Out of the Blue

I thought my virtual doctor's appointment yesterday went quite well. This was finally a follow-up on our physicals from a few months ago so it made sense for a teleconference just to discuss test results. We did not like the doctor who did our original checkups, but MrsBlue and I liked the new doctor a lot, so we will stick with her. This will be my first female doctor, which I'm imagining will make the more intimate aspects of my next in-person check both more and less awkward. I can definitely see why many of you said that this is probably the future of medicine. Some consultations with a doctor just require conversation, so it will save everyone time, effort, and exposure to illness to avoid office visits when they are unnecessary. As an example, even via video she was able to confirm my self-diagnosis of tendonitis. She says the wraps I bought to help with this were the right move, and suggested a heating pad as an additional treatment.

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33 Replies. 2 pages. Viewing page 1.
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33.
 
Re: Out of the Blue
Jun 7, 2020, 17:19
33.
Re: Out of the Blue Jun 7, 2020, 17:19
Jun 7, 2020, 17:19
 
Patrick wrote on Jun 7, 2020, 08:21:
It's multifactorial, but the big reasons that come to mind immediately:
1. I don't have my staff prepping the patient and cleaning up the chart before I get to them. Which means it's a few more things I need to do -- on top of all the other "one more things" that the wonderful EHR packages we all use now have shifted to the clinician. That takes time.
2. How many incidental issues are we not picking up without being able to examine the patient? That's worrisome to us.
3. Learning curve re: patients can't log on / can't connect / the audio isn't working / the video isn't working / whatever. So you spend time trying to troubleshoot the issue, may eventually abandon it and handle the patient over the phone. The phone visits are reimbursed at a dramatically reduced rate. From a business standpoint you can't keep spending more time to receive less. Makes it hard to pay your staff.

PS I don't get much time to game anymore (although I'm loving playing Zelda: BOTW with my 6 year old - I'm a little late to the party on that one) but I still check your page almost every day, as I have since the days of shareware Quake and figuring out how to add a Diamond Monster Voodoo 1 card to my PC. I get more out of the news / tech links now. Keep up the good work!

Thanks for explaining. Our state passed a law requiring telemedicine visits reimburse at the same rate as in-office visits. CMS did the same, so I just your PB patients are reimbursing less? Hopefully CV19 will force your state to rectify this before too many of you go out of business.

As for the prep, my oncologist had his staff call me a few days ahead of time to make sure all the tech issues were resolved before the actual appointment. The staff guy laughed and said it was a big learning curve for him to figure all this stuff out, but after doing 25 people or so he'd gotten pretty good.

As for playing games with your kids, I recommend the Lego games. They're couch coop split screen so you can play together on one PC (or console). Check out Trine and Rocket League too.
To prevent CV-19, avoid the Serious Seven: weddings, funerals, faith-based activities, bars, gyms, house gatherings and other small events.
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32.
 
Re: Out of the Blue
Jun 7, 2020, 11:31
32.
Re: Out of the Blue Jun 7, 2020, 11:31
Jun 7, 2020, 11:31
 
@Patrick, I copied what you wrote and emailed all my friends.
I titled it "Be kind to your telemedicine doctor, they're tired"
And prefaced it with;
"A doctor said telemedicine was more tiring than in-office visits (I'm paraphrasing)
Here's his response when asked why."

I think you have the makings of a great editorial that many papers would publish.
Thanks
A mask is not a political statement.
It's an IQ test.
It's a compassion test.
It's a decency test.
It's a social responsibility test.
Avatar 58135
31.
 
Re: Out of the Blue
Jun 7, 2020, 11:10
31.
Re: Out of the Blue Jun 7, 2020, 11:10
Jun 7, 2020, 11:10
 
Patrick wrote on Jun 7, 2020, 08:21:
It's multifactorial, but the big reasons that come to mind immediately:
1. I don't have my staff prepping the patient and cleaning up the chart before I get to them. Which means it's a few more things I need to do -- on top of all the other "one more things" that the wonderful EHR packages we all use now have shifted to the clinician. That takes time.
2. How many incidental issues are we not picking up without being able to examine the patient? That's worrisome to us.
3. Learning curve re: patients can't log on / can't connect / the audio isn't working / the video isn't working / whatever. So you spend time trying to troubleshoot the issue, may eventually abandon it and handle the patient over the phone. The phone visits are reimbursed at a dramatically reduced rate. From a business standpoint you can't keep spending more time to receive less. Makes it hard to pay your staff.

PS I don't get much time to game anymore (although I'm loving playing Zelda: BOTW with my 6 year old - I'm a little late to the party on that one) but I still check your page almost every day, as I have since the days of shareware Quake and figuring out how to add a Diamond Monster Voodoo 1 card to my PC. I get more out of the news / tech links now. Keep up the good work!

