Exclusionary Criteria

DocYourWay, Inc. (“DYW”) provides telemedicine services to physicians, physician groups, and other health care professionals including DYW Medical Group, LLC, nurse practitioners, and physician assistants who are properly licensed and insured within their state of residence. The primary care physicians are usually board-certified in Emergency Medicine or Family Medicine, with additional properly licensed specialist physicians who are also Members. Even so, use of DYW was not created or designed to replace any primary care physician but to assist them in treating certain minor medical conditions. While Member physicians of DYW remain available for follow-up questions by patients, this service is not intended as the sole source for management of certain chronic conditions.

When a DYW Member physician determines a prescription is indicated, it can be sent to a preferred local pharmacy for convenient pickup. However, DYW Member physicians may not prescribe controlled substances, including narcotics, the sleep aids Ambien or Restoril, benzodiazepines, medications prescribed for weight loss, erectile dysfunction, or psychiatric medications (including refills) such as SSRIs, tricyclics, and antipsychotics.

Further, certain medical services are just not recommended when using telemedicine technologies, and, as such, not all conditions can be diagnosed or treated by engaging in a telemedicine consultation with a physician or other Member provider on DYW. Every case is unique and the facts and circumstances call for physicians to use their best judgment and discretion for the care of each patient’s situation, consistent with industry standards and best practices, so the following is for illustration and education only and may or may not apply in any given case. Physicians providing services through DYW collectively developed the following guidelines to assist Subscribing consumers in evaluating the use of telemedicine to obtain certain medical services.

Should an individual patient appear to fall within the descriptions set forth below, the Member physicians on DYW recommend that the consumer seek healthcare assistance from an in-person provider or facility, whether it is their primary care provider, a specialist, or an urgent or emergency care facility.

General:

  • Under age 3: Most patients under age 3 cannot be relied upon to adequately describe their symptoms. Children under age 3 also have more limited reserves, may quickly deteriorate, and often require an in-person examination by a physician.

  • Ages 3 to 5 and unable to vocalize or describe a problem: When child is unable to describe his or her symptoms, it is important to see a pediatrician or family doctor who can provide an in-person examination to diagnose the patient.

  • Over age 69: Some patients over age 69 suffer from one or more chronic health conditions that may limit a Member Physician’s ability to safely treat a particular condition of this person with telemedicine.

  • On dialysis: Patients on dialysis may suffer from fluid or electrolyte abnormalities and require laboratory testing as part of their examination.

  • On chemotherapy: Patients on chemotherapy may experience problems, which can require immediate laboratory testing as part of the examination.

  • Has a pregnancy-related problem: A pregnant patient presents as two patients, the mother and her fetus. While the mother is able to describe the symptoms she is experiencing, it is crucial that the treating doctor check out the effects of the mother’s condition on the fetus. This can often only be done with an in-person examination.

  • Ingestion of poison, foreign, or toxic substance: These patients often need immediate first aid in neutralizing and/or removing the substance from their system in a hospital emergency department.

  • Fever greater than 104 F or 40 C: A fever at this level may be evidence of an acute process that will require immediate medical intervention with the need for further testing and an in-person examination by a physician.

Any patient who does not fit any of the above-listed criteria, but presents with any of the following problems may be instructed to go to the nearest hospital emergency room, or seek care from a physician in-person, as these symptoms may indicate a serious life-threatening condition:

  • Fever greater than 103 F/39.5 C associated with any of the following:

    • Difficulty breathing

    • Dizziness or confusion

    • Neck pain

A fever accompanied by any of the foregoing may be evidence of an acute infectious process in the brain or lungs, or another part of the body, and require immediate evaluation in a hospital emergency department.

  • Head pain with the following characteristics:

    • Worst headache of my life or a very severe headache

    • A personal or family history (blood relative) of subarachnoid hemorrhage or aneurysm

    • Dizziness or confusion

    • Loss of vision

    • Hypertension or diabetes or alcoholism

    • Fever and stiffness of neck

    • Regular use of blood thinner medications, such as Coumadin, Lovenox, Plavix, Warfarin, Heparin

    • Alcoholism

Headaches that meet any of these criteria may be a sign of bleeding in the brain, or impending stroke, and require immediate presentation to a hospital emergency department where emergent brain imaging studies may be done to rule out or treat a stroke.

