"I am a new kind of physician"

Brooklyn MD launches first online practice. Are you ready to go back to the future?

By Graham Lanktree

Online MD Jay Parkinson stands on Brooklyn Bridge Photo credit: Dr Jay Parkinson

"I'm normally at a coffee shop, on the street, or at my house," says 31-year-old New York family doctor Jay Parkinson. No, this gen-Xer isn't slacking off while someone else handles his cases. He's actually describing his 'office.' You see, last month Dr Parkinson opened North America's first fully online practice — www.jayparkinson md.com.

"I don't like to label myself an online doctor," says the doc who's based in the bohemian Williamsburg neighbourhood of Brooklyn, across the East River from Manhattan. He insists his real goal is to bring back a community feeling to the doctor-patient relationship, rather than rushing to see 30-35 patients a day for only a few minutes each. "I see my patients first and then follow up. The whole point is to spend an hour with the patient. It's just that technology is how this happens."

GEAR UP
Instead of a medical assistant, the doctor's sidekick is his new iPhone. Dr Parkinson is clearly a bit of a gear geek. "The video interface of the iPhone integrates excellently with the practice since patients send me pictures, and from just those I can get a lot of information to follow up," he enthuses. He also relies on his iPhone to take calls, look up info online, chat with patients and check their electronic medical records (EMR). He uses the online Life Record EMR but is on the lookout for newer platforms that would allow him to drag and drop photos and video into patients' files.

Like any family doc, Dr Parkinson refers his more complicated cases to specialist colleagues. "One young patient I saw recently had VPH and I had to recommend he see a urologist," he says. The difference is that his database of the best New York specialists also includes those with the cheapest fees.

His service targets patients between the ages of 18-39 who don't have traditional health insurance. "I'm just trying to give this age group basic services, many of them don't have insurance and can't afford the high prices," he says.

EARNING POTENTIAL
So the gear's impressive — but does online medicine pay? "I can make a really good living seeing five, or at most eight, patients a day," he says. For $500 a year Dr Parkinson provides an hour long in-home or workplace visit to collect his patient's medical history. It also covers two house calls, as well as prescriptions, unlimited electronic check-ins, and questions through email and instant messenger (ie, real-time chat).

Physicians in Canada can currently only charge patients for services not covered by the provincial health insurance plan, but some doctors are finding creative ways to get around often-fuzzy regulations (see "Chaoulli Group opens for business" on page 17).

In the first few weeks of operation Dr Parkinson's already signed up 20 patients. Without an office or secretary his overhead is next to nothing. New patients can contact him by filling out an application form on his website which will then land in his email inbox.

FEAR FACTOR
"There's a real potential to go online," notes Vancouver FP Dr John Sloan, one of a small group of doctors in Canada who makes house calls to geriatric patients. But he says most Canadian MDs are scared off by the perceived risk. "Everybody would jump to tell you all the risks about confidentiality and getting sued. It's just a smoke screen for people who don't want to change their practice."

"Doctors and long term care providers could link up through a list serve and conference with patients that way," he adds, "but many groups seem to be against sharing information."

However, he says visiting a patient in their own home is one of the best ways to learn about their health. "Some information is only available if you go to their living space and open the fridge to realize they're not nourishing themselves properly."

Although their patient demographic is very different, both doctors glean the same information from home visits to promote healthier lifestyles in their patients. "You get all kinds of information to help make a diagnosis that you can't find in an office visit," agrees Dr Parkinson. For instance, spotting cigarette packages or lots of junk food packaging would be a tip-off that the patient needs help to lose weight or stop smoking.

"This is the MySpace generation. Like it or not people put their lives online," reflects Dr Parkinson. "I'm really just trying to give young people the medical attention they need."