Laugh it up

TelaDoc, which provides telephone consults to patients 24x7, was profiled in yesterday's Los Angeles Times. Patients pay $35 per call, plus an $18 registration fee and $4.25 per month membership fee. Patients are guaranteed to receive a call back from a doctor within 3 hours.Clearly a lot of thought has been put into this model. The fees are reasonable, especially considering that typical office visit co-pays are within striking distance of the $35/call fee. The company is striving for the right balance between physician accessibility and capacity utilization. Previous concepts that put a doctor on the phone right away were too costly. A three hour window seems about right. If it's more urgent than that the patient shouldn't use the service anyway.The downside is that patients don't interact with their own doctor and that the doctor is limited in what he or she can discern over the phone. TelaDoc physicians will make referrals to local doctors when appropriate.Not surprisingly, the medical establishment (AMA, American Academy of Family Physicians, etc.) opposes the service. A USC professor calls the service "unethical" and says, "This is laughable." I disagree. There's a role for this service, along with other remote services such as doctor/patient web-based messaging and remote monitoring. It's a complement to existing services, not a replacement.I hope competition from TelaDoc causes more practices to respond with same-day appointment availability.