Interesting take on the downsides of remote doctoring... thanks for explaining. It does seem like it's going to take more tinkering to make it a sustainable part of the medical practice going forward. And your concern that some diagnoses will be missed seems quite well-founded.

It's pretty understandable that your gaming time isn't what it once was, but I love hearing stories about people sharing the hobby with their kids. Glad you're still getting value from the site, though. Thanks for the kind words.:)
Stephen "Blue" Heaslip
Blue's News Publisher, Editor-in-Chief, El Presidente for Life
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30.
 
Re: Out of the Blue
Jun 7, 2020, 08:21
30.
Re: Out of the Blue Jun 7, 2020, 08:21
Jun 7, 2020, 08:21
 
It's multifactorial, but the big reasons that come to mind immediately:
1. I don't have my staff prepping the patient and cleaning up the chart before I get to them. Which means it's a few more things I need to do -- on top of all the other "one more things" that the wonderful EHR packages we all use now have shifted to the clinician. That takes time.
2. How many incidental issues are we not picking up without being able to examine the patient? That's worrisome to us.
3. Learning curve re: patients can't log on / can't connect / the audio isn't working / the video isn't working / whatever. So you spend time trying to troubleshoot the issue, may eventually abandon it and handle the patient over the phone. The phone visits are reimbursed at a dramatically reduced rate. From a business standpoint you can't keep spending more time to receive less. Makes it hard to pay your staff.

PS I don't get much time to game anymore (although I'm loving playing Zelda: BOTW with my 6 year old - I'm a little late to the party on that one) but I still check your page almost every day, as I have since the days of shareware Quake and figuring out how to add a Diamond Monster Voodoo 1 card to my PC. I get more out of the news / tech links now. Keep up the good work!
29.
 
Re: Out of the Blue
Jun 6, 2020, 15:17
29.
Re: Out of the Blue Jun 6, 2020, 15:17
Jun 6, 2020, 15:17
 
Blue wrote on Jun 6, 2020, 13:56:
Patrick wrote on Jun 5, 2020, 17:01:
I'm a primary care doc for about 18 years. My health system tried getting us involve with telemedicine a couple years ago and we didn't get any real traction until covid-19 struck. It definitely has its place but, in general, lots of patients don't love it. Seems to be a generational gap.
Many of my colleagues aren't in love with it, either. For some reason many of us find it more fatiguing than seeing patients in person (i.e. I'm WIPED OUT after a day of seeing 20 telepatients compared to seeing 20 patients in-person).
Probably the biggest determinant will be payor willingness to continue reimbursing for such services. Medicare has basically said they will pay indefinitely during the pandemic (who defines when that's over?). Some private payors have agreed to continue through July. Others won't give us an answer at all.

Interesting. It's hard to understand why doctors find the online consults more fatiguing than the in-person variety. I wonder what causes that?

I can't speak for him, but my experience:

"As a tech guy, the analogy is me sitting at my daughter's laptop trying to fix an issue she's having with it, vs. me being on a business trip and trying to diagnose and fix issues with her laptop over the internet with her driving. The former allows me to focus on the actual laptop issue, while the latter I need to think about the issue while also concentrating on communicating technical things in layman's terms so she can fix it herself. That's at least twice as much energy expended, if not more."
To prevent CV-19, avoid the Serious Seven: weddings, funerals, faith-based activities, bars, gyms, house gatherings and other small events.
Avatar 22024
28.
 
Re: Out of the Blue
Jun 6, 2020, 14:28
Jivaro
 
28.
Re: Out of the Blue Jun 6, 2020, 14:28
Jun 6, 2020, 14:28
 Jivaro
 
Based on my wife's experience as a nurse, it's being in that chair and not moving around. When she focuses on getting up and moving around between appointments, she feels much better at the end of the day. Go figure. Us nerds have known that forever.
Avatar 55841
27.
 
Re: Out of the Blue
Jun 6, 2020, 13:56
27.
Re: Out of the Blue Jun 6, 2020, 13:56
Jun 6, 2020, 13:56
 
Patrick wrote on Jun 5, 2020, 17:01:
I'm a primary care doc for about 18 years. My health system tried getting us involve with telemedicine a couple years ago and we didn't get any real traction until covid-19 struck. It definitely has its place but, in general, lots of patients don't love it. Seems to be a generational gap.
Many of my colleagues aren't in love with it, either. For some reason many of us find it more fatiguing than seeing patients in person (i.e. I'm WIPED OUT after a day of seeing 20 telepatients compared to seeing 20 patients in-person).
Probably the biggest determinant will be payor willingness to continue reimbursing for such services. Medicare has basically said they will pay indefinitely during the pandemic (who defines when that's over?). Some private payors have agreed to continue through July. Others won't give us an answer at all.

