Doctortutes

Doctortutes. I made that word up, in case  you haven't guessed. It is not an amalgamation of  the words "doctor" and  "substitutes".  It is a combination of "Doctor" and  "prostitutes".  Doctortutes:   Doctors who pimp themselves out for money. 

Now it may be argued that pretty much all doctors; -except maybe the ones without borders, charge money for their services, so therefore all doctors could be termed doctortutes. Not so. Charging a fair or market price for a recognized service, and operating out of a regulated environmentt, such as a hospital or private practice,  as most doctors do, is accepted, legitimate business practice, not doctortution. But trawling the streets, classifieds or the Internet soliciting clients IS Doctortution, in my opinion.   And quite a few doctors are engaging in the practice (pun intended):  Some are lone operators with flash, smooth-talking  websites; -the Internet equivalent of acrylic platforms.

But most don't bother with these costly "cheap" tactics.  Most use pimps.

Yes. I said it: Internet doctor pimps.  Who needs science fiction when the real world is right here? 

Here is the story:

Just the other day, I was noodling around the Internet, researching something (probably a scam), minding my own business (sorta), when a pop-up window appeared on my screen (note to self: upgrade pop-up blocker).  The window advised me that there were twenty doctors standing by waiting to answer my medical question, and invited me to type it into the box.  So for laughs, thinking this will stump all 20 of them I typed in  "why do I have a seizure after I eat a meal?"

And then another box popped up, asking me how much I was willing to pay for this answer?  And the term "doctortute" hit me. I started to save screen shots and write this piece...

..and then my feckin computer crashed!  I lost all the screenshots and everything else.  Bummer.

My computer mysteriously came back from the dead a day and a half later after I decided not to finish my cliffhanger story about the beginning of 2010. Apologies to my regular readers, but I took that crash as a sign, even though I know some people may suggest that maybe it was the internet doctor pimps and the doctortutes who might have actually have been sending the "sign", as that is what I was working on at the time of the crash. I don't believe it.  Conspiracy theories  don't impress me any. (while superstition apparently does...  I'm Irish. What can I say?)

So last night I went back on the hunt for the doctortutes. I found some at justanswer.com, which seems to be one of the biggest pimp sites; supporting not only doctortutes, but also plumbertutes, mechanictutes, lawyertutes (OK that's nothing new) and various other "tutes" who will answer questions in exchange for your cold, hard credit card number. 

 
It's actually not a bad gig for a "tute", who I imagine is playing Solitaire or Farm Town in-between answering questions.

I didn't manage to find the popup that had found me the last time (I have no idea what I had been doing to deserve that!),  but on the main site there was a space to input my question, with 24 doctors online, apparently waiting eagerly to answer it. 

 

I couldn't resist. I knew it meant committing funds that I don't have (can you claim blogging expenses on your tax returns? Honestly, legitimate journalists have it so much easier than Sick Mothers), but I really had to see where this would lead. I figured that even if I didn't get a viable medical  answer  out of this (and I didn't expect one), I might at least get a good story for this blog, albeit at rather a high price. And I kind of liked the idea of exploiting a dotortute in order to write about him here -which is probably something I should address in therapy (I'll put it on the list).

 

So I went for it.

I typed in my question:  "Why do I have a seizure after I eat a meal?"  There was a followup question of what I had done about it, and I wrote "tried multiple AEDs, most of which made the problem worse".  And I hit "Enter"

Then we get to the nitty gritty: 

 

I was told "Dr. P "wants to answer my question" and I was asked how much I wanted to pay for this answer? I was given a few price options and  prompted to the middle one, which is  $38.  Would I pay $40 to have that question answered? Hell yes! I would pay a lot more than that.  Of course, I figured their definition of a satisfactory answer might differ from mine. However, the curiousity was killing me, so I continued on.

The site had said that I wasn't going to pay unless I was satisfied with the answer.  It then  advised me that it was going to take a "deposit"  against this answer. OK fair enough. Except the 'deposit' was the entire amount, placed into "my account"  Hmmm.... 

 

Well; in for a penny, in for 38 dollars: I continued on.  I had been  promised that someone called "Dr P" had been standing by to answer my question. Then Dr P was suddenly  gone..

 

...and  Doctor Ozz was looking at it.  I guess he passed it up too. Finally someone called "Mysticdoc" decided to take my question. That was worrying.  I wanted a real doctor, not a mystic!  Then I looked at his profile, and realized that "Mystic" was probably meant in terms of Mystic, Connecticut, as opposed to "Mystic Meg"

 

Thank Christ for that! Because if it was anyone connected to her, that would be downright scary...

 

Mysticdoc actually came back with some intelligent questions.

 

 Do you have any other medical condition?

