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Nine Reasons Why Healthcare Delivery Using Advanced Communications Technology Should Be Reimbursed

The patient had experienced excellent health for most of his life except for recurrent kidney stones since the age of 17. He served in Africa with the Peace Corps and had malaria in 1967 with no evidence of jaundice at that time. In 1982, he had a urological operation at a medical center for recurrent kidney stones, which showed medullary sponge kidney. At that time his platelet function was normal, but his alkaline phosphatase was slightly elevated. There was no evidence of an enlarged spleen at operation. Other than recurrent kidney stones, the patient was in excellent health until March 1994 when he was seen again at a medical center for kidney disease. A CT scan showed an enlarged spleen, kidney stones, and a somewhat small liver. His liver enzymes and alkaline phosphatase were slightly elevated. The patient experienced increasing fatigue, weakness in both arms with occasional numbness, pain in both arms, and arthralgias. In April 1995, the patient was seen by his local gastroenterologist for persistent elevation of liver enzymes. The examination was notable for an enlarged spleen but not for ascites or edema. Laboratory findings showed pancytopenia, negative hepatitis B & C serologies, and a normal ferritin. A bone marrow examination was interpreted as normal. Chest X-ray was normal, without hilar adenopathy, masses, or signs of active disease; a liver/spleen scan showed splenomegaly as well as abnormal uptake of the tracer in the liver without space occupying lesions. In May 1995, the patient was seen at a major medical center for evaluation by a liver specialist. Additional history revealed a father who had stomach cancer with metastatic disease to the liver and a mother who died of