Doc in A Box, Your New Primary Care Physician

Pharmacies, CVS, Walmart, are betting that, in the future, you will look to them for your primary care. It certainly won’t look like the kind of care your mother got.  You won’t have a doctor.  You’ll walk up to a telemedicine console and visit with someone you don’t know. You’ll put on your own blood pressure cuff, through the machine, and maybe someone will listen to your heart. Various devices will be attached and you will take readings as requested by the machine. If you are lucky, a pharmacist will be there, working with a nurse practitioner, and maybe they can help you; maybe you’ll be able to get a limited physical exam.

The good news is the cost will be about $89, or even less.  You can use it to get a prescription if you’re sick, get a vaccination, and/or talk to someone if you need a referral.  Insurance has not worked out all the details about co-pays or co-insurance payments. Only recently does CMS reimburse doctors for telemedicine visits.  You can walk up anytime; no appointment necessary.  If you do something simple, like sprain your ankle, you can pick up an ace bandage, a brace, or a boot in the pharmacy.

There are other things that haven’t been worked out. Who do you call if there is a complication?  I you don’t improve, where do you go?   Do you go back to the machine, pay another $89, video chat with somebody else. Is that repeat visit free? Are you referred to an Urgent Care facility, ER?  What will that referral look like?  Will it be a person or a machine? Can they give referrals at all?  For example, if they provide scripts redeemable at their own pharmacies, is that what is known as a Stark Violation, an interested referral with a profit motive, therefore illegal?

It also seems a bit confusing.  Who will check your hearing, your eyes, your reflexes?  Are you going to step into some kind of machine to get a physical? If you need it, how are you going to have your blood drawn?   Will you have to go to a lab for your basic tests?  Will there be a facility on site? Who will give you the results of your tests and explain to you what they mean? If you need more serious attention, how will the follow up be done?  Who will do it?  Will there be any follow up at all or is this all Urgent Care all the time, except with a machine?  How will you get your records?  Will you have some kind of relationship with the pharmacy, instead, so that the pharmacy will be responsible for tracking your results in the same way a primary care doctor keeps track of your medical history and follows your medical issues?

The other confusing part is how the person you speak to will have access to your medical records and your history. Right now your records are not generally available.  Since the consulting physician doesn’t know you and doesn’t have your records, he will have to rely exclusively on what you tell him. People are notoriously bad at remembering their exact medical history.  People don’t generally remember things like the specific names of medications they are taking and the dosages, when, exactly, they had surgery, if they have weak lungs, how many times they have had pneumonia, what specifically they might be allergic to, etc.  The pharmacy may have your medications on record, but maybe not, and the records are not integrated with the telemedicine system because they are not part of the same medical service.   Without access to your medical records, an accurate medical history, it becomes difficult to treat you and errors are likely to be made.  All this remains to be worked out.  Someday, you may carry around your own medical history, just like you carry around your phone.

It’s a brave new world. Technology has revolutionized how we live our lives.  Now it is changing the way medicine will be practiced.

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