What medication you are taking currently?

How do you know these are seizures?

Association with any particular food?

Any family history of seizures?

What tests have been done so far?

 

These questions I answered equally intelligently, with the honest facts as best I could remember and summarize  them (what tests have been done? OMG  that's a tall order to remember on the fly!)

There was some back-and-forth. The way the system works is this: the "tute"  doesn't get paid until the client accepts the answer and the client can ask follow-up questions related to the answer (but any questions on a "new" matter would be another chunk of change) . Therefore, the doctortute is incented to give a satisfactory answer. It would be highly unlikely that I would receive the two most popular answers I get from regular doctors, which are

a. "I can't help you"

b. "have you seen a psychiatrist?" (ie. it's all on your head)

Now, although I have argued against this in the past (here and here if you are curious),  these are both considered perfectly legitimate responses in traditional medical practice, where doctors are not actually required to help you and they still get paid for the visit and their time. However in doctortution, the compensation is directly tied to a satisfactory answer. The  "patient" (I have to use this term loosely here. Hey, Let's keep in theme and use the term "john" ) can  refuse to pay if an unsatisfactory answer is given.  Yes, the pimp still has your money, but the john can either go to another doctortute, or can start the process to have the money returned (and I am not sure how easy this process is, but it is there).  It is an interesting change to the dynamic, don't you think?  Much more customer oriented.

"Mysticdoc" gave me two good pieces of information I think I can use:

1. Sodium and calcium (both minerals with which I have had issues  in the past) play a huge role in seizure pathogenesis.

2. A  functional MRI (fMRI) would probably be a good test for me to see what is going on in my brain. I asked him if the MRSpect, the scan that #30 is planning to do as part of his study is the same thing, and he said no. The fMRI would be better. Hmmmm. 

Funny thing is this: #25 had mentioned performing a fMRI a few years ago, them he changed his mind because "nobody would read the paper". Fuck papers! This is about getting my life back, not about papers.

So I figured Mysticdoc had earned his $40 and I paid him (love that they leave space for a tip!) and allowed him to move on.  I declined to leave a deposit against any future questions I might want answered. No free money from me!

 

Then I thought some more: You know,  with the discounts many HMOs and other insurance companies negotiate, a regular visit doctor visit probably pays about the same as one of these internet consultations, but with much higher overhead (offices, staff, insurance). So for the doctors, doctortution is quite a good gig. They can hang out at home in their jammies, with one eye on the telly, picking and choosing which questions to take, getting paid directly for their time.  It's not a bad deal for them. And it answered the question I had when I first saw the site: Expecting people fresh out of med school, I had been surprised to see some of the doctors lurking sported lots of qualifications and years of experience.  I guess if you are a doctor, this  is a handy way to use your qualifications part-time to top up the old income: You know, pay the country club fees, alimony  and your daughter's speeding tickets.

Is doctortution a good thing?

I don't know. I think it is an interesting development in the healthcare system, and it satisfies our need for instant gratification. Of course, an Internet doctortute is no substitute for an actual physical examination or for someone's regular doctor and -needless to say- doctortutes can only advise, not diagnose or prescribe. But I think, as a fresh and unbiased set of eyes  on a case, doctortutes might have their (limited) use. I know my experience has spurred me to go find a new neurologist, a seizure expert this time.

I'm losing count, but I think this will be #31. Maybe that will be the charm?

Comments

[yanub]

That picture of "Mystic Meg" is scary!

Very interesting result you had! I might try it myself at sometime since you had a pretty fair response. I like that concept that the doctor has to try to satisfy the customer with the answer, to give something other than a rote answer. I can see where some doctors might like doing this kind of work even more as an intellectual challenge than for the money. If they get to pick the question, it may be in part because it is an issue they've been studying up on and are feeling a bit excited about but may not have any patients who need that exact bit of knowledge. Well, I'd like to think some of them feel that way about it.

I thought you had been to a seizure specialist. Huh. How strange that no one has referred you to one when your seizures are such a significant problem.

[Jakey Hound]

Apparently on-line counselling is getting pretty popular these dayz.

Can you ask the on-line Doctor "what is that rash on my leg?" Would they actually look at it using a webcam?

[One Sick Mother]

Yanub,

Mystic Meg does the horoscopes on one (or several) of the UK papers and she has been around for centuries (feels like). She was scary 30 years ago, and has only gotten moreso since. Not that the lighting helped any, either.

I hadn't thought about the intellectual challenge part of it, but it is an interesting thought.

I have been to two seizure specialists. Neither helped me, although one tried. I was advised in the ER once that if I wanted help outside of the influence of those two, I should travel outside of this area.


Jakey: Yes I have seen some TV segments about it, but more doctor-doctor consultations on difficult cases. I have not seem much about straight doctortution.

