Gulf Coast Pain Management
Lynne Carr Columbus, DO
Website links doctors with their patients

After much hesitation, mainstream doctors are finally organizing for the Internet --
setting up Web and e-mail communications that should make it much easier for
patients to communicate with their doctors.

Doctors have been slow to take advantage of the Internet: some had fears about
the confidentiality of e-mail while others were worried e-mail provided no way
to get paid for their service.

Now comes a for-profit firm based in San Francisco called Medem, which offers
encrypted e-mail messaging for doctors and their patients and a method of payment.
 
Medem has the backing of the medical establishment. Its investors include the
American Medical Association, the American Academy of Pediatrics, the American
Psychiatric Association and other elements of the medical establishment. More than
80,000 doctors have joined the service.

"Managed care has made doctors so busy that it's gotten nearly impossible for a
patient to get a relatively simple, clinical question answered," says Ed Fotsch,
a doctor who's Medem's chief executive. "We're changing that."

"It started out of necessity," says Dr. Bernd Wollschlaeger, who operates the
Aventura Family Health Center. The physician, who recently won an award from
the Florida Medical Association for his work in educating the public about medical
responses to biological and chemical terrorism, sponsors miamihealth.com, which
runs through Medem servers.

"It's often the easiest way to communicate with your patients," Wollschlaeger says
of the Internet.

At least one of his patients, Ayrton Queiroga, agrees: "E-mail is the best way to
communicate with doctors since they are always busy."

Medem is the medical establishment's answer to a wave of other services out there,
such as MyDoc.com, a website run by the Roche pharmaceutical firm in which a
rotating group of doctors prescribe medications for simple ailments to patients that
they may have never met. If the matter seems complex, MyDoc recommends the
patient go to a doctor's office.

Dozens of other websites sell Viagra, hair restorers, diet and pain pills -- with an
anonymous doctor filling out a prescription after the buyer completes a brief
online questionnaire.

Another Web service -- MDhub.com -- asks for your medical questions online,
which the website will then fax to your doctor's office for free.

The AMA's position is that Internet communication and writing prescriptions
based on e-mail is appropriate only when a doctor has already examined a patient
in person and has an ongoing relationship with the patient.

"We're in favor of any technology that benefits patients," AMA President-elect
Donald Palmisano said during a trip last week to South Florida. ``But we want
it done in a proper manner.''

The Medem website provides a full range of medical information provided by
professionals. Patients of Medem doctors get a password that allows them to use
the website to send encrypted messages to doctors -- and to receive the doctors'
encrypted replies. The AMA considers this much more private than simply
exchanging e-mails, which can bounce among public servers.

The site also provides a way so that the doctor to gets paid for his online advice.
Patients registering with the website can be required to provide credit card information.
By accepting a return e-mail from his doctor, the patient could agree to pay a fee.

Fotsch says the size of the fee is up to the doctor -- but it might not have to be
much for a simple discussion -- such as the refill of a prescription or a reaction
to an old condition acting up.

Medem doctors are projecting charges of $20 to $30 for a simple e-mail, Fotsch says.
"That's about the size of many insurance co-pays."

Fotsch says Medem is in no hurry to get such e-mails covered by insurance -- because
the process would require more paperwork -- "but we've had several Fortune 500
companies approach us about adding Medem to their plans."

These employers realize, says Fotsch, that if a problem can be resolved with a
quick e-mail, it might save a half-workday that an employee would have taken
for a trip to the doctor's office.

Lynne Carr Columbus, a pain-management physician in the Tampa area, says she
charges $30 for online consults, which are generally progress reports on how
medications are working, and her patients are happy to pay because it saves them
a trip to the office. She doesn't charge for routine messaging, such as a request for
an appointment.

Wollschlaeger, the Aventura doctor, says that he hasn't focused on using Medem's
billing mechanism, and most of his patients continue to communicate with regular
e-mail, rather than the encrypted website communication. "It will be learning process,"
he says, about getting his patients to use encrypted messages. "But for me, Medem has
been very helpful in my practice."

Fotsch adds another benefit: "If anything it helps to enhance the existing
physician-patient relationship."

BY JOHN DORSCHNER
jdorschner@herald.com

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Dr. Lynne Carr Columbus, D.O.