Has defensive medicine diminished the role telephone medicine?

The most recent story in the defensive medicine series led to the following comment:

Why would a physician even consider prescribing anything other than say, birth control, over the phone? That doesn’t sound like defensive medicine, it sounds like common sense.

This begs the question: Are there any diseases that can be treated over the phone?

The answer is yes. Go to your local drug store, and you will find many OTC medications that patients can simply pick up without even talking to a physician. Prilosec OTC for GERD or Claritin for allergic rhinitis. Both of these medications used to be prescription-only.

In the UK, antibacterial eyedrops for conjunctivitis and statins for hypercholesterolemia are now being sold OTC, further examples where patients can self-diagnose without a physician visit.

How about a UTI? Studies have shown that a history alone (without physical exam or laboratory testing) can diagnose some 90 percent of cases.

Do you call a physician every time you have a headache? Most would simply take a Tylenol and call it a day. Today, if you call a doctor about a headache, there is a good chance you’ll be told to come in for an office visit and walk out with an order for a head CT.

So no, not every complaint needs to be seen. Back when defensive medicine was less prevalent, many of these minor complaints could be treated over the phone. Patients were happy at the convenience. Physicians were happy because they did not drive up the cost of health care with unnecessary office visits. Emergency rooms were happy because they were not deluged with minor, non-emergent issues.

This scenario no longer exists today. Defensive medicine has diminished the role telephone medicine. Every patient needs to be seen without exception. After-hours, patients are directed to the emergency room for every complaint, further promoting ER overcrowding. Any refusal is documented in the chart. The consequences of not doing so are too great.

By the way, the comment above eluded to the “safety” of prescribing birth control over the phone. Try prescribing an oral contraceptive to a women with an unbeknownst elevated level of antiphospholipid antibodies over the phone. Note the pulmonary embolus that she received from her 2.3 times increased risk of venous thromboembolism. See the physician who prescribed the oral contraceptive over the phone get sued.

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