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In the age of the smart phone, do we really still need to line up and wait to talk to a doctor?

You can do all your banking from your smart phone, use the self-checkout at the supermarket, renew your car license online and live-stream the latest movies into your living room. It seems like the only thing that you still have to line up and wait for is health care.

But even that is starting to change. A little.

“Virtual health care” is pretty much what the term implies. It’s a service offered by a number of companies in Canada that allow people – patients, clients – to consult with health care professionals on line, and without making an appointment, waiting a week, going to the doctor’s office, sitting in the waiting room for 45 minutes, and missing half a day’s work.

There are different models for how they work and what services they offer – and new models are coming along all the time – but the basic way they work is similar. You sign up as a client and, yes, you pay – per visit, by annual subscription or even annual family subscription. You sign on to a secure website with your user name and password – just like you would if you were doing banking. You provide information about yourself, which will be kept as your profile. Once you’re set up, you can send a question, go to a live chat, talk to someone, or even video-conference with a doctor or other professional.

In other words, just like talking to your general practitioner in his or her office.

However, there are limitations on what the virtual doctors can and cannot do. They can answer your questions (and potentially set your mind at ease). They can give you advice – anything from “Don’t worry about it, it will go away, and if it doesn’t, or if it gets worse, come back for another chat” to, “Oh, my goodness, you should go to a walk-in clinic or the ER right away.” They can suggest over-the-counter medications or, for a range of common ailments, write a prescription and send it to your pharmacy. In many cases, they can suggest you go to a GP or specialist (and, in some cases, set up the referral).

I was looking for some perspective on this. Basically, my question was, “Of all the visits by patients to doctors, how many could have been handled virtually?” It’s hard to find reliable numbers, but what I found makes me pretty sure we can say, “At least half.” One virtual health care provider quotes a study that say 76 percent of all doctor’s visits could have been done online. Ok. So one way or another, that’s a lot of room for virtual health care.

All good. But what your virtual practitioner can’t do is to offer treatment. In Canada, medical acts between consenting adults are about the only acts that are still strictly illegal. Medicare does not allow doctors or other practitioners to bill the system for anything other than in-person services, and does not allow them to charge for medically necessary services of any kind. Hence the subscription fees.

Different companies charge different rates, but we’re talking in the range of 10 dollars for a visit, or 500 dollars for an annual family subscription with unlimited access.

Which may or may not seem like a lot of money. To many employers, though, it seems like not a lot of money at all, especially when they compare the cost of an employee subscription to the cost of employees booking off for half a day or a day every time they need a medical question answered for themselves or their children.

It’s also, if you ask me, a pretty nice benefit that employers can offer their people.

A couple of questions do occur to me right off the top. Like, what about Telehealth Ontario? It’s a free service that anyone can call any time of the day or night. I’ve heard good things about Telehealth. You talk to a Registered Nurse (who are the people, in my experience, who are most likely to have seen it all before and know what to do). They are very good at things like helping you decide whether you should take your sick child to the ER. They offer information on how to access services, give practical advice on things like breastfeeding, and are one place you can go – anytime and right away – to talk to someone about mental health, depression or suicidal thoughts. On the other hand, Telehealth is phone-call only, and the range of services is, obviously, more limited.

The second question that comes up right away is, “Sure, but why not e-mail your family doctor?” Well, to quote a recent Globe and Mail story on the subject, Good luck with that. Canada rated dead-last in an international survey of electronic access to family medicine. Only six percent – yes, six percent – of family physicians will even let you book an appointment by e-mail, let alone ask about that nasty rash on your arm. (The basic problem, again, is that medicare makes it almost impossible for a physician to get paid for anything other than a face-to-face session.)

Still, I can’t help but wonder about the future of health care in general, and where all this is leading us. This has got to be the way forward. I think of the supercomputer built by IBM – they call it Watson, and you may have seen it beating grandmasters at chess or scoring blow-out wins against the all-time Jeopardy champions on the popular TV game show. So… if I tell Watson that I have a fever, I’m coughing, my nose is stuffed up, my head aches and I’m sore all over, what would it say? I’m guessing, “I’ll take flu for $200, please, Alex.”

If there is a topic that you would like me to write about, please email me at bill@penmore.com.

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