In keeping with his enthusiasm for new doctoring platforms, he was among the first to jump on board when Prime launched. When he can spare the time, he picks up a shift, during which he generally hears from a handful of patients. He can log in from anywhere, has to do almost none of the bureaucratic paperwork that burns physicians out, and gets to meet and help interesting people in that predictable, finite, and instantly gratifying way that typifies Internet interactions.
I wanted to experience a HealthTap consultation from a patient’s perspective, so I waited for something to happen to me. The editor of this magazine suggested I get myself punched in the face. I turned that over in my mind. Luckily, my throat started to feel scratchy. The next morning, it was legitimately sore. Jackpot.
“Would you like to speak with a doctor?,” HealthTap prompted. Yes. “Is this an emergency?” No. Next, the site allotted me 150 characters to explain my problem: “Sore throat for two days, getting worse, no other symptoms.”
Within 30 seconds, I was in the virtual presence of Dr. Vicken Poochikian. He was bespectacled and white-haired, sitting in front of a painting in what may have been his home or office. He wore a sweater over his collared shirt, and a white coat over that. He must have been someplace colder than where I was.
Pleasantries were brief.
“Are your bowels doing okay?” he asked. Doctors are trained to ask these all-encompassing questions as part of a traditional examination, even if the patient clearly states that he has no other symptoms.
“Do you have coughing?”
And so on, until Poochikian was satisfied that I indeed had no other symptoms. I inquired about antibiotics (knowing that they weren’t yet medically warranted); he said it was too soon. I was ready to shine a flashlight in my mouth and lean over my computer’s camera, but I wasn’t asked to do so. He suggested that I stay hydrated, take it easy, and call back in a couple of days if I wasn’t feeling better. Immediately after we disconnected, he documented our encounter for a record that will follow me through future HealthTap visits. His notes were to the point, in sharp contrast to the tedious documentation required in most electronic-medical-record systems. His account of my exam, in its entirety, read: “Common cold symptoms. On video he didn’t really look sick or in any distress.”
This cursory exam is emblematic of a larger trend in medicine: physical examination has become less central to diagnosis than it once was. To some extent, this is because of increased reliance on tests and imaging. Doctors are less and less concerned with honing their stethoscope skills, because echocardiograms are readily available. Tapping on a sore stomach tells a doctor something, but rarely as much as a CT scan does. And to some extent, this change has been a matter of necessity. The average medical appointment now allows a doctor little time to interrogate or thoroughly examine a person, or really get to know him.