Digital doctors

The exchange isn't unusual, except that the patient is in the Appalachian hamlet of Rainelle and his doctor is more than 160 miles away in Morgantown.

It is made possible through Mountaineer Doctor Television, which brings doctors and patients together through high-speed digital phone lines and simple video equipment rather than by traveling treacherous mountain roads.

"Those roads between Rainelle and here are nothing to brag about," diBartolomeo says. "And somebody didn't have to take a whole day off work to bring them to the doctor."

MDTV, based at West Virginia University, is one of the biggest telemedicine providers in the region, with 21 teleconference sites in West Virginia, five in Pennsylvania and one each in rural Maryland and Ohio.

"Besides actually touching and smelling the patient, there's very little that cannot be accomplished," says Chris Budig, director of the Telehealth & Education Network at WVU.

Founded in 1991, MDTV was first funded with a grant from the Appalachian Regional Commission. Doctors began seeing patients the following year, starting with just seven. By 1998, they had seen 680 people in one year, and last year 2,230 people used the service, which is no longer funded by grants.

Today, the satellite facilities pay their own phone bills, which can range from $22 to $35 per hour. Used wisely, Budig says, it can save money.

So far, MDTV has had the most success in institutional settings such as the VA Medical Center in Martinsburg and the William R. Sharpe Jr. Hospital in Weston. Dermatologists, rheumatologists and other specialists hold regular long-distance clinics, sparing the facilities from hiring their own doctors at salaries well beyond $100,000 apiece.

Surveys have found that patient satisfaction is high, Budig says -- even for those who were initially nervous.

For one thing, patients don't sit in a waiting room for hours. If the conference is set for 10:30 a.m., diBartolomeo is at the table when the call comes in.

He has been seeing patients on MDTV for at least four years and has only had to summon three to Morgantown for hands-on visits.

Patients also have the luxury of seeing their primary care doctor at the same time as the specialist.

MDTV has turned out to be particularly attractive to psychiatric patients, who Budig says find the distance comforting rather than upsetting.

Rural hospitals, clinics and doctors' offices are so overwhelmed that most have yet to embrace MDTV, even though Budig and diBartolomeo say it could serve patients and doctors better.

MDTV has tried to entice doctors to participate by offering an hour of continuing medical education credit to those who do a teleconference.

But doctors with full waiting rooms are still much more likely to refer a patient to a specialist by handing them a phone number, Budig says. Taking time to schedule a teleconference often cuts into time they could spend on other patients.

"Rural hospitals in West Virginia are in such dire straits that suggesting they hire somebody else to do something more is just like the straw that breaks the camel's back," diBartolomeo says.

Equipment that costs $30,000 to set up is money that, to some physicians, is more wisely spent on a registered nurse. To really take off, he says, MDTV needs more hub sites in centralized rural locations.

That, however, would depend on the willingness of doctors, medical centers and clinics to fund them.

"Most doctors are plenty busy," diBartolomeo says, "so they don't go looking for something that's going to cost them thousands of dollars just to get even busier."