I don't know if I could ask the "rash on the leg" question. It's an interesting one, but I'm not willing to part with any more cash to find out.

...and anyway. I don't have a rash!

OSM

[fridawrites]

"Doctortutes" cracks me up. I thought of another example of them--and that's those who prescribe the behavioral modification for pain/fibromyalgia programs that aren't backed up with studies/info about specific outcomes. Someone I know was recommended to a 3-week, 40 hour a week program. Now that's a lot of money, and who's really going to benefit from that? When the 3-week program ends, she'll feel much better for a bit after pushing herself that hard. But I think the longer-term benefits are for other people, whether or not they see it that way. Medicine is a business.

I once contacted one on a message board--the doctors were paid to write articles and such for a major website but also answered questions. Now this was free and not pay. She sent me in the right direction for a problem that my current doctor and midwife wouldn't help with (unending postpartum bleeding at 12 weeks, with hemorrhage and ER visits)--I later found out there was a huge upheaval in my dr's. practice then, and everyone except the newcomer to that practice left shortly after. It was inexcusable for my reg. practitioners not to get the basic bloodwork/sono needed, and I changed doctors and got the help I needed. I've been with the new one almost 10 years. So these web doctors can help.

Like you, I would be wary of paying for advice but for someone reaching the end of their leash with a complex problem, it's very little money/risk and some good might come out of it. Sometimes it really does help to have someone fresh, open-minded re-examine a problem.

Some people have dysautonomia after meals; dysautonomia can cause seizures. Not necessarily connected, but it's always worth throwing out ideas when there are complex medical issues.

And yes, they should do an MRI with you; even if a diagnosis on that basis alone isn't likely, they can definitely exclude some possibilities rather than leaving them open.

[Barbara]

Very interesting and a very clever post.

I have an e-consult offer buried in my blog. Don't want to be thought of as a 'tute', but your analogy works for the the pop-up kind - esp since it crashed your computer. When you go look for it...well, looks like you got what you paid for, eh?

[Zoe Ashcraft]

HEy girlie! zoe here, you know, I wonder if our seizures aren't somewhat the same- ? I tend to feel one coming on if I eat much in the way of carbs- (POTS specialist confirmed this is a norm)

also- I have one whenever my bp is taken- (that's a real nono now)
in hot showers, or baths
after exertion,
if I massage my cartoid arteries, or my Temporal/Shpenoid bone areas-
-- and I come right out of them when I am given oxygen. (that haS to be a no-brainer, right?)

I'm leaning towards it being the Dysautonomia/some kind of Syncope - which I thought was the LEAST serious of my collection of conditions - ha! (I love your writing and it's been waY too long since I've visited you and your blogginess!:)

Love you,
zoe

[LR :)]

This may be a largely grasping for clouds here, but I've been looking into vitamin K since it plays a role in connective tissue and calcium. That's the short version. I'm not going to supplement, but eat more vitamin K foods for awhile. Vitamin K controls calcifications of arteries and connective tissues. Damage to mitochondria occurs from excessively high intracellular calcium. I've read this before, but as I'm learning more about connective tissue and vitamin K, it has garnered my attention now since our soft skin and very bendy joints at my house (and hence joint deterioration) seems to be a problem. I'll let you know if a trial run of upping our vitamin K greens makes any difference here. (Not in a "cure" way, but a relief way.)

[elizabeth]

Interesting and tantalizing. I have hoped that medicine was a science instead of (as you point out in the next post) - an ego game where anything any OTHER doctor says is immediately thrown out.

To get an objective opinion and assistance for money is sort of the reason people GO to doctors isn't it. Why is it then that there seems to be better doctoring and more direct, scientific approaches when the doctor and the patient aren't actually connected.

I share your frustration - as finally, after years, doctors here get a BONUS if they take on someone with a chronic condition (incentives to take on those annoying people with...you know...medical problems, like you and I - and I thought the kind of people doctors trained to treat - how wrong I was. Does medical school divide the classes into 'those you want to treat: boils, colds, and easy answers' and 'Stuff you should know a bit about in order to avoid getting sued' coupled with the course 'how to quickly dump the patient who might require you to do reading or research since your graduation 10-15 years ago.'

Me, cynical, not when I found that the waiting time NOW for a MRI appointment is earliest, April, 2011 - yup 14 months.

[Jeanne]

Thank you for being brave and doing this for me. If I knew about it when I was going through a battery of testing and acting as a hologram for an episode of "House", I would have jumped on it.

In fact, I did do this for my Volvo V70, which seemed worth the investment. FWIW, that only cost me $35. And they hit the nail on the head, unlike doctors who tend to theorize.