A Doctor’s Visit Without the Cold Stethoscope

It can take weeks to get a doctor’s appointment and visiting the emergency room for a curious, but not so serious, ailment can be costly. Now, new services are linking patients to doctors via phone or video chat for advice about common medical conditions.

These telemedicine websites let people pose questions to a licensed doctor, paying $10 to $40. Some services offer free follow-ups and referrals as part of a more comprehensive treatment. We tested four services and asked questions on behalf of family and friends about health issues that didn’t require an urgent trip to the doctor. These included swimmer’s rash, an ingrown toenail and a pain above the eye. We didn’t wait more than a day to get responses, but the quality of service varied significantly.

People typically use the services to supplement traditional doctor visits, since many of the doctors used by the sites aren’t licensed to practice in every state. “There’s a difference between advice and treatment,” says Lyle Berkowitz, medical director of information technology and innovation at Northwestern Memorial Hospital’s primary care group in Chicago.

The sites have drawbacks. For example, most doctors won’t have a grasp of a patient’s medical history, Dr. Berkowitz, says, but they can be convenient for a quick consultation.

Only two of the services we tested could offer prescription services because they used doctors licensed in the patient’s home state. (Some drugs cannot be prescribed online or by phone.) Typically, users with health savings accounts can use them to recoup telemedicine costs, and insurers in some states may cover submitted claims, say the companies.

At Healthcaremagic.com, we asked our question of a general medicine physician for $9.99 (a specialist was $25). After registering, we posted a question on the site about a rash we got on a Mexico vacation and uploaded a photo. After three hours, an India-based physician provided a thorough answer of how to treat what he thought was likely a parasite infection from the ocean. The doctor said to treat it with over-the-counter medications and suggested a visit to a traditional doctor to get an antibiotics prescription. (The company doesn’t provide prescriptions.)

At a dermatologist’s office a few weeks later, we were told it was a discoloration of skin when it comes into contact with lime juice in the sun and it would clear up on its own, which it did. “We get very few questions related to misdiagnosis,” said Chief Executive Kunal Singha of the Bangalore, India, company, in an email.

Patients can ask two free follow-up questions within three days of the answer (for specialists, there are three free follow-ups). We could view the credentials of the responding physician. The site, which does much of its business through corporate accounts, has over 3,500 physicians from 10 countries, says Mr. Singha.

At InteractiveMD.com, the registration process took the longest because we had to answer a survey about our medical history. The service’s fees and $40 per appointment made it about twice the cost of the others. After logging in at night, we booked an appointment to talk to a doctor over the phone about an ingrown toenail for the morning. Our doctor didn’t call at the appointment time. When we called customer service to reschedule for later in the evening, we still didn’t receive a call. We finally spoke with a physician the following day. “It’s a brand-new technology and it’s a brand-new bedside manner for them,” says Jesse Kessler, chief executive at InteractiveMD, a division of iCan Group, in Boca Raton, Fla. Most users book the first available appointment with an average waiting time of 45 minutes, he adds.

We liked speaking to the doctor by phone, and during our eight-minute call the doctor answered all of our follow-up questions and offered a referral to a local podiatrist. Prescriptions are available. The site also offers video chats, but over 80% of users choose to speak to the doctor by phone, Mr. Kessler estimates.

For Palo Alto, Calif.-based Healthtap.com, which launched its site last year, popular topics include women’s health, pediatrics, hypertension, diabetes and allergies, says Chief Executive Ron Gutman. Healthtap.com, which is free, was our favorite. Signing up and posting our question (which needs to be 150 characters or less) to a forum of doctors was quick. Within 30 minutes, we had two responses about potential causes of a headache near our temple; a third doctor agreed with one response. When clicking on the links to both U.S.-based doctors, we were able to see their impressive credentials.

The site works by engaging doctors to answer questions with an average of four weighing in on each answer, says Mr. Gutman. Doctors who weigh in are often located near the user’s location, which enables physicians to market themselves and build their practice’s clientele. People who want more detailed information can pay $9.99 for private consultation or schedule an in-person appointment.

We tried to ask San Francisco-based Ringadoc about dealing with water retention in hot weather, but the service couldn’t instantly connect us to a doctor as promised on the website. We tried the service twice and waited on hold on the phone. When we spoke to Jordan Michaels, Ringadoc’s founder, he said the site was still in beta testing and was only fully up and running in California. And since the doctors need to be licensed in the same state as the patient for a more comprehensive diagnosis and prescription rights, Mr. Michaels says, the available California doctors couldn’t pick up our call from Illinois. Ringadoc will be available in at least 20 states next year, he says.

A version of this article appeared August 7, 2012, on page D5 in the U.S. edition of The Wall Street Journal, with the headline: A Doctor’s Visit Without the Cold Stethoscope.

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