Treatment Plan

The Doctor Is In Online

BY LEO SEMES, OD, FAAO

I recently woke up with a subconjunctival hemorrhage. The diagnosis was easy for me (see my December 2013 Treatment Plan column); but, as we all know, the condition can be disconcerting to patients. So, I decided to see what online advice I would get.

My Experience

At JustAnswer.com, I typed the following: “When I got to work this morning, a co-worker observed that my right eye was red in the lower inner corner. I had no pain or decreased vision.” I was asked what level of urgency and details I wanted (low, medium, or high); the cost varied according to my choice. I selected medium response time and high details, which would cost me $43. The longer wait time and fewer details would cost only $27, but I wanted to see how much information a naïve patient would get.

After entering a credit card number, I was asked to acknowledge, via disclaimer, that this response would not substitute for informed professional medical advice, nor would this establish doctor-patient relationship; furthermore, no warranty was expressed nor implied, and the information was offered “as is.”

After acknowledging this disclaimer, I was directed to Dr. Rick, a board-certified ophthalmologist with more than 15 years of experience. I later discovered additional credentials that he is a retina specialist and a Fellow of the American College of Surgeons. In addition, he had 387 satisfied questioners.

Given my initial information, I received a response within about two minutes. Dr. Rick wanted to know whether my eye was bright red and whether could I send a picture. I responded that it was bright red, but I did not send a picture. I had, at this point, 10 minutes of expert work time left. I guess that if my situation was more complicated, I could have provided additional details.

After a few more minutes, I received this advice: “Thank you for that extra information. Good news! Everything is going to be OK. No need to worry.

“Please allow me to explain: You have experienced a subconjunctival hemorrhage, a common event that occurs to many people. In the vast majority of cases, subconjunctival hemorrhage is nothing to worry about. It is usually not a sign of any serious condition, but rather is just a small broken blood vessel in the conjunctiva that looks much worse than it really is. No treatment is necessary. Think of a subconjunctival hemorrhage as a bruise. The reason it looks so red (some people say it looks like a piece of raw meat) is that the skin on your eye is very thin, so the underlying blood shows through easily. On your arm, for instance, a bruise looks blue/purple because the overlying skin is thick, blocking the red color of the blood.

“Like a bruise elsewhere, a subconjunctival hemorrhage will slowly go away over the course of a couple of weeks. It may spread around the globe some and change colors as it clears. This is nothing to be concerned about.

“Does this make sense to you?”

Well, it did make sense to me because I already knew the diagnosis. I gave this first test of online diagnosis an excellent rating, which, by the way, was the feedback that I was asked to give.

The Bottom Line

To put this into perspective, the $43 I paid was $13 more than my co-pay would have been for my primary care physician. But, I would not have been able to get that appointment immediately. So, there’s a little give and take there. The information given to me was detailed enough and would have been reassuring if I were a naïve patient. But, what about more complex situations? I am guessing that the details of the explanation and diagnosis were carefully written and “canned.”

All in all, it was an interesting exercise, though I am not eager to try it again. But what about our patients? What is reassuring from my experience is that at least minor issues may be adequately managed. CLS

Dr. Semes is a professor of optometry at the UAB School of Optometry. He is a consultant or advisor to Alcon, Allergan, and Regeneron, and he is a stock shareholder in HPO.