Take Two E-Mails and iPhone Me in the Morning

By Jennifer Huget
Special to The Washington Post
Tuesday, October 16, 2007

In the olden days, doctors were on call at all hours, ready to dispense advice over the phone or to make house calls, carrying stethoscopes in their black bags.

As of Sept. 24, Jay Parkinson, 31, of Brooklyn, N.Y., has been on call at all hours, ready to dispense advice via cellphone, e-mail, online video chat and instant message -- and to make house calls, carrying a MacBook in his black bag.

Although many doctors routinely store medical records digitally and use e-mail to communicate with patients, Parkinson is among the first to conduct virtually all his business, well, virtually. Targeting patients ages 18 to 39 -- a relatively healthy, technology-friendly bunch -- Parkinson says he aims to provide cheap primary care for the hip-but-uninsured while keeping down costs for the insured.

The wave of the future? Possibly, think such experts as Robelynn Abadie, president-elect of the Association of Health Insurance Advisors. But she also cautions that boutique practices such as Parkinson's may leave less-healthy people -- those most needing health care -- in the cold. And she stresses that even young, healthy people should find a way to get insurance and not rely solely on pay-as-you-go services like Parkinson's.

Here's how it works: Pay Parkinson's $500 annual fee and you get an initial in-person consultation, at your home or office, that can last as long as two hours. After that, you're entitled to two additional visits; further face-to-face visits cost $150, which Parkinson's Web site calls an average fee for primary care physicians in New York.

For patients with whom he has held that initial consultation, he's available for routine questions online and appointments at a mutually convenient location weekdays from 8 to 5 and round-the-clock for emergencies. So, say you cut your finger while slicing your morning bagel. Parkinson suggests you e-mail him a digital image of the wound; he can tell whether it needs stitches or just a drugstore bandage. (And if there's any doubt, he'll send you to get it checked.)

Parkinson got his MD at Penn State and a master's in public health from Johns Hopkins (where he also did a preventive medicine residency) and has done a pediatrics residency at St. Vincent's Hospital in New York.

By restricting his practice to those younger than 40, he avoids having to screen for and deal with diseases and conditions that typically beset older people. He currently has 15 patients enrolled and expects to keep his practice small, with perhaps 1,000 patients.

Parkinson also offers his patients information about specialists and providers of lab work and other services in the New York area. So if you need an MRI, for instance, call Parkinson to find out where to get it done cheap. Want a flu shot? He'll refer you to a colleague who offers them at low cost. He also says he can steer clients toward good deals on prescription drugs.

Parkinson only enrolls patients in Brooklyn and Manhattan; if you live more than 20 minutes from his home-base coffee shop (and you have health insurance), he'll see you but charge you extra.

Though Parkinson bills his services as useful for people lacking insurance -- particularly those, like his fellow artists (Parkinson's a photographer), who earn just enough not to qualify for government health programs -- he encourages his clients to buy some in case they get hit by a bus or get a serious disease that would require treatment outside the scope of his practice.

Parkinson says he can help patients figure out the best plan for them, given their financial and health status.

In the past three weeks, since his practice has attracted the attention of several news outlets, Parkinson has received e-mails from people all across the country asking about his services. And his snazzy Web site has had more than 10,000 hits a day.

Abadie thinks Parkinson is entering a growing market, noting that eDocAmerica has for years given enrolled participants phone and online access to registered nurses and doctors. "What he's talking about . . . these services are already in place," she says.

Rick Kellerman, board chair of the American Academy of Family Physicians, declined to comment specifically on Parkinson's practice. But he cautions that online doctor-patient communications can work only if the two have established a sound relationship in person. And, he adds, patients need to be mindful of privacy and security issues.

Parkinson explains that all his electronic communications identify patients only by a user name invented by the patient; no real names or Social Security numbers appear in those messages. And, he says, he advises patients, "Don't tell me anything over e-mail or IM that you wouldn't tell the whole world."

Still, Kellerman says, "I think there will be some resistance" to an approach like Parkinson's in the medical community. "People are trying to see how to use new technologies, but we can't be foolhardy. There has to be a balance between trying new things and understanding their limitations."

Parkinson, who was spurred to try this experiment by what he sees as the failure of the health insurance system to serve young working people, says, "Everybody's been quite supportive. This is a great Band-Aid for a real problem."

Jennifer Huget is a frequent contributor to the Health section. Comments:health@washpost.com.

© 2007 The Washington Post Company