The scene was one we have all starred in: It was a greyish weekend morning in February, that seemingly endless mid-winter month where the grind of coughs, runny noses and fevers becomes unbearable. My five-year-old daughter, Isla, woke up extra early with a cough that sounded like a seal bark. She was feverish and had lost her voice. Isla, my husband and I were thin on patience because my two-year-old son, Finn, was running around maniacally, having recently recovered from his own drippy, days-long virus. Ugh. We probably needed to see a doctor. Again.
Scott and I eyed one another, each hoping the other would volunteer to trudge out into the wild. On Sundays, walk-in clinics are non-existent in our area; the only real option was to go to an emergency room, which would mean a nightmarishly long wait. And who knew what new viruses we risked contracting there. We had already been sick for what felt like months. Plus, going out meant I’d have to clean myself up a bit. Sleep-deprived and over-caffeinated, I looked like someone’s bad dream.
Then I remembered an ad for a digital doctor service called Maple that I had scrolled past on my Facebook feed. I looked it up and discovered that, if we were willing to pony up some cash—$79 plus tax for a weekend “visit”—we could see a doctor virtually. He or she could even prescribe medication, the site said, all while I was in my pajamas (yay!). A glimmer of hope ignited in my heart. Maybe we could get some antibiotics without having to toil for hours in a gross waiting room—and I could avoid putting on a bra. Was this some Internet hoax, I blearily wondered? Only one way to find out. For less than a hundred bucks, it seemed worth the gamble.
It took just minutes to create a free profile on my laptop, enter my credit card info and click through a list of symptoms that Isla was exhibiting. I added her medical history, then clicked a button to summon a doctor and, after a few minutes’ wait, we were connected via video with Brett Belchetz, a Toronto-based emergency room physician who appeared to be chatting live from his (nicely decorated) dining room. He asked a few questions and coached us through using a smartphone to shine a light down Isla’s throat so he could see it in detail.
In all, it took about 10 minutes. In the end, he said she didn’t have strep throat and likely didn’t need antibiotics (although, if she had, he could have sent our prescription directly to the pharmacy in our neighbourhood for pickup). We hung up, relieved (that we hadn’t wasted half a day in the ER), frustrated (that the virus would just have to run its course drug-free) and awestruck (how could seeing a doctor at 8:30 a.m. on a Sunday be so easy?!).
The whole thing was as simple as online shopping. Maple, which operates in Ontario, Nova Scotia, British Columbia and Manitoba, with plans to expand nationally by year end, guarantees 24/7 on-demand service with a Canadian-licensed doctor, even if it happens to be Christmas Day. The company’s fees increase at times that one might find most convenient to choose digital. For example, it costs $99 for a call between midnight and 7:59 a.m.
Maple does offer ways to keep its costs down for frequent visitors, though. Belchetz, who happens to be a co-founder, says the company offers both individual memberships ($359 plus tax per year) and family memberships ($579 per year). Increasingly, services like Maple are covered by corporate health-benefit plans.
And while there are limits to what doctors can digitally diagnose, they can do more online than you might think. “I don’t physically need to see the vast majority of patients I see in the ER to diagnose them,” Belchetz says. “A lot of the time the only reason we put on a stethoscope or touch someone is to meet their expectations. The vast majority of diagnosing is visual examination and history.”
Stomach flu, skin issues, sore throats, ear and eye infections, mental health, sexual health and basic prescription renewals are all common issues that Maple’s doctors treat, Belchetz says. In the event that a Maple doctor thinks you ought to see a physician in person, there is no charge.
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But some family doctors believe that there is really no replacement for an in-person interaction. Sarah Newbery, past-president of the Ontario College of Family Physicians, says her biggest worry about the rise of digital doctors is that continuity of care will suffer. Though she believes they have their place for some treatments, she says having a relationship with one doctor who knows you (and sees your or your children each time they are ill) has benefits that aren’t always obvious.
“When a family practitioner sees a child in the office, even if it’s for the common cold, they’ll be listening to the speech development of the child, checking his or her weight and a variety of things that allow us to identify other issues in that child’s health that maybe should be flagged or filed,” she says. “That nuance is lost in digital health.”
On the flip side, though, digital doctors open (virtual) doors to a host of people who don’t have regular access to a family doctor, including patients who live in remote communities, those who can’t drive or leave their home and people who work unconventional shifts.
Of course, the improved access comes at a cost. And while fees aren’t astronomical, they aren’t pennies, either. Plunking down my own credit card for Maple made me wonder how many families simply cannot afford to fork out cash on a whim to dial up a doc. Was I feeding a two-tiered system by using the service, I worried?
For now, in most provinces, the answer, sadly, is yes. But in British Columbia, where the province does cover some digital interactions between doctors and patients, a shift is happening. And south of the border, there has been a full-scale movement towards digital interactions, many of which are covered via insurance. Kaiser Permanente, the United States’ largest health plan provider, serviced 110 million patients in 2015; more than half of them—52 per cent—were successfully treated via a digital platform.
Maple and its competitors are hoping that more Canadian provinces will move to insure digital interactions soon to ease pressure on the medical system and reduce unnecessary emergency room visits. “The vast majority of people are forced to go to a walk-in clinic or to the ER for problems that aren’t really emergencies—like a sore throat or a prescription renewal,” says Belchetz. “And it’s not good for their health. In the ER, you’re exposed to all sorts of communicable illnesses. You might go in with a twisted ankle and pick up the flu or something worse.”
There is also the inconvenience of spending hours waiting to see a doctor—a factor that should be an incentive for employers to foot the cost of digital docs for their employees.
For my family, our first digital doctor visit won’t be our last. I bookmarked the site and won’t hesitate to use it again, including when we’re away from Canada on vacation. But in order for everyone to benefit, our provincial health plans will need to step into the digital age.
How it works: Get a fee-for-service on-demand digital connection to a doctor licensed to practice in Canada, 24 hours a day, seven days a week. Talk with a doctor via video, telephone or text. Files can be sent to your family doctor.
Fees: $49 plus tax for a weekday visit; $99 for an overnight call. Annual memberships available.
Where it works: Currently offered in Ontario, Nova Scotia, Manitoba and British Columbia, with plans to cover all of Canada by end of 2017.
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