A Doctor in Your Pocket: Accessible APPropriate Care?

Have you seen ads online for mobile apps or online based doctors? They’ve been available in Canada since about 2015, but being a chronic patient, I’ve never had any real desire to try. I value my care team, their knowledge of my history, and I know I’m in some ways more complicated than the average patient, and I like my doctors having everything in front of them in a sort of archive of my chronic life.

Sometimes, though, we chronic patients develop average patient issues that have zero to do with our chronic health issues. And so it was when I suspected I was in the early stages of developing a urinary tract infection (UTI) during the last week of May.

When I needed a doctor

Well, that’s inconvenient, I thought. I felt totally fine except for the frequency with which I had to leave my desk! (If any of you find yourselves at the University of Winnipeg here is a pro-tip: 8 months into my job I reminded myself that the bathrooms in Manitoba Hall are much nicer/cleaner seeming than those in Centennial Hall!)

I walked over to campus health twice, the second visit realizing it wasn’t open till Tuesday. It was Monday. So upon returning to my office, I picked up my phone and called my doctor’s office, a convenient ten minute walk away, “She’s at the walk-in clinic today and tomorrow. You can go there, just call ahead.”

Very helpful, but also that is not getting my last-week-of-work work done, especially as that clinic would be 35 minutes to get to by bus. And this wasn’t a situation in which I needed somebody who knew my medical history, a random walk-in clinic doctor would do.

Enter the app: A doctor in my pocket

At some point after my doctor’s assistant told me my doctor was not in, I thought about this app called Maple, in which Canadians can pay to see a doctor. This is the controversy, as Canadians do not normally pay to see doctors, which is a good thing. In reality, debated long and hard about paying to see a doctor, but it came down to this:

• I will make $52 at work in the next 3 hours. The app will cost me $49.
• I will not have to go into a germ infested walk-in waiting room and wait between 1 and 3 hours for a doctor, probably catching something else in there.

Plus I figured it would be a good story to tell after I’d experienced it for myself.

First I selected my provider type—a general practitioner (family doc, ER doc or nurse practitioner). I got assigned a family doc, whom I Googled and works for Alberta Health Services with a specialty in telemedicine.

Selecting a specialty and finding my match

I entered details of the problem and confirmed payment, and then waited for it to pair me with a doctor. Note the start time of my interaction with the app was probably around 4:45 PM.

After this I received a notification that the doctor was reviewing my information before we got started. The official start time in Maple is noted as 4:52 pm if we correct from Eastern Time. As I’d provided enough detail in the pre-consult notes (ie. brief medical history and that I felt generally well) he asked me a few questions, such as if I experienced fever or chills (no and no).

Yes, I did say "no fever or chills that I know of." I once walked around with a fever for a week in May because I am inept and “just thought it was getting hot out”, and my office has been so darn cold I’d possibly have no clue if I developed this symptom!

Prescription for macrobid

You’ll see that the doctor suggested a prescription but I was able to decline it -- for example, if I’d had a drug allergy I hadn’t previously informed him of. Before accepting a 5 day supply of antibiotics I did ask if I could have a shorter course -- he said I could discontinue after 3 days if symptoms resolved, so I accepted.

I had no other concerns, so I ended the consult and chose my regular pharmacy as where to direct the Macrobid antibiotic prescription, with a diagnosis of cystitis (bladder inflammation caused by a UTI). In reviewing my physician, I said he was fine but it would be nice if he stopped using text slang like “u” and “k” for professionalism!

A positive end to my consult

End of consult: 4:59 pm. Total consult time? 8 minutes. Total in-app time? 13 minutes. I was going to say no germy waiting room, but this consult took place on a bus so take that for what it’s worth!

I picked up my prescription that same night at about 7:35 PM, so we’re talking total time of less than 3 hours. Pretty good considering I could’ve been waiting in a waiting room for an hour or two. Instead, I got to go see my cousin’s three-year-old daughter play soccer (so darn adorable).

When I would and wouldn’t use an app based physician

There are VERY FEW situations in which I think using an app based physician would be appropriate. Uncomplicated UTI caught extremely early? Yes. Skin rash you don’t know if you should be concerned about? Yes. Ear infection when you’ve had like 170 prior ear infections and know exactly what you need? Probably. Irritating bug bite or insect sting so long as you’re not allergic? Sure.

There are probably a few other scenarios, but while these docs in your phone can assess other things, I’m not sure I’d feel safe being assessed that way, especially by text message. And definitely not if the situation could get worse fast.

This is reflected pretty accurately in the specialties Maple allows physicians to practice within the app (so far): Psychotherapy (note: not psychiatry!), dermatology, sleep therapy, medical cannabis, cosmetic surgery (even this gives me pause!), hemorrhoid surgery (WHAT?), gallbladder surgery (again: ???), and naturopathic medicine. Note that it costs more to see a specialist on this app, too.

Are these services good for chronic health conditions? The answer, in my opinion, is no. Yes, I fairly quickly used an app based physician for a new-onset UTI, but no, I would not use an app based physician for management of a long-term condition, like asthma.

Why I wouldn’t use an app-based health service for asthma

Quite simply, I wouldn’t use an app based doctor for asthma because they don’t know me. It is hard to get your history accurate when typing into a tiny box. They can’t hear my lungs, they can’t run tests, and depending on if you’re doing text or video chat, they might not even be able to hear me!

The bottom line is asthma, and other chronic health conditions are complicated -- especially if you’ve got more than one. Because these things are complicated, we need two-way feedback, in person, so we can be confident the doctor treating us has everything they need to know in front of them to manage whatever has popped up, be it an acute exacerbation or regular asthma care.

So while these apps are certainly an attractive option -- in my case, I paid for convenience in a medical system where I otherwise can get care without a credit card number -- they are not good solutions for everyone. I think are applicable for a very narrow scope of common medical issues, and the problem is educating patients on when this is and is not an appropriate solution! No matter if you’re a chronic patient or not, you definitely should know your body and be very aware of your health when determining if an app based physician is good for you.

Have you used an app-based medical or physician service like this? What was your experience like?