Two Emails—One Message

Received from the same telemedicine provider on the same day:       “WE NEED YOU!!!!!  DUE TO HIGH, HIGH, VOLUME IN (THIS STATE) WE’RE ASKING YOU TO SIGN ON THE SYSTEM AND TAKE SOME ENCOUNTERS. HURRY, PATIENTS ARE WAITING!!!!”   and     “Dear Dr. You’re required to participate in this new training experience if you would like to continue to take encounters with our system. The experience can be accessed here (link). It...

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Malpractice Insurance and Telemedicine

There are two basic types of Malpractice Insurance   “Occurrence”—Covers you if the insurance was in force when the incident happened. “Claims Made”—Covers you if the insurance is in force when the lawsuit is filed, coverage can be extended with the one-time payment of a fee, a.k.a  “a tail.”     When evaluating an engagement with a telemedicine provider, “occurrence” coverage is the gold standard.  If your prospective employer offers occurrence coverage, that’s golden.  ...

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The Biggest Surprise Working Telemedicine

What’s been the biggest surprise in my telemedicine practice?     How appreciative people are.     Getting healthcare is a nightmare of paperwork and uncertain charges.     Telemedicine is quick, easy and transparent.     Patient expectations are so low when they seek medical care, that when they’re exceeded, they’re happy and thankful.     And you, as the clinician on the front line, reap the benefit.    

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Upon Finding a Healthcare Organization With “Clinician Wellbeing” as Part of its Mission Statement

I finally found a health system who has the wellbeing of their clinicians as part of their mission statement—but I had to practice telemedicine to do it.     Telemedicine services badly need physician labor.     And the labor has to be happy to please their customers.     In addition, most telemedicine services have an “on-demand” component. There’s no “non-compete,” no significant disruption for the clinician if they decide to simply stop taking...

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What Anthony Bourdain Taught Me About Telemedicine

In his great work “Kitchen Confidential,” Anthony Bourdain tells of how, when he was an itinerant cook in New York City, he always knew when the restaurant he was currently working in was getting ready to close.     The liquor distributor started asking for cash on delivery.     Time to find a new job.     One of my best telemedicine services recently stopped paying for missed encounters.     I would take...

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Watch For Services That Identify the Chief Complaint

In the ER or UC there were always those clinicians who coasted by picking up the easiest patients.       The colds, the UTIs, the yeast infections.       I’ve noticed the same thing happening in telemedicine.       In telemedicine systems that allow clinicians to know the chief complaint before picking up, there are those clinicians who only treat the easiest cases.       I recently spoke to one who...

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Read “The Digital Doctor”

The “Digital Doctor” is a must-read book for any clinician considering the practice of telemedicine.     It’s not as practical as mine, it’s more broad-ranging—especially regarding the rise of data collection in medical practice.     A great, quick read, the book gives you a great overview of what’s coming in the short term and how these services are being marketed to patients.     The data collected by these consumer health monitors is going to...

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Picking the Right Service to Work With

As a clinician, the telemedicine service provider you work with should pay you more if you have to sign up for shifts and/or do more than minimal charting.     The standard fee paid to a clinician for a primary care telemedicine encounter is currently $23. If you have to fill out past medical histories or enter allergies, you should ask to be paid more.     Your employer uses your free labor to subsidize...

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Repeat Back Your Med In Common Parlance One Last Time For Safety

You’re concluding your telemedicine encounter.   You’re considering prescribing a medication.   As you discuss your treatment plan with your patient, couch that med in common language.       “I’m going to prescribe you Bactrim, it’s a sulfa medication.”   “I recommend a course of ceftin, it’s related to penicillin.”   “Azithromycin is the best choice, so I suggest taking a Z-pack as directed.”       This gives your patient one more chance...

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Telemedicine Thursday—Kawasaki’s and Liability

If you miss Kawasaki’s in a febrile child because you treated them over the phone, does that mean you shouldn’t do telemedicine? Does this mean telemedicine is “too risky?” Nope. It means when you care for a child, ask about the appearance of their mucous membranes—and document. It means that you have to learn how to do telemedicine correctly—like any other skill. It means that, just like in the office, you have to do a consistently...

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