, as well as patients with anxiety.

They say CBT is ideally suited to the Internet because it isn't talk therapy but a set of exercises that the client does on his or her own time. They follow-up with virtual therapy sessions to measure progress and refine goals.

David Gratzer is willing to venture into uncharted territory for mental health treatment because he believes that it's time to put the needs of patients and families first, not those of doctors or the health care system.  To do that, you have to start by listening.  Gratzer and Khan say that consumers are fed up with long waits, lack of trained professionals, and inconvenient services.

Dave deBronkart echoes that idea. He`s an patient activist better known as e-Patient Dave. He says people who run healthcare are obsessed with the potential for violations of patient privacy, and that's hobbling the convenience of online appointments and medical services. 

Let us know what you think. Are you ready for online care?  How much should the desire for convenience push back against the need for privacy?


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