Pregnancy and Breast Feeding

I recently took care of a woman with a classic exacerbation of chronic bronchitis.     Smoker, productive cough with purulent sputum, temporal fever of 101.3,  symptoms for 7 days.       I was preparing my prescription for doxycycline as I ran through my standard set of questions—and it turned out she was breastfeeding her 2 month-old.         She never volunteered the information until I asked her directly.      ...

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Different Approaches to Telemedicine Care, One Good Rule of Thumb

One of my telemedicine service partners just announced that they no longer want clinicians to treat tick bites—all should be referred to urgent care.     Don’t know if they lost a lawsuit, had a risk-review or if it was something else.       But does bring up a good rule of thumb—If the telemedicine service partner you work with pushes you to be more conservative with your care, that’s ok. If they push...

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All The Characteristics of a Great Investment

One day, after paying all your bills and paying down your debt you might notice you have some money left over for you to save and invest—what should you do with it?     In case you haven’t noticed, we’re in the middle of the “everything bubble.” Every sort of asset:  stocks, bonds, rental property, precious metals, and even digital currencies have been mispriced. Even the dividends of large, formerly staid companies are being called...

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Be Careful: Your Goals and Your Telemedicine Service Provider’s Goals Are Not the Same

If you contract to provide services through a telemedicine service provider remember that their goals and yours are not the same. Their goal is to make money. So is yours. But the amount of risk you’re willing to take on in pursuit of that goal is markedly different. In their case, getting sued is the cost of doing business. In your case, it’s devastating. So manage your patients and do your documentation to your standard,...

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Telemedicine and Rectal Chief Complaints

Telemedicine encounters for parts of the body the patient can’t see are problematic—none more so than problems with the rectum.     Don’t assume any rectal problem is simply hemorrhoids—even if the patient identifies it as such.     Fissures, fistulae, undiagnosed IBD are only a few of the problems that it’s not uncommon to miss.     And don’t let the patient try to bully you into the use of video encounters to try to...

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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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