Prescription on phone

Practice that relies on e-mail and calls makes it easy and less time-consuming for patients in the US


For Alan Dappen, practising medicine had become an exercise in frustration. Hamstrung by limits on the time he could spend with patients, confronted by monthly reports documenting the number of visits he had billed, and beset by insurers' increasingly skimpy payments, the board-certified family practitioner figured there had to be a better way.

So did Robert Wickham. The 56-year-old bank executive said he found visits to his family doctor a burdensome and often unnecessary chore that consumed a valuable chunk of his workday.

Earlier this year, after Dappen left a large medical group to launch Doctokr ("Doc Talker") Family Medicine, a solo practice that relies heavily on telephone and e-mail communication, Wickham became one of his first patients. In the past six months he has used Dappen's services three times without having to schedule any office visits.

"He diagnosed and prescribed quickly, and he's saved me loads and loads of time," said Wickham, who deposited $150 in a prepaid Doctokr account shortly after it opened in January. Each of his calls to Dappen — for a lingering cough, a rash and an infection — cost about $35 in telephone time and were covered by his initial payment. The balance can also be applied toward an office visit and e-mail consultations.

For the cough and rash, Dappen prescribed medicines for Wickham and called in prescriptions. He sent Wickham to a lab for a test to diagnose the infection, then called him with the results.

To Dappen, 51, scrapping office visits for routine problems and being available to talk with patients directly is "more efficient, less expensive and more personal" than the typical arrangement in which, he noted, "the last person you get to talk to is the doctor". He estimates that 70 per cent of the calls he receives are for conditions that can be handled over the phone, without an office visit. Dappen also sees patients at their homes or at a medical office he leases on a limited schedule. "I'm available 24/7," he said.

The goal of most doctors, he said, is to funnel patients into their offices, because those visits, unlike most telephone and e-mail communication, are reimbursable by insurers. Dappen said his practice is different: He does not participate with insurance plans and bills for his time and expertise, "like a lawyer or accountant". His telephone charge is $5 per minute, and the average cost of his services is roughly $30 — "not much more than a co-pay", he said.

Patients' records are stored in his laptop computer, that is protected by a firewall; only he has access to medical records, he added. He carries a cell phone that alerts him to his answering service.

While Dappen insists that he is streamlining care, some other physicians express concerns about his approach. While they applaud his efforts to forge a new, more responsive model of medical practice, they are leery about some of his methods — particularly his reliance on telephone contact.

"It's obvious that the current system is dysfunctional — patients hate it and doctors hate it — or this kind of thing wouldn't be happening now," said Jim Martin, a San Antonio family physician who is president of the 94,000-member American Academy of Family Practice.

Martin said that one drawback to Dappen's approach is its reliance on patients' descriptions of what's wrong, which may not be accurate.

©Los Angeles Times-Washington Post News Service