Visiting the Doctor, Virtually

By ANN CARRNS

We’ve all wished at times that we could just chat with a doctor from our office, instead of taking time away from work to drive to the clinic. Now, a case study of medical care delivered online suggests that virtual visits can effectively treat some common ailments at a lower cost than in-person visits.

A report by the creators of the Virtuwell clinic, an online service started by the HealthPartners health care system in Minnesota that has handled roughly 40,000 cases, says that such visits were, on average, $88 less expensive than treatment provided in traditional settings. The visits also saved an estimated 2.5 hours, on average, of patients’ time.

Still, the summary of the clinic’s operations is of interest as the medical world seeks ways to make use of the Internet for patient care. The report says, for instance, that while the retail cost of a Virtuwell visit is $40, some insurance plans cover the visits at a lower co-payment for their members. Roughly 85 percent of Virtuwell visits have involved an insurance claim, the report says; in 2011 Virtuwell was the first online “convenience care” to receive approval for Medicare coverage.

Virtuwell’s Web site, which serves patients in Minnesota, Michigan and Wisconsin, features the slogan, “Sick? Click. Cured.” The service works like this: Patients go to virtuwell.com and answer questions about their symptoms and medical history, any allergies and medications they are taking. (The questionnaire begins by asking, “What do you think you have?” and features a drop down menu listing conditions like acne, flu, deer tick bite and yeast infection. Placing the cursor over the condition reveals a brief description of the symptoms.)

A certified nurse practitioner then reviews the questionnaire and writes a treatment plan − usually within 30 minutes. The patient is notified by text or e-mail when the plan is ready. If a prescription is needed, it is sent electronically to the pharmacy of the patient’s choice.

If they wish, customers may communicate by e-mail or phone to a nurse practitioner, during or after their online visit. Nurse practitioners also initiate calls to patients in about half of the cases, the report said.

The nurses evaluating the information follow well-established clinical guidelines developed by HealthPartners and other Minnesota-based health systems. In the case of a suspected urinary tract infection, for instance, the guidelines state that a low-risk patient with a typical range of symptoms may be safely treated without an in-person exam or laboratory testing. The most common ailments treated by Virtuwell are sinusitis, urinary tract infections, conjunctivitis and viral upper respiratory infections.

Virtuwell does not handle conditions in which the guidelines direct an in-person exam, lab tests or X-rays. Roughly 56,000 patients reporting symptoms outside the service’s scope were referred to in-person providers, the report says. An analysis of antibiotic prescriptions suggests that they are prescribed appropriately by Virtuwell practitioners.

Before such services can be more widely available, however, state laws and regulations must be changed. That includes laws that require doctors or nurses to be in the same state as the patient, and requiring the doctors or nurses to have had a previous face-to-face visit with a patient before treating them remotely.

After reading

Would you use an online service like Virtuwell? Discuss it with your partner.

IV. Speaking Tasks

Role-play

You will be divided into 2 groups: Doctors and Patients. Doctors are given the Doctor's Activity Sheet and the Treatment Cards. Patients are given the Patients Activity Sheet and three Ailment Cards.

Students will	Doctors will
go to the doctor, describe their ailment, get a prescription, and get some advice.	listen to ailments, ask a few questions and then prescribe medicine and give some advice.

For each ailment, the patients will visit two doctors and get some advice and a prescription.

But first you should make a Doctor's Appointment. You will work in pairs: a Receptionist and a Patient. Read the lists of Key Making an Appointment Phrases and Sample Conversations then act your own conversation.

Key Making an Appointment Phrases (Booking a Doctor’s Appointment)

Patient

Receptionist

ü I’d like / I need to make an appointment / to see the doctor. ü The doctor wants to see me again in two week’s time. ü I need to make an appointment for my husband. ü My child needs to come in for a check-up. ü I need to renew my prescription. ü Is there anything open (available).... ü When is the doctor free? ü Do you think the doctor could squeeze us in today? ü Can you tell me what the charge would be for this visit?

ü How may I help you? ü Have you been in before? ü What is your chart number? ü Do you need urgent care? ü What is the appointment regarding? ü Which day / what time is good for you? ü There’s a slot available at … in the morning. ü Is January the 3rd okay with you? ü How does four o’clock sound? ü I’ll pencil you in for …o'clock next … ü I’m sorry the doctor is not taking new patients. ü Dr Jones is away. You’ll be seeing Dr Lee. ü We’ll call you if there are any cancellations. ü We’re running an hour behind schedule. ü How will you be paying for this appointment? ü Do you have health insurance or medical coupons? ü We charge by sliding scale. You will need to bring your last 2 pay-stubs, an ID, and a …$ deposit.

Sample Conversations (Booking a Doctor’s Appointment)

1.

