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Opinion: Losing Touch With Patients

continued...

True, this is perhaps an extreme example. But even on a more mundane level, just calling in a medication doesn't allow the opportunity for discussion and education. I am not here just to tell you, the patient, what medication you should take; I am also here to teach you about your disease, in this case high blood pressure, and present you information on the many possible therapies.

Most of the treatments will center around medications, but not exclusively. In fact, much of high blood pressure can be controlled with improved diet and regular exercise, although this method is not for everyone. Any treatment can take time, and first and foremost, it is important to get blood pressure under control. So I advocate starting on medicine, and backing off then if other treatment factors demonstrate their effectiveness.

Once again, though, I can't have that discussion or properly teach my patients without face to face contact.

In addition, all medicines have side-effects. The higher the dose, or the greater the number of medications, the greater the number of side-effects. In today's rushed office environment, I may only have time to discuss the major, and most common, side-effects. But you may not experience the classic side-effects. You may experience subtle symptoms that are related to the medication. You may have a different opinion about the drug because of the experiences of a spouse or parent. You may have questions or you may not even know what questions to ask. An experienced doctor can elicit questions from you that you may not have known you wanted to ask. Again, this is best done face to face where you and your doctor have the advantage of body language as well.

Another perhaps less important, but practical issue nonetheless, concerns payment of services. In the current clime of healthcare, a doctor is only paid -- or can submit a bill to an insurance company -- if they actually see and interact with the patient. Encouraging phone medicine and or practice via the Internet further increases the amount of unreimbursed services a doctor is expected to provide. This may not immediately concern you, but as a patient, over time, this problem could make it less and less likely that quality will be adequately maintained.

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