Weird things happen on the Internet, even to doctors.
These days, anyone with an Internet connection can reach a doctor at anytime and from anywhere. Typically, it costs about $40 to $50 to schedule a video visit with a physician, via a crop of venture-backed mobile apps like MDLIVE and Doctor on Demand.
The doctors using these apps typically deal with colds and flus, but from time to time, something a lot more horrifying happens: Full frontal exposure.
Specifically, male patients are flashing their doctors.
"There was a period where it was happening to some of our doctors once a week," recalls Bob Kocher, an investor in Doctor on Demand. Kocher says it did not happen more frequently to female doctors, as the user didn't know who they were going to get once they requested a visit.
The sign-up process for these apps takes about 5 or 10 minutes, and users are asked for basic personal data and their health insurance details. But in many cases, these individuals will attempt to hide their identities by using aliases.
"One of the challenges was in blocking certain individuals, if they used false information," said Ian Tong, Doctor on Demand's chief medical officer.
Tong says the company tried to fix the problem by canceling accounts of known offenders and attempting to connect these people to mental health support whenever possible. It also shuttered marketing campaigns that offered free trials, which tended to attract this kind of behavior.
MD Live CEO Randy Parker has similarly dealt with inappropriate behavior, especially when users believe they are anonymous. And Jay Parkinson, CEO of Sherpaa, which charges a flat fee for access to a doctor via an app or on the phone, received more than 30 pictures of men's genitals after launching a partnership with Vice, where anyone could text a doctor to get their health questions asked.
"It's the Internet," he said.
This behavior might be commonplace among social media apps -- Snapchat famously began as a sexting app -- but it brings up some intriguing questions about privacy and anonymity when it occurs in a health care context. The burgeoning market for telemedicine is expected to reach $24 billion by the end of 2020, given the changing regulatory environment and the challenges for people who live in rural areas to access a physician.
It also hints at new challenges as doctor's offices shift from physical spaces to the Internet. Online, such behavior is more common, experts say, as it it gives some individuals a false sense of anonymity and that they will not be held accountable for their actions.
American Well, a Boston-based app company that provides virtual visits, has also experienced this sort of behavior, which it classifies as harassment.
"I think what's important to note is that the issue you're raising – the exposure dilemma – is really one of a few ways in which patients may use the system inappropriately," says Roy Schoenberg, the company's CEO. "We have a systematic approach to managing it that in many ways is reflective of how doctors deal with problematic patients in traditional settings." That includes shutting off the user's login, and verifying the ID through credit card authorization. That prevents an individual from using the service a second time.
Health care apps that deal with patients are beholden to privacy and security rules, known as HIPAA.
Experts have said that if users share medical information in the process of signing up for these apps, it would be protected under privacy laws. The live interaction might also be protected, if the doctor counsels the user to seek help -- both Doctor on Demand and MDLive now offer a tele-mental health service.
"If the doctor offers council it then becomes treatment and is covered as protected health information under HIPAA (federal privacy rules)," said Michael O'Hara, a certified security compliance specialist.
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