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Dr. Jeff Kane: Online docs

Jeff Kane

Telemedicine has been around awhile as a service to inaccessible patients and for some emergencies. Innovators are now unveiling the next logical advance, standard medical care via the internet.

GoodRx.com, a drug discounter I mentioned in a previous column, has now brought forth GoodRx Care, which will have a remote doctor consult with you for $49 or, if you’ve purchased Gold membership, $19. Its services include treatments for common ailments, prescription refills, and testing.

It’ll be popular, and for good reasons. When I have bronchitis, I’d rather spend $49 plus a prescription than pay the $200-700 my local urgent care or ER would charge. And I could take care of it now instead of waiting to see my regular doc, who’s full up till next Easter. And think of what I’ll save on gas.

This approach will usually suffice for simple problems. If I’m sick with something serious, though, there are elements no Zooming can heal. “Something serious” means when I’m suffering disturbing emotions along with my symptoms. Confronting cancer or congestive heart failure, I’m more distressed than with hay fever. In that case I’d want to see a doc in person. I’ll find online prescriptions useful, but the compassion, perspective, and guidance of actual physical presence are necessary.

Not so long ago, actual touch was the heart of healthcare. An exam began with a careful history, which in medical school consisted of three pages (in cursive!), followed by a physical, divided into observation, auscultation (listening to the body’s sounds), palpation (exploring by feeling), and percussion (tapping with fingers for rebound tones).

None of those disciplines are available online. Observation and auscultation via Zoom are necessarily cursory, and palpation and percussion impossible. Of course, their precision is horse-and-buggy compared to MRIs and PET scans. So for much of what patients present with, online contact can suffice, but what’s the tradeoff? What does online medicine miss?

I’m hearing from an increasing number of friends that they’re considering leaving their current primary doctor. Their most common complaint isn’t any deficit of medical acumen, but of relationship. For most of us, well-being necessitates personal, intimate contact, not its antithesis — clinical detachment, poor communication, rushed appointments, and absence of touch. My friends’ criticisms having arisen in live meetings, there’s no reason to expect virtual meetings to be more personable.

I’ve long lamented that as healthcare’s glamorous hardware evolves, its software — its personal, no-tech aspect — seems to atrophy. Ultimately distant transactions, robots, artificial intelligence, and, finally, vending machines may provide a kind of healthcare we’d consider scientific, but will always be incapable of providing its essence, compassion. So see Docs Online if you must, but please keep in mind what it can’t offer: reassuring companionship, depth and continuity, and a comforting hand.

Jeff Kane is a physician and writer in Nevada City.

Telemedicine has been around awhile as a service to inaccessible patients and for some emergencies. Innovators are now unveiling the next logical advance, standard medical care via the internet.
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