Last night I talked to my friend, a medical resident at an elite urban hospital. She called me on her walk home after a stressful day in the general medical wards. She had 17 patients with a wide range of problems: heart failure, emphysema, HIV, alcohol withdrawal, diabetes complications, even a man who had swallowed a handful of razor blades.
The last time we had talked, a month ago, she was working in the cardiac intensive care unit. That week she was juggling five patients, all with heart failure. She was literally running from one to the next to slow down the inevitable: They were all going to die soon, it was just a matter of when and how painfully. She was torn up by the thought, irrational but powerful, that every one of her decisions could cause one of them to die. (None did.)
Healthcare resources in the U.S. are getting thinner every day, and not only at big hospitals. Many forecasts predict a doctor shortage in the years to come. As one small sign of this sea change, last year my health insurer sent me an email recommending NowClinic, a website that connects you to a doctor with a webcam, ichat or phone. “Instead of making a trip to the clinic every time you’re sick, this service allows you to describe your symptoms to a doctor in real-time,” the email read. “The physician can then write you a prescription on the spot and have it filled at your choice of pharmacy.”
At first I was skeptical of the concept. I thought it sounded like a glorified WebMD and would ultimately be an ineffective way of cutting costs. How could a Skype chat be anything like the long-term, in-person relationship you have with your doctor?
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