No waiting or examination rooms. Still Dr. Jay Parkinson of New York seems to be having a good time of it combining house calls with Instant Messaging (IM) and e-mail service.

For a yearly fee of $500, Parkinson makes an initial visit to his patients in their apartments and offers two additional visits as needed. But he is available to them any time between 8 a.m. and 5 p.m. weekdays for unlimited consultation on messaging or e-mail.

Parkinson launched the practice to focus on Brooklyn's young, uninsured working creative types. "A lot of artists in New York City don't have insurance because they're freelancers," says Parkinson, who earned his M.D. from Pennsylvania State and has a master’s degree in public health. "They're young and wired. Once you figure out an issue, you can follow up with e-mail, Instant Messaging (IM) and video chat. The vast majority of these people don't need repeated physical exams."

Parkinson uses web-based Life Record to keep his medical records. He can access them on his iPhone if, say, he's out to dinner and a patient needs a prescription refill. At home, he's parked in front of a MacBook.

When his patients need lab work or specialists, Parkinson refers them to a network of low-cost providers. "I've been very sneaky in the last three months, calling up 2,000 doctors and facilities in the area and asking how much they charge," he says. After all, there's no central directory of physician prices, and insured Americans have little reason to ask. The results have been shocking. In researching the cost of mammograms for a patient with a strong family history of breast cancer, Parkinson found prices ranging from $125 to $750 for the service.

Anne Baker (name changed at her request), an uninsured 31-year-old art gallery owner, was one of Parkinson's first patients. After breaking out in a mysterious full-body rash, Baker found Parkinson online and contacted him. The following day, Parkinson visited Baker's apartment and went over her medical history in depth. "It was like filling out that form when you first go to a doctor, except we did it verbally," says Baker. "He got a lot more nuanced than any form would." Parkinson diagnosed the source of her rash -- an allergic reaction to lotion -- and followed up with an e-mail afterwards.

"I sent him an e-mail letting him know it cleared up, and two days later he checked back to see how I was doing," says Baker. "It was amazing!"

Parkinson doesn't yet have malpractice insurance, but says it's typical for a new practice to wait on insurance until building up a sufficient patient base. But insurance agencies may be spooked by a tech-heavy new business model. Parkinson hopes otherwise, arguing that because his practice makes doctor-patient communication easier, insurers should feel more comfortable, not less. He also won't be performing pelvic exams on women, instead referring them to Planned Parenthood and other low-cost providers.

In his first four days in business, he signed up 15 patients, turning away those who live outside Brooklyn. (House calls farther afield just aren't feasible.) He plans to buy a scooter to zip around the borough.

Source-Medindia
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