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Dear HOUSE Calls,

I took a picture of my partner’s wound on his leg and emailed it to his doctor and asked what we should do. He prescribed an antibiotic. Is this the wave of the future? Can doctor’s bill for this type of consultation?

This is a hot topic, thanks for raising it. There are issues of billing, communication, correct diagnosis, liability, and access. There are business models for this. There are insurance codes for telephone consultation. These are usually reimbursed at very low levels and only by very few insurance companies. In our medical system, physicians make a living by seeing patients. There are capitated or single payer systems were physicians make money for not seeing patients. That system has other challenges, but would make this sort of consultation quite reasonable from a financial perspective.

This is no different from telephone medicine.

We generally feel if a problem can be managed in about a minute or so, a telephone call is reasonable approach. But if a patient needs 15 minutes of our time, a visit a important to us from a scheduling and financial perspective. Regarding communication, telephone medicine is generally preferably to email medicine for making a diagnosis. Two-way communication is much better this way, and we can detect discomfort or distress that is hard to pick up by email. For quick questions, email avoids phone tag. In this case, we want to know, ‘is the wound warm? Is there any pus? Is the leg swollen, painful? Any fever?’ So that brings us to correct diagnosis.

In this case and many cases, a picture is a worth a 1000 words, but to see and touch the wound is worth 10,000 more. What if it is not infected? What if the antibiotic is unnecessary and your partner has a severe reaction? The treating physician has the same liability for delay in diagnosis or misdiagnosis in the event of a complication. On the upside, we all believe that access to care should be convenient and affordable but with careful attention to quality.

This type of consultation is so easy in this day and age. We should note that we are especially fond of this type of consultation in conjunction with further dialogue and an office visit. Perhaps you get a picture of that rash at its worst and come in the next day for an office visit. Many of these issues are not new, and we have been dealing with the same issues in regards to the telephone for a long time. The challenges and opportunities are evolving.

HOUSE Calls is a weekly column by Dr. Adam Goldstein, Dr. Cristy Page, and Dr. Adam Zolotor on behalf of YOUR HEALTH™ and the UNC Department of Family Medicine.

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