Anna Monteleone’s Fourth of July getaway was just days away when her 10-month-old daughter started acting funny. Monteleone worried it was an ear infection, but getting to a doctor after work would be near impossible. “[Early evening] is the worst time ever for kids trying to get to the pediatrician,” says Monteleone, 38, who lives in New York City.
So she called got a doctor to come to her kid instead using Pager, an app that sends doctors to patients’ homes and provides other telemedicine services. “They came and they checked her ears, and there was nothing wrong,” recalls Monteleone, whose friend works for the company. She was relieved the family could then proceed on their trip antibiotic- and worry-free. “It was a huge time-saving service,” says Monteleone, who has since used the app once more for both of her daughters.
Pager, which is available in New York City and San Francisco, is one of several emerging smartphone applications that aim to provide consumers with prompt, high-quality care by merging the old-fashioned house call with modern technology. Others include Heal, which caters to patients in a growing number of cities in California, and Medicast, which partners with health systems throughout California and Miami and plans to offer house calls in Seattle, New York and Nashville, Tennessee, by summer, says Sam Zebarjadi, the company’s co-founder and CEO.
“It’s just another way of getting care that’s not within the four walls of the health care facility,” says Zebarjadi, who was inspired to create the app after waiting four hours in an urgent care clinic on New Year’s Eve for a four-minute visit that stung him with a $780 bill. “It’s supposed to give you the same level of access and the same level of care that you would otherwise get.” As Dr. Renee Dua, co-founder of Heal, puts it, her app should make it “as easy to see a doctor as it is to order a pizza.”
For Monteleone, using Pager was pretty close to dialing Domino’s. She simply downloaded the (free) app, filled out profile information, answered questions about her baby’s condition and waited for the doctor to arrive. She paid via the app, which provides the cost of the visit upfront, and communicated with the physician through it before and after the visit. Though she hasn’t used Pager for herself yet, she says she “totally” would should the need arise.
“It’s a huge time-saver when you’re in a bind and you need someone to come and you can’t get to your pediatrician’s office or your own doctor,” Monteleone says. A bonus? Her girls don’t have to change out of their pajamas when examined early in the morning.
Experts agree that the technologies fill an important void in health care. “There’s a lot of patients and families out there who have urgent problems, and they don’t know how to get access to fast, qualified, good customer service medical care when they want it,” says Dr. K Eric De Jonge, president-elect of the American Academy of Home Care Medicine who makes (app-free) house calls in the District of Columbia.
What’s more, requesting a doctor through your phone is often cheaper than visiting an urgent care clinic or going to the emergency room, says Dr. Jay Sanders, CEO of The Global Telemedicine Group, a health care management consulting firm. The median cost of an ER visit is $1,233, according to a 2013 study in Plos One. By contrast, Pager charges a flat fee of $200 for a visit that includes on-site testing, treatments and one dose of most prescriptions. Heal accepts some insurance and charges people without it $99 for a home visit. Since Medicast works through existing health systems, the cost for a home visit through the app is up to the system.
“You don’t have to pay an arm and a leg for direct-to-consumer service,” Zebarjadi says. “Your health system might actually provide services like house calls or telemedicine; insurance may even cover it.”
But there’s more to health care than cost, says Dr. Ernest Brown, a family medicine physician in the District of Columbia whose independent practice has been entirely house calls for almost 10 years. “Providing medical care should not put a price on care that competes with the urgent care model,” he says. “This will only lead to more mistakes and poorer care.”
Brown, who has treated three patients after they were misdiagnosed by clinicians from Uber-like medical apps, warns that the providers summoned by apps aren’t always trained in making house calls. He also worries that the products don’t support long-term doctor-patient relationships and that they are driven more by monetary interests than patient care. “I understand consumerism — you want what you want when you want it,” says Brown, who has developed a house call service that aims to empower both doctors and patients. “[But] it’s not like they’re buying a pair of shoes. It’s just not that simple.”
That’s why it’s important to know what you’re getting into before “ordering” a doctor via a touch screen. Here are five expert tips:
1. Do your research.
Not all house call doctor apps are created equal. The technologies differ in terms of how and how much they charge, the types of clinicians they recruit and the services they offer. For example, some offer primary care services like annual physicals and flu shots, and others can connect you to psychological counseling or lactation consultants. “Doing a little bit of research beforehand and knowing the options, the lowest-cost options and the [most] convenient options is always smart,” Zebarjadi says. If you wait until you need the care to look into it, you may choose a less-than-ideal option out of desperation, he says.
2. Do a background check.
While Heal doesn’t provide ways to rate physicians like Uber riders can rate their drivers, “prospective patients can research a Heal doctor as they would any other doctor before making an appointment,” says Tracey Koblick, a spokeswoman for the company. Checking into clinicians’ backgrounds is a good idea, De Jonge says. For urgent care visits, doctors trained in emergency medicine, family medicine and primary care are probably the best, he says. They should also have board certifications from “credible medical schools and residencies in the U.S.,” he adds. When they treat you, look for “compassionate and skillful care” from professionals who listen well and will provide follow-up care, De Jonge suggests.
3. Know the difference between “urgent” and “emergency.”
A video chat, online form or phone call can’t always distinguish between an emergency and nonemergency situation, De Jonge says. That’s why it’s important for consumers to know the difference — and only use an app for home-based care if the problem can wait an hour or two. If it needs immediate attention, call 911 or go to an emergency room.
4. Have a long-term plan.
“A lot of problems that are urgent are part of a long-term serious illness,” De Jonge says. Shortness of breath, for instance, may be a symptom of congestive heart failure, a chronic condition. That’s why “it’s important for [the clinician] to have good information about the prior history and prior records of the patient to help them do a god job,” De Jonge says. It’s also important that the service offers a way to follow up or coordinate with your current provider in case, for instance, you have a reaction to a prescription. Heal, for one, gives patients free, online access to notes about their visits, while Medicast works directly within a patient’s existing health care system.
5. Don’t ditch primary care.
Experts have mixed opinions about whether such apps will support or deter patients from seeking primary care, but there’s no question that doing so is important. So is traditional health care, Sanders says. “[Telemedicine technology] is not meant to be a substitute for,” he says, “it’s meant to be in addition to.”
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Your Doctor Is Arriving Now originally appeared on usnews.com
