December 1998 Bulletin

Orthopaedist offers advice online

Answers questions from public via 'virtual house call' service

Richard Warnock, MD, fields questions on an Internet service.

By Bonnie Booth

As the orthopaedic surgeon at, Richard Warnock, MD is participating in an admittedly controversial concept-answering medical questions and dispensing medical advice through the Internet.

"Some doctors think there is no place for this," said Dr. Warnock, an orthopaedic surgeon in North Andover, Mass. "But it may have a small place. It isn't the place for diagnosis and it isn't the place for treatment, but it may be the place to answer questions." bills itself as a "virtual house call" site where American board-certified emergency medicine specialists are available 24 hours a day, seven days a week to provide consultations and second opinions, emergency refills of prescriptions and care for minor medical illnesses. The site also lists other specialists, including Dr. Warnock, who are available to answer questions. However, the specialists' roles are more limited. Dr. Warnock does not interact in real time with web site visitors. Instead, he answers questions via e-mail within 24 hours of when the correspondence was initially posted.

Visitors to the site are charged $50 for a consultation with a specialist. When they register for their consultation, they enter a valid credit card number and are then issued an authorization number.

While he's been involved with the venture for about a year, Dr. Warnock said he has not been inundated with requests for information.

"I haven't fielded a large of number of calls," he said. "People aren't going to look for answers off the Internet for a majority of the things in my field. General practitioners are going to get far more questions. I've been getting mostly second opinion calls, people wanting to know if there might be options their doctor hasn't considered."

Dr. Warnock is licensed to practice medicine in Massachusetts and New Hampshire and right now CyberDoc Inc.'s administrators are careful to keep referrals to him from site visitors who reside in those two states. This helps him avoid the issue of whether dispensing advice through the Internet could be considered practicing medicine without a license in the other 48 states, and therefore a violation of their laws.

He also has fielded questions from people who live outside the United States and do not have ready access to medical care. Along with offering second opinions, he is sometimes called upon to further explain a procedure or treatment.

"There are some doctors who people go to for their level of expertise, but not for their level of explanation," Dr. Warnock said. "They trust what he says because of his reputation, but they sometimes don't understand (what the physician says).

"Most people have the diagnosis in hand and are either uneasy about the diagnosis or want to bounce it off a second doctor," he continued. "They realize they are not getting the benefit of the examination. If they can't provide me with enough information that I feel comfortable talking with them, I won't answer their questions." He said that has been the case only once.

The site is fully encrypted and Dr. Warnock keeps his own records on his consultations. He said he isn't worried that consulting on the web site will open new avenues for him to be sued for malpractice.

"It's hard to imagine getting sued since you aren't doing any operating," he said. "But there's always a chance you can get sued for malpractice for anything you do. Has the doctor/patient relationship been established? I don't know. I'm not a lawyer. I called my malpractice insurance carrier and they didn't have a problem with it."

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