Reach Out and Cure Someone

By ANDREW PURVIS

Ah, the conveniences of the electronic age! At a time when everything from diaper and sushi deliveries to kinky romantic trysts can be had with a few touch tones, yet another novel entry has arrived in this vibrant market-by- wire. Why spend hours traveling to the doctor's office, leafing through out-of-date magazines, waiting for the healer to spare a moment of precious, not to mention expensive time, when one can now get instant medical gratification over the phone? Why not simply dial a doc?

That is the proposition being promoted on freeway billboards, along train platforms and in newspapers around New York City this summer. The ads tout a unique new 900-number service called Doctors by Phone, which provides professional medical advice for $3 a minute. Similar campaigns are scheduled to appear next month in Los Angeles, Miami and Chicago, among other cities. But the program has already drawn fierce criticism. Says Philip Boyle, an ethicist at the Hastings Center in Briarcliff Manor, N.Y.: "There is just no substitute for the clinical encounter. They are selling something that they cannot provide."

The service certainly could soothe a sore spot. American physicians are notoriously hard to reach, leaving thousands of patients frustrated by their inability to get answers to basic medical questions. In addition, asserts Dr. Thomas Kovachevich, 49, founder of Doctors by Phone, patients often hesitate to bother their busy doctors with problems that seem too trivial or embarrassing. Kovachevich, an adjunct assistant professor of family medicine at the Chicago Osteopathic Medical Center, points to a class of relatively simple medical queries that can be addressed quickly and effectively over the telephone. These range from deciding which specialist to consult to interpreting blood tests and probing the obscure side effects of a particular medication. More ticklish questions may be easier to ask of an anonymous voice. Some of the more common problems raised in the thousands of calls received during the past month: "The condom broke. Do I need an AIDS test?" Not necessarily. "I can't perform sexually. Could it be related to my medication?" Yes, depending on the drug.

Since 900 numbers are perhaps better known for personalized horoscopes and phone sex than serious subjects like medical care, Kovachevich has taken pains to underscore the respectability of his operation. To avoid obvious conflicts of interest, he does not allow his doctors to see the patients they talk to (all referrals are made to the New York County Medical Society), and his staff cannot prescribe medications over the phone. Such caution is also a hedge against malpractice suits. Although the service is fully insured, some courts have been critical of care delivered by telephone.

Most of the 80 physicians taking calls are recent graduates of leading medical schools in the New York City area, usually hospital residents still in training, most of them seeking extra income to pay off student loans. A few of the doctors are retired. The pay is comparable with that offered to entry- level emergency room attendants (about $40 an hour), and the work, some feel, is more rewarding. Says Dr. Neil Stollman, 28, a senior resident in internal medicine at Columbia-Presbyterian Medical Center who has manned the phones on and off for Kovachevich since June: "In the emergency room, I would often get this kind of call. Just a simple question. But meanwhile two people are dying. I just didn't have time to talk. This gives me the opportunity to focus on a patient." Kovachevich predicts a new era of "information doctors" who specialize in caring for people by wire alone.

Critics of remote-control medicine say communicating by phone may be a reasonable way to diagnose a problem with a car, but not to understand the intricacies of human disease. Dr. Daniel Isaacman, a pediatrician at Pittsburgh's Childrens Hospital who has examined the question of remote diagnosis, cites a study in which 61 emergency-room doctors were contacted by phone and presented with the same hypothetical patient, a baby boy with a 102 degrees fever. For a child under two months, such a fever can signal a life- threatening infection. Nearly 30% of doctors responding did not ask the child's age and so failed to recommend that the youngster even come in for an exam. Richard Kessel, executive director of New York State's Consumer Protection Board, which is looking into the service, notes that patients may be spending money on what they think is a final answer, when "many will still have to go to a doctor and pay additional bills." Kovachevich says that about 75% of calls are indeed referred to other doctors.

A serious concern of physicians is that if 900 services catch on, they will deter patients from establishing a rapport with their family doctor and cause them to miss out on vital ongoing preventive advice. "A cornerstone of good medical care is continuity and getting to know a patient as an individual," explains Isaacman. "This service is going to discourage that kind of care and encourage patients to seek a quick, temporary fix."

Several medical societies, including the American Medical Association, are studying the 900 idea, but they have yet to come to any conclusions about its usefulness or safety. For now, it seems, patients would be wise to think carefully before dialing -- and get a stopwatch. At $3 a minute, or $180 an hour, the bill itself could trigger cardiac symptoms too grave for any phone doctor to resolve.