At the company’s Web site, users post questions and doctors post brief answers. The service is free, and the doctors aren’t paid. Instead, they engage in gamelike competitions, earning points and climbing numbered levels. They can also receive nonmonetary awards — many of them whimsically named, like the “It’s Not Brain Surgery” prize, earned for answering 21 questions at the site.
First, and most obvious, why would a doctor participate? It seems to build up their reptuation.
By participating, doctors who want to attract new patients have a chance to gain visibility. When searching for answers to a particular question, users can add a geographic filter, narrowing the search to doctors who are nearby. But doctors who already have busy practices and can’t accept new patients are less likely to be interested in participating on the site.
HealthTap started its Web site last May. It says that it has signed up more than 9,000 physicians and that it is adding 100 a day. The site does not carry advertising, and the company declines to comment about how it plans to generate revenue.
Now the real question? What are the ethical and regulatory implications of offering treatment to a patient a doctor has never seen, knows nothing about, in less than 400 characters.
HealthTap requires only that its physicians be licensed in the United States and in good standing — that is, not accused of malfeasance. Lamentably, it does not use board certification to establish a floor for qualifications required for physicians to participate. The company says it does not require board certification because this “is not required in the U.S. to see and care for patients.”
Another worrisome aspect is the breeziness of HealthTap’s answers, which are limited to 400 characters, a length hardly well-suited for providing nuanced answers to some medical questions.
A disclaimer at the foot of every page says that the site “does not provide medical advice, diagnosis or treatment.”
Here’s how they describe their exception-to-the-law on the site:
Content posted on, created for, or compiled by the Site is an informational/educational service only and is not intended or designed to replace a physician’s independent judgment about any symptom, condition, or the appropriateness or risks of a procedure or treatment for a given person.
HealthTap is a website, not a doctor. This means that the Content is not a substitute for professional medical advice, diagnosis, or treatment, and you should:
- Seek the advice of a your physician or other qualified healthcare provider whenever you have a question about a medical condition or symptom;
- Never delay seeking this advice or disregard professional medical advice because of something that you read or see on the HealthTap site; and
- Call your doctor or 911 immediately if you think you may have a medical emergency.
YOU AGREE NOT TO USE CONTENT FOR MEDICAL ADVICE, DIAGNOSIS OR TREATMENT.
I wonder what the American Medical Association thinks?
DR. PETER W. CARMEL, president of the American Medical Association, says he is concerned about the use of online medical information, which should “complement, not replace, the communication between a patient and their physician,” he wrote in an e-mail.
With online health information sites, “a medical history is not taken, a physical exam does not occur and any suggested treatment is not monitored or assessed,” he said. “Using this information in isolation could pose a threat to patients.”
In response, Mr. Gutman said, “We respect the A.M.A. and would welcome collaboration with them and any other forward-thinking medical organizations looking to improve the quality of care.”
Fat chance. And that raises the question of what would happen if a similar site opened up with lawyers? Well, simply saying that “this site does not provide legal advice” would hardly be sufficient to skirt the rules of professional conduct. Offering such advice would very likely constitute the creation of an attorney client relationship, and with it all the attendant requirements. What about lawyers providing advice to people who live outside the jurisdiction they are licensed (so easy to do online)?
Bar associations would shut this down, pretty quick. I don’t know enough about the regulatory mechanisms the medical cartel employs, but I’m sure they can do likewise.