The best doctors are exceptional detectives and masters of all the tools they have to figure out what’s wrong with you. How do they do that and what do they use to diagnose you? Here are the six main ways:
- They ask you questions about your symptoms (how long, what kind of pain, etc.)
- A physical examination of your body with a good old-fashioned poke here and a listen there.
- Lab tests (blood work, etc.)
- Imaging (x-rays, ultrasounds, MRIs, etc.)
- Experiments (if I prescribe you this anti-histamine and your rash goes away, it must have been an allergy)
- Time (if you have bad belly pain and your doc thinks it’s just gas but it might be appendicitis, she’ll watch you in the ER to see if your pain goes away)
Of these six tools, what needs to be done in-person in a doctor’s office and what can be done online with your doctor?
Asking you questions
Does not need to be done in-person and would likely be more efficient and higher quality if not done in-person. This can be done online with a back and forth between you and your doctor. And most any doctor will say that 80-90% of diagnosis stems from asking detailed, targeted, thoughtful questions. It’s also important to ask questions in a structured, checklist-driven way— something that can’t easily be done in-person. And secondly, it’s important to give patients time to thoughtfully contemplate questions and respond to them— something they can’t do during time-sensitive oral conversations during an office visit. And, finally, looking a doctor in the eyes when talking about something embarrassing is hard and I believe it’s easier to write about embarrassing things than talk about them.
A physical exam
Needs to be done in person: Sometimes. Honestly, in many situations, the old-fashioned physical exam is a blunt tool. It’s often used to support what you already suspect from the questions you ask and occasionally to direct the test you order to confirm your suspicions.
Many of the clues you’d get from a physical exam can often be done by-proxy. If it’s a rash, a high quality photo is much better than a doctor seeing it in their office and not taking a photo of it. If you injured your leg and you’re worried it’s broken, there are questions your doctor can ask to determine whether or not it’s broken. For example, via a phone call, your doctor can ask you “can you jump up and down?” If you can, your leg is not broken. If you’re monitoring your blood pressure, for $130 you can purchase an iPhone-connected blood pressure monitor and share the results with your Sherpaa doctor. If we suspect strep throat, having a friend use your iPhone to take a photo of the back of your throat is just as good as a doctor shining a light in your throat. If we need to know your temperature, a simple thermometer is a few dollars at Walgreens. If you need an updated eye exam to get new contacts, you can use Simple Contacts to do your eye exam on your iPhone.
An old-fashioned in-person physical exam is very, very rarely the missing piece of a puzzling diagnosis.
Needs to be done in person: Sometimes. If you need STD testing or your cholesterol checked, you can purchase tests from Everlywell and do everything from the comfort of your home. If you need your cholesterol checked, you can purchase a kit at Walgreens. However, if you need a good old-fashioned blood test, your doctor can order them at Quest or LabCorp in your neighborhood and you simply show up and get your blood drawn and the results are sent back to your online doctor who ordered the tests.
Needs to be done in-person: Yes, at an imaging center. To look inside your body with an x-ray, you need to go to a local imaging center. Your online doctor can order these tests and you visit the imaging center and the results are sent back to the doctor who ordered the test.
Needs to be done in person: Sometimes. If the experiment involves trying a medication for a short period of time and then checking back in with results, it’s best to not do this in-person because you’ll have to pay for two doctor office visits. If you could just send off a message with an update so your doctor could use this information to determine your next steps, that’d be inexpensive and ideal.
Needs to be done in person: Rarely. Almost every health condition follows an expected timeline. If you have a UTI and start antibiotics, if the antibiotics are working you’ll start feeling better in a few hours. If you have appendicitis, you can expect that appendicitis to worsen over the course of hours if it’s not being treated. If your pain is just gas, you’ll probably feel a lot better in a few hours. Reporting updates about how you’re feeling surely does not require an office visit. If expensive office visits are the only ways to update your doctor so your doctor can make a decision about what she thinks you have, that’s going to be expensive and inconvenient.