Dr. Cayce C. Tangeman, a MyMD member physician, talks with patients using the service's video conferencing feature. One evening recently, Kristi Moore was worried that her asthmatic daughter had strep throat, and she wanted a doctor's opinion. So she grabbed her iSight camera and a flashlight, got her daughter to open her mouth wide and sent live video of her throat over the internet to an on-call doctor she had found online.
After looking at the images, the doctor decided that the young girl was suffering from a harmless postnasal drip, and she only needed some allergy medication.
Moore and her family, who live in Woodstock, Georgia, are pilot participants in a new program from MyMD, an online concierge medical service that offers access to on-call doctors 24 hours a day.
In the past, the company's doctors had talked with patients over the phone, but now MyMD is giving 1,000 of its top member doctors iBooks and iSight cameras, hoping they will be able to do some of their consulting via video conference.
"I think it made her feel better that she could chat with him in person, rather than over the phone," said Moore of her daughter's experience using the MyMD program. "When you have children and have to pack them up in the middle of the night, I wouldn't have been happy to find out it was just postnasal drip. So it was really fantastic."
As the traditional model of health care continues to become unwieldy, with some patients enduring long waits to see a doctor for a few minutes, concierge practices are becoming more common. Some doctors are reducing the size of their practices in order to be available, on call, to concierge patients. With minor issues, much of the consulting can be done over the phone.
But now, MyMD is hoping to lead the way toward video conferencing as an integral part of such services, and because of the relatively low cost and high quality of cameras like Apple Computer's iSight -- around $130 -- the company is hoping many of its customers will also be able to purchase them.
"I have worked with a number of telemedicine trials with dedicated equipment that cost tens of thousands of dollars per workstation, but have never seen the quality of the Mac video conferencing, especially at such an incredibly low price," said one doctor in the MyMD program.
Patients don't have to buy new cameras and laptops. The service also works on Windows PCs using inexpensive webcams or camcorders, and AOL's instant messaging service. Cheap USB webcams don't deliver the iSight's high-quality picture, but they still get the job done.
(It's) "being able to see the patient and being able to get a sense of their emotional state, and whether they're in physical pain," said John Blanchard, one of MyMD's member doctors. "Clearly, there's no replacement for being in the room with the patient, but this is an application that can bring technology to health care."
Michael Chalkley, MyMD's CEO, said he sees the video conferencing service as a supplement to a normal health care regimen -- not a replacement. And he said that for its relatively low fee -- $4 a minute, or $50 for 15 minutes, the service is cheap enough to be useful when patients need advice on something they feel confident is a minor concern.
The company offers two tiers of service. The basic service is anonymous, but MyMD's premium eConsult Housecall service requires patients to submit medical records and take blood tests. Then, whenever they call, their records are available to any doctor they speak with.
Chalkley said there are many benefits to the company's doctors -- and to the patients. For example, he said, carrying a laptop and camera allows the doctors to be just about anywhere and still be on call. Similarly, he said, patients can be sure they have access to a doctor at a moment's notice, no matter where they are in the world.
"Imagine the nightmare -- if you don't speak Japanese -- of trying to find a doctor to talk to in Japan at 3 a.m.," he said.
Joel Klompus, a San Francisco doctor not affiliated with MyMD, said it clearly wasn't appropriate to use video conferencing for many medical situations -- emergencies especially. But for minor medical concerns, the method can be valuable.
"Body language and facial expressions and expressions of pain ... would come across a lot better on video than they would over a telephone," he said. "I do think there are some risks (to doing video consulting) and it would have to be managed.... I think it's certainly learnable."
Meanwhile, medicine is not the only field in which inexpensive but high-quality video cameras like Apple's iSight can be a useful communications tool.
Jason Ediger, an educator in the Orange County, California, department of education, has created an educational portal for iSightEd, where teachers and students from around the world who use iSights can work together on various projects.
For example, in Kansas, one school's students use iSight cameras to broadcast images of migrating monarch butterflies to viewers all other the world. In another case, students at a school on Martha's Vineyard communicate with those from other schools to practice speaking Spanish.
"It's a neat way to bring experiences and experts to kids that they wouldn't have access to otherwise," said Ediger. "The coolest thing for me is just seeing the innovation that educators bring to this. People are using this in ways we wouldn't have thought of before."
Calvin Floyd, a MyMD customer, would likely agree. The owner of a rural Georgia hunting lodge, Floyd not long ago used his iSight to help out a customer who thought he'd been attacked by ticks. They filmed the man's leg and, from the images, the doctor at the other end determined the man was only suffering from poison ivy.
"I think it's going to be good for us," said Floyd of being able to offer instant medical advice to his hunting clients. "An online doctor is kind of new to a lot of people, and they feel more secure when they can look and see a doctor is talking to them."
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