  • Chest pain with the following characteristics:

    • Severe or crushing chest pain

    • Member is 35 years of age or older (with exception of chest pain starting after minor trauma)

    • Hypertension or diabetes

    • Cocaine or crack use

    • Dizziness or confusion

    • Difficulty breathing

Chest pain that meets any of these criteria may be a sign of heart attack, acute heart disease, or damage to the heart muscle and require immediate presentation to a hospital emergency department where emergent heart monitoring and imaging studies may be done to rule out or treat a heart attack or other types of heart disease.

  • Abdominal pain with the following characteristics:

    • Severe pain

    • Dizziness or confusion

    • Blood in vomit or from rectum

    • Chest pain, back, or groin pain

    • Previous intestinal obstruction

Abdominal pain that meets any of these criteria may be a sign of an acute problem with various abdominal organs requiring immediate presentation to a hospital emergency department where emergent testing and imaging studies may be done to rule out or surgically treat a variety of digestive, reproductive, circulatory, or other acute problems.

  • Bleeding with the following characteristics:

    • Uncontrolled bleeding anywhere on or in the body

    • Use of blood thinner medication such as Coumadin, Lovenox, Plavix, Warfarin, Heparin

    • Dizziness or confusion

    • Blood from eye or ear

Bleeding that meets any of these criteria may be a sign of an acute problem with various organs requiring immediate presentation to a hospital emergency department where emergent testing and imaging studies may be done to rule out or medically or surgically treat a variety of digestive, reproductive, circulatory, or other acute problems.

  • Difficulty breathing with following characteristics:

    • Persistent difficulty breathing that is moderate or severe

    • Dizziness or confusion

    • Chest pain

Difficulty breathing that meets any of these criteria may be a sign of an acute problem with the respiratory or circulatory systems requiring immediate presentation to a hospital emergency department where emergent testing and imaging studies may be done to rule out, or medically or surgically treat the acute problem.

  • Fall, injury, or trauma with following characteristics:

    • Obvious fracture, dislocation, or inability to move a body part

    • Severe pain

    • Pain in the neck or eye

    • Pain in the abdomen

    • Dizziness or confusion

    • Difficulty breathing

    • Uncontrollable bleeding

A history of trauma that meets any of these criteria requires immediate evaluation in a hospital emergency department where emergent testing, imaging studies, and surgery may be necessary to treat these acute problems.

  • Insect bite, sting, or allergic reaction

    • Throat or tongue swelling

    • Hives or welts

    • Difficulty breathing

    • Dizziness or confusion

    • Previous severe allergic reaction

Patients with these symptoms may be undergoing anaphylaxis, the most severe allergic reaction. These symptoms may require a call to 911 and evaluation in an emergency department.

  • High blood pressure

    • Dizziness or confusion

    • Chest pain or difficulty breathing

    • Systolic pressure (top number) greater than 190

    • Diastolic pressure (bottom number) greater than 110

Patients with high blood pressure and these associated symptoms may be having a severe form of blood pressure leading to stroke or a heart attack and should be seen immediately in an emergency department.

  • High blood sugar

    • Dizziness or confusion

    • Persistent vomiting

    • Chest pain or difficulty breathing

    • Fever greater than 101.5 F / 38.6 C

    • Most recent blood sugar measurement over 400

Patients with diabetes have little reserve and are more susceptible to major medical problems. If a diabetic has any of these symptoms, they may require an acute evaluation in an emergency department.

  • Shoulder pain

    • Not associated with trauma, injury, or arthritis

Shoulder pain may be a subtle form of a variety of problems including a heart attack. If the pain is not due to arthritis, an injury, or trauma, the patient may require an acute evaluation in an emergency department.
Other medical conditions may be excluded at the discretion of physicians using DocYourWay on a case-by-case basis.
PLEASE NOTE: This Exclusionary Criteria is a set of general recommendations developed by physicians using the DocYourWay platform to assist Subscribers in seeking the best available care. It is not intended as a definitive or final list, nor is it a specific recommendation for any one person. This information may be updated from time to time in accordance with industry best practices and the recommendations of Member physicians of DocYourWay.

Last Updated: February 14, 2016