Interesting. It's hard to understand why doctors find the online consults more fatiguing than the in-person variety. I wonder what causes that?
Stephen "Blue" Heaslip
Blue's News Publisher, Editor-in-Chief, El Presidente for Life
Avatar 2
26.
 
Re: Out of the Blue
Jun 5, 2020, 23:01
26.
Re: Out of the Blue Jun 5, 2020, 23:01
Jun 5, 2020, 23:01
 
NKD wrote on Jun 5, 2020, 22:12:
NWA said it best.

"Fudge the Polite Gentlemen in Uniform?"
To prevent CV-19, avoid the Serious Seven: weddings, funerals, faith-based activities, bars, gyms, house gatherings and other small events.
Avatar 22024
25.
 
Re: Out of the Blue
Jun 5, 2020, 22:59
25.
Re: Out of the Blue Jun 5, 2020, 22:59
Jun 5, 2020, 22:59
 
doctors are the body's tech support staff and people are... well, people are stupid customers. nothing changes heh. still good analogy!
24.
 
Re: Out of the Blue
Jun 5, 2020, 22:59
24.
Re: Out of the Blue Jun 5, 2020, 22:59
Jun 5, 2020, 22:59
 
Cutter wrote on Jun 5, 2020, 17:08:
The Half Elf wrote on Jun 5, 2020, 14:35:
Due to waiting 8 weeks for any update to my Unemployment Case, the phone was disconnected (all while trying to call Unemployment 10 times a day and await responses to applications). What viable Voice service's are there on the PC that are free or as stupid cheap as possible? Thanks Guys.

Isn't it illegal to disco phones/kill power/evict where you are? That's the case in most places I know of.

Yeah, I thought all the major carriers had agreed not to disconnect everyone for a few months, but maybe that's running out already.
To prevent CV-19, avoid the Serious Seven: weddings, funerals, faith-based activities, bars, gyms, house gatherings and other small events.
Avatar 22024
23.
 
Re: Out of the Blue
Jun 5, 2020, 22:57
23.
Re: Out of the Blue Jun 5, 2020, 22:57
Jun 5, 2020, 22:57
 
Patrick wrote on Jun 5, 2020, 17:01:
I'm a primary care doc for about 18 years. My health system tried getting us involve with telemedicine a couple years ago and we didn't get any real traction until covid-19 struck. It definitely has its place but, in general, lots of patients don't love it. Seems to be a generational gap.
Many of my colleagues aren't in love with it, either. For some reason many of us find it more fatiguing than seeing patients in person (i.e. I'm WIPED OUT after a day of seeing 20 telepatients compared to seeing 20 patients in-person).
Probably the biggest determinant will be payor willingness to continue reimbursing for such services. Medicare has basically said they will pay indefinitely during the pandemic (who defines when that's over?). Some private payors have agreed to continue through July. Others won't give us an answer at all.

I think the odd thing for me is that it's kind of pointless until we get some kind of in-home tools that can send data to the doctor for analysis. I was joking earlier about Theranos, but getting reliable temp, heart rate, O2 sats, etc. data to you guys would at least add some hard numbers to the "I don't feel well doc" kind of complaints you're going to get over Zoom.

I think the exhausting part for you as a doctor is that in person, you can assess a patient in a few minutes without asking too many questions. Over the internet, you have to spend a lot of mental energy getting the patient to describe issues to you, and then make some kind of diagnosis based on very limited information, assuming the patient didn't misunderstand.

As a tech guy, the analogy is me sitting at my daughter's laptop trying to fix an issue she's having with it, vs. me being on a business trip and trying to diagnose and fix issues with her laptop over the internet with her driving. The former allows me to focus on the actual laptop issue, while the latter I need to think about the issue while also concentrating on communicating technical things in layman's terms so she can fix it herself. That's at least twice as much energy expended, if not more.
To prevent CV-19, avoid the Serious Seven: weddings, funerals, faith-based activities, bars, gyms, house gatherings and other small events.
Avatar 22024
22.
 
Re: Out of the Blue
Jun 5, 2020, 22:12
NKD
22.
Re: Out of the Blue Jun 5, 2020, 22:12
Jun 5, 2020, 22:12
NKD
 
NWA said it best.
Thou art an artless, greasy tallow-catch.
Avatar 43041
21.
 
Re: Out of the Blue
Jun 5, 2020, 21:17
21.
Re: Out of the Blue Jun 5, 2020, 21:17
Jun 5, 2020, 21:17
 
So disgusted they aren't allowed to hurt civilians with impunity they quit the squad. Did they ask for their mommies too?
"Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly, and applying the wrong remedies." -- Groucho Marx
20.
 
