So, you haven’t done any acute care or primary care shit for a while. Maybe you’re a subspecialist in Internal Medicine or an ER provider. Maybe you’re an NP or PA in some specialty. Now you’ve been recruited to practice telemedicine.
The practice of telemedicine is easy and the risk is lower than traditional medicine. But don’t take it lightly because it’s as heavily regulated as any other provider-patient interaction.
The current viral pandemic has shifted all clinical practices online. From orthopedic surgeons to primary care clinics. We are all trying to manage our patients virtually.
We have fought for years with payers to let us perform a virtual practice and get reimbursed fairly. It didn’t make sense for the providers to all commute to the clinic, for the patients to all commute to the clinic, and for staff to all commute to the clinic.
Most of the visits are for rechecks, med refills, or questions about medications. The majority of medical visits aren’t even necessary – they are done so that we can bill and make money.
Imagine the footprint we have on the environment with all of these visits and unnecessary vital checking, driving, glove usage, etc.
Practicing telemedicine means that you can still collect an HPI, you can get an ROS, and you can even document a physical exam.
You’ll still come up with an assessment and a plan. You’ll list a DDx and you can prescribe medications and even send patients for imaging, labs, or studies.
The physical exam part is what everyone is hung up on. But when is the last time your stethoscope saved your ass in a QA case, a medical board investigation, or lawsuit?
The practice of telemedicine can replace all the in-office visits which don’t require a critical physical exam, a physical intervention, or a procedure.
Primary care is easy, don’t overthink it. Most patients need some screening tests such as orders for mammograms and some blood tests to screen for high cholesterol and diabetes.
The rest of it is medication management. And if you’re practicing virtual medicine then you’re adjusting blood pressure medication dosages, maybe adjusting some insulin, or prescribing the same old things.
If in doubt, you can simply type in “insulin management” or “hypertension management” and the word “workflow” and then click on the “images” tab in your browser and you’ll see tons of workflows that people have published.
I wish I could say that there is an art to Primary Care medicine. For someone who has been practicing it for a long time, it has all turned into a workflow.
Urgent Care is simple. Most patients are rather astute and self-triage into the right setting. You’re not going to get chest pain, SOB, or hypotensive on your schedule – can’t recall ever having that.
If you do, it’s often because it’s something rather benign. Most of your cases will be UTI’s, pregnancy issues which are simple, rashes, aches and pains.
Triaging the patient and giving them some advice is all you really need to do. When in doubt, reference Up To Date. It’s only like $60/month, month-to-month. It’s a worthwhile investment.
Physicians Practicing Telemedicine
For physicians who haven’t done telemedicine before or haven’t done the primary care or urgent care stuff, switching to telemedicine can be a bit stressful.
Look, I can’t think of anything better than my telemedicine course. I go through EVERYTHING you need to know. I go over the common diseases you’ll see, how to say no, and what patients to worry about.
For most telemedicine companies you can ask for lots of support from the medical director. If not, ask for more “shadowing” sessions – it’s a great way to get through the tougher cases.
But remember that you don’t have to see everyone. Feel uncomfortable with a particular patient? Just don’t accept the patient visit or tell the patient that you’ll get them someone more comfortable with that particular chief complaint.
APC’s Practicing Telemedicine
PA’s and NP’s … you guys are awesome. You’re really jumping into this telemedicine thing in this time of need. I know because y’all buying up my course, left and right.
You should always have someone else that you can bounce ideas off of. And if you purchased my course, you have access to my cell phone, so text me any questions you have and I’ll get back to you in real time.
Get a simple urgent care booklet which you can buy at any medical bookstore or order on Amazon. It’s a great reference for the most common conditions.
Again, remember, you don’t have to prescribe shit. You can simply reassure the patient which is worth so much.
Finally, once you master telemedicine, create a course and sell it to your APC colleagues.
Don’t prescribe meds! That’s the best advice I can give you. Sure, for obvious stuff like a UTI or med refill, do it.
But you should try to triage patients, give them advice on what to do at home. Don’t get into the habit of giving them something. All of a sudden you’ll be giving out mobic, tessalon, albuterol, and prednisone.
I was able to maintain less than 20% prescribing rates. And it served me very well and my patients left the visit happy. You can do it, but your wording matters. And I go over that in my telemedicine course in detail.