Receptionist:	Good morning, Doctor Jensen’s office. How may I help you?
Patient:	Hello, I’d like to make an appointment to see Doctor Jensen, please.
Receptionist:	Have you been in to see Doctor Jensen before?
Patient:	Yes, I have. I had a physical last year.
Receptionist:	Fine, what is your name?
Patient:	This is Maria Sanchez.
Receptionist:	Thank you Ms Sanchez, let me pull up your file.
Patient:	I haven’t been feeling very well lately.
Receptionist:	Do you need urgent care?
Patient:	No, not necessarily, but I’d like to see the doctor soon.
Receptionist:	Of course, how about next Monday? There’s a slot available at 10 in the morning.
Patient:	I’m afraid I’m working at 10. Is there anything available after three?
Receptionist:	Let me see. Not on Monday, but we have a three o’clock opening next Wednesday. Would you like to come in then?
Patient:	Yes, next Wednesday at three would be great.
Receptionist:	Alright, I’ll pencil you in for three o’clock next Wednesday.
Patient:	Thank you for your help.
Receptionist:	Your welcome. We’ll see you next week. Goodbye.
Patient:	Goodbye.

2.

Receptionist:	Doctor’s office. Jane speaking. How can I help you?
Caller:	I need to make an appointment with Dr. Harris.
Receptionist:	Do you know your chart number?
Caller:	No, sorry. It’s at home and I’m at work right now.
Receptionist:	No problem. What’s your name, please?
Caller:	George Mason.
Receptionist:	Okay Mr Mason. Hold one moment while I grab your chart, please.
Caller:	Sure.
Receptionist:	Thanks for waiting. Now, what do you need to see the doctor about?
Caller:	Well, I’ve been fighting a cold for more than a week, and I think I might have a chest infection or something. My cough is getting worse each day.
Receptionist:	Hmm. Doctor Harris is off tomorrow. Do you think it can wait until Wednesday?
Caller:	Oh, I was really hoping to get in today or tomorrow in case I need some antibiotics. Maybe I’ll have to go to the walk-in-clinic instead.
Receptionist:	Actually, we had a cancellation for 2:00pm today if you can get away from the office.
Caller:	Gee, it’s almost 1:00pm already. I think I can make it if I leave right now.
Receptionist:	We’re running a bit behind schedule, so you can probably count on seeing the doctor around 2:30.
Caller:	That’s great. Thanks for fitting me in.
Receptionist:	No problem, Mr. Mason. We’ll see you in an hour or so.

Patient’s Activity Sheet

You are a patient. Visit your doctor and tell them about your condition. Write down your doctor’s recommendations in the table below. You should “get a second opinion”. Visit two doctors for each ailment.

Doctor’s Name	Medical Condition	Prescription	Prescription Directions	Other Advice
Dr. Jung	rash	ointment	apply three times a day.	Avoid scratching skin. Don’t use soap.
Dr. Brown.	rash	ointment	apply three times daily	Don’t use cosmetics.

Ailment Role Cards

Ailment: You have got high blood pressure Duration: You have had it for 2 months. Previous Medication: You haven’t taking any medication for it.		Ailment:You have got a rash on your arms and legs. Duration: You have had it for about four days. Previous Medication:You have put a cream on it.		Ailment: You have got diarrhoea. Duration: You have had it for three days. Previous Medication:You have taken some pills that you bought at the drugstore, but they didn’t help.
Ailment: You have got the flu.   Duration: Two days.   Previous Medication: You took some aspirin.		Ailment: You sprained your ankle. Duration: You sprained this morning. Previous Medication: You took a painkiller.		Ailment: You have got a sore throat Duration: You have had it for two days. Previous Medication: You have been taking some throat lozenges (throat candies).
Ailment: You have got indigestion. Duration: You have had it for three weeks. Previous Medication: You have been taking some ant-acid but it hasn’t helped.		Ailment: You have got constipation. Duration: You have had it for two weeks. Previous Medication: None.		Ailment: You have got a bad cut. Duration: You cut yourself this morning. Previous Medication: None.
Ailment:You have got a high fever. Duration:You have had it for three days. Previous Medication:You have been taking some febrifuges but it hasn’t helped.		Ailment:You have got a splitting headache. Duration:You have had it for two weeks. Previous Medication:Aspirin.		Ailment:You feel dizzy and nauseous. Duration:You fell down today’s morning and hurt your head. Previous Medication:None.

Doctor’s Activity Sheet

You are a doctor and patients are going to come into your office. Ask them about their condition, prescribe some medicine, and give them some advice.

 

Name	Medical Condition	Duration	Prior Medication	Allergic to Medication? Y/N
Mary	rash	1 week	cream	No

Sample Conversation: Visit to the Doctor

A = Doctor B= Patient A: Hi. Come on in and have a seat. Now what seems to be the problem? B: I have a rash on my arm. A: How long have you had the rash? B: It’s been about a week. A: Are you taking anything for it? B: I put some cream on it but it doesn’t seem to be helping. A: I see. Are you allergic to any medications? B: Not that I know of. A: I’m going to give you a prescription for some ointment. I want you to apply it three times a day. You should also avoid scratching your skin. And it’s important to use as little soap as possible. Make an appointment to see me next week if it doesn’t get better over the next few days.

V. Grammar Check