Re: Out of the Blue
Jun 5, 2020, 21:05
20.
Re: Out of the Blue Jun 5, 2020, 21:05
Jun 5, 2020, 21:05
 
57 Buffalo officers resign from special squad over suspension of two who shoved 75-year-old
Buffalo would be better served by firing all 57.
A mask is not a political statement.
It's an IQ test.
It's a compassion test.
It's a decency test.
It's a social responsibility test.
Avatar 58135
19.
 
Re: Out of the Blue
Jun 5, 2020, 20:40
19.
Re: Out of the Blue Jun 5, 2020, 20:40
Jun 5, 2020, 20:40
 
Finished season 2 of Homecoming, it's good. I never listened to the podcast.
A mask is not a political statement.
It's an IQ test.
It's a compassion test.
It's a decency test.
It's a social responsibility test.
Avatar 58135
18.
 
Re: Out of the Blue
Jun 5, 2020, 19:58
18.
Re: Out of the Blue Jun 5, 2020, 19:58
Jun 5, 2020, 19:58
 
Patrick wrote on Jun 5, 2020, 17:01:
I'm a primary care doc for about 18 years. My health system tried getting us involve with telemedicine a couple years ago and we didn't get any real traction until covid-19 struck. It definitely has its place but, in general, lots of patients don't love it. Seems to be a generational gap.
Many of my colleagues aren't in love with it, either. For some reason many of us find it more fatiguing than seeing patients in person (i.e. I'm WIPED OUT after a day of seeing 20 telepatients compared to seeing 20 patients in-person).
Probably the biggest determinant will be payor willingness to continue reimbursing for such services. Medicare has basically said they will pay indefinitely during the pandemic (who defines when that's over?). Some private payors have agreed to continue through July. Others won't give us an answer at all.

wooo a doctor blueser. nice!
17.
 
Re: Out of the Blue
Jun 5, 2020, 17:13
17.
Re: Out of the Blue Jun 5, 2020, 17:13
Jun 5, 2020, 17:13
 
Patrick wrote on Jun 5, 2020, 17:01:
Medicare has basically said they will pay indefinitely during the pandemic (who defines when that's over?).
The end of the pandemic should be based on Science and testing testing testing but under the current lack of leadership it will be based on the stock market.
A mask is not a political statement.
It's an IQ test.
It's a compassion test.
It's a decency test.
It's a social responsibility test.
Avatar 58135
16.
 
Re: Out of the Blue
Jun 5, 2020, 17:08
16.
Re: Out of the Blue Jun 5, 2020, 17:08
Jun 5, 2020, 17:08
 
jdreyer wrote on Jun 5, 2020, 16:24:
RedEye9 wrote on Jun 5, 2020, 14:59:
Good luck. Reminds me never to move to Florida or Kentucky.

IIRC, intentionally those states defunded unemployment offices a few years ago in order to make them not work so that people would be "forced" to find jobs. Gotta love it.
RepubliCONs at their finest.
And that sweet feature about having health insurance through your employer, hows that working for the 40 million folks who lost their job.
A mask is not a political statement.
It's an IQ test.
It's a compassion test.
It's a decency test.
It's a social responsibility test.
Avatar 58135
15.
 
Re: Out of the Blue
Jun 5, 2020, 17:08
Cutter
 
15.
Re: Out of the Blue Jun 5, 2020, 17:08
Jun 5, 2020, 17:08
 Cutter
 
The Half Elf wrote on Jun 5, 2020, 14:35:
Due to waiting 8 weeks for any update to my Unemployment Case, the phone was disconnected (all while trying to call Unemployment 10 times a day and await responses to applications). What viable Voice service's are there on the PC that are free or as stupid cheap as possible? Thanks Guys.

Isn't it illegal to disco phones/kill power/evict where you are? That's the case in most places I know of.
Morty: You sold a gun to a murderer so you could play video games?
Rick: Yeah, sure, I mean, if you spend all day shuffling words around, you can make anything sound bad, Morty.
Avatar 25394
14.
 
Re: Out of the Blue
Jun 5, 2020, 17:01
14.
Re: Out of the Blue Jun 5, 2020, 17:01
Jun 5, 2020, 17:01
 
I'm a primary care doc for about 18 years. My health system tried getting us involve with telemedicine a couple years ago and we didn't get any real traction until covid-19 struck. It definitely has its place but, in general, lots of patients don't love it. Seems to be a generational gap.
Many of my colleagues aren't in love with it, either. For some reason many of us find it more fatiguing than seeing patients in person (i.e. I'm WIPED OUT after a day of seeing 20 telepatients compared to seeing 20 patients in-person).
Probably the biggest determinant will be payor willingness to continue reimbursing for such services. Medicare has basically said they will pay indefinitely during the pandemic (who defines when that's over?). Some private payors have agreed to continue through July. Others won't give us an answer at all.
33 Replies. 2 pages. Viewing page 1.
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