Should Surgeons Meet Patients Online ?

A New York Times article January 20, 2010 explored the idea of patients initially contacting health care providers online for treatment options and price quotes for treatment. The article focuses on patients with plastic surgery care, a service usually not covered by health insurance and thus paid for on a cash basis.
Here is an excerpt from the article; "You log on to SurgeonHouseCall.com and create a free patient profile declaring your wish to get a tummy tuck. You fill out a brief medical history and include photographs of the problem area.

In no time, three plastic surgeons offer detailed opinions on the best course of action — with price quotes. It’s as if SurgeonHouseCall.com co-opted the LendingTree slogan, “When banks compete, you win."

While I see this model relevant today I see this more likely to become a reality in the future when physicians are competing on price rather than the health insurance plan fixed fee market currently in place. Doctors will compete on price when they opt to drop off insurance plans such as Medicare or Pacificare (just random examples) or when treating people using Health Savings Accounts to pay for their care. In each of these scenarios one would expect treatment plan, the number of tests ordered, and price to matter when choosing a health care provider. This method would allows the patient to "shop" for physician services similar to shopping for a television or appliance because the patient will factor in price just as they do with other purchasing decisions.

Advocates of virtual consultations suggest that convenience and receiving multiple opinions online benefits to a prospective patient. “It changes the first in-person consultation, empowering the patient with knowledge of the procedure, decreased anxiety level and financial readiness”. Patients benefit from a online type of evaluation. They get an idea of the cost, and what you get for that cost before they make a commitment, before they walk through that door to see the physician. It is a way for patients to use the online information exchange with a surgeon for a connection to the physician, his online mannerisms, his thought process and treatment option. This may be one way for patients to choose their care provider in the not to distant future.

Before online patient information exchange becomes main stream important legal issues must be addressed.

Providing a diagnosis to patients across state lines also raises legal issues. The online contact can not be a medical consultation. A patient-doctor relationship is “clearly established and begun when a physician agrees to undertake diagnosis and treatment of the patient, and the patient agrees.” Such a distinction matters, because usually doctors should only be able to care for patients in states where they are licensed. Under any conditions it would be poor practice and foolish to diagnose a patient and outline a treatment plan without seeing the patient face to face.

Paramount in this brave new world is ensuring that patients receive the same standard of care online and in person, said Dr. Chaudhry of the medical board association. “It should be the same exact standard as if the patient was in your examining room. You can’t cut corners.”

I see in the not so distant future a prospective Orthopedic Surgery patient making online contact with several physicians, providing the online doctor with certain generalized facts about their condition (with or without photographs and xray/mri images), and receiving in return several hypothetical diagnoses and cost estimates to treat these conditions. The patient will then review the options and then decide if and when to seek treatment. In this new Online Information Exchange world this patient is empowered with the background knowledge gained from their online communication - this patient will have a more meaningful dialogue with their doctor leading to a better decision for the treatment they may receive.

Fibromyalgia Syndrome: Outcome Following Total Knee Replacement Not As Good As Most Other Patient Groups

According to Wikipedia, fibromyalgia is characterized by chronic widespread pain and allodynia, a heightened and painful response to pressure.[1] Fibromyalgia symptoms are not restricted to pain, leading to the use of the alternative term fibromyalgia syndrome for the condition. Other core symptoms include debilitating fatigue, sleep disturbance, and joint stiffness.

A Mayo Clinic study of 141 Total Knee Replacements done in patients with Fibromyalgia Syndrome concluded that nearly half of the patients reported continued knee pain after replacement surgery (much higher than most other patient groups) and more patients in the study had trouble regaining knee motion. Total Knee Replacement surgery did provide improvements in pain compared to preop levels.

The conclusion is that there is a high prevalance of continued pain and stiffness in Fibromyalgia patients undergoing Total Knee Replacement surgery. The Orthopedic Surgeon should counsel these patients pre-operatively so this sub group of people can make an informed choice as to whether to have this surgery and to align expectations with reality.