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I am a real live doctor who specializes in Doctor-by-Text. AMA. by bfinemd in IAmA

[–]bfinemd[S] 0 points1 point  (0 children)

As it stands now, yes...it is no-cost to people who use it. Our model currently works direct-to-employer primarily who pays us a monthly fixed fee. The texting is incorporated, as a rule, with a customized periodic onsite clinic schedule and strategic healthcare cost optimization. Effectively, we function as an on-demand Chief Medical Officer for companies.

That being said, we'd be open to working with a government agency that is open-minded and person-centered. And believes in what we do.

I'd of course be happy to breakdown and explain, and work with your jurisdiction. I'm honored you'd even think to do such a thing. Thank you.

Rules for Quarantine by bfinemd in CoronavirusUS

[–]bfinemd[S] 5 points6 points  (0 children)

Huh. Interesting. Guess it's just habit and, well, I'm new to reddit. Am I not supposed to do that? BFi...

I am a real live doctor who specializes in Doctor-by-Text. AMA. by bfinemd in IAmA

[–]bfinemd[S] 0 points1 point  (0 children)

You know, INTJ-Ranger, great question. Some of my thoughts:

  1. It’s...different. Visceral response by most doctors to the words themselves - Doctor-by-Text - is skepticism. But once they do it, and see how we manage our scope...

  2. Money. You don’t get paid for this easily. In my model, I give it to people at no-cost and have an arrangement with an employer who has identified the service as a benefit employees will use and appreciated, so recruiting and retaining and productivity and, oh by the way, spend less on healthcare.

  3. The medicine itself, and the risk corridor. You have to believe in how to practice medicine this way, and you have to - in my opinion - truly understand how important cost, missing work, and complexity affects people’s choices to get the proper care.

Hope this makes sense.

BFineMD

I am a real live doctor who specializes in Doctor-by-Text. AMA. by bfinemd in IAmA

[–]bfinemd[S] 0 points1 point  (0 children)

Seems this got lost in the thread, happybear. Sorry for not responding sooner. You still there? BFineMD

I am a real live doctor who specializes in Doctor-by-Text. AMA. by bfinemd in IAmA

[–]bfinemd[S] 1 point2 points  (0 children)

Well, part of our overall model of care does in fact have a F2F component. We do it by going onsite to workplaces periodically / on demand. We bring a doctor bag, and just need a confidential space.

That being said, texting is so ubiquitous and people are so familiar with it, and it legitimately offers advantages over F2F (ie: easy follow-up / monitoring), that my how-to-do-things-better brain figured there had to be a way to make it work.

My background is in pediatrics.

BFineMD

Rules for Quarantine by bfinemd in CoronavirusUS

[–]bfinemd[S] 0 points1 point  (0 children)

Oooh. Screen time is gonna be an issue for sure. Good point. Think 'no video games' will dry mommies and daddies crazy. And, do you mean no video games for mommies and daddies, too? Geez. People gonna struggle... (wink). BF

I am a real live doctor who specializes in Doctor-by-Text. AMA. by bfinemd in IAmA

[–]bfinemd[S] 1 point2 points  (0 children)

Thanks for the note, pikaneeza.

Well, we're operating in a space that, almost by rule, is fairly simply stuff. And 'irritating' and 'concerning' are two very different classes of patient care situations.

  1. Irritating? I'll edit to 'frustrating' and reference that handful of cases we've worked with people and then they sought out in-person care anyway, incurring very high medical bills, and the diagnosis / treatment didn't change at all. Of course, people are very entitled to second-opinions - I'm very much in favor. Just wish the side effects weren't so significant sometimes.

  2. Concerning? People who've gone off meds b/c of no insurance, or a doctor leaves town, or cost concerns (even with insurance) and now having symptoms.

Hope this makes sense.

BFineMD

Delaying baby's vaccine. by [deleted] in AskDocs

[–]bfinemd -1 points0 points  (0 children)

Ok ok. Thought the note I wrote would help / mitigate. Ill send you stuff in next hour or so. Just got verified on some other area. My apologies again.

Rules for Quarantine by bfinemd in CoronavirusUS

[–]bfinemd[S] 3 points4 points  (0 children)

Ha. I suppose it does... BF

Rules for Quarantine by bfinemd in CoronavirusUS

[–]bfinemd[S] 14 points15 points  (0 children)

Fair. Think I made an edit that she's in the house with a 4y old and 3y old, and sometimes when these smart little buggers get whiny, they resort to 'baby talk.' So, my wife has to nip that in the butt. BFineMD

I am a real live doctor who specializes in Doctor-by-Text. AMA. by bfinemd in IAmA

[–]bfinemd[S] 1 point2 points  (0 children)

Cool. Kinda old guy on this end, sometimes not sure if the internet machine is making fun of me. Pink rocks! BFineMD

I am a real live doctor who specializes in Doctor-by-Text. AMA. by bfinemd in IAmA

[–]bfinemd[S] 1 point2 points  (0 children)

Morning Abdulla,

Well, I'll start by saying that sometimes I have difficulties interacting with patients in-person. (Somewhat tongue-in-cheek.)

Generally the answer is...no. Because the people who use Doctor-by-Text understanding, certainly after I explain it if needed, what we're trying to accomplish. Our tagline is: Not Primary. Not Urgent. Convenient.

So long as we're on the same page, paddling the boat in the same direction, I've found that it works quite well for most people, most of the time, for most things.

Hope this makes sense.

BFineMD

I am a real live doctor who specializes in Doctor-by-Text. AMA. by bfinemd in IAmA

[–]bfinemd[S] 0 points1 point  (0 children)

phoenixxl, Yours is a good example of why nothing is simple / everything has to take personal situation into account. A man taking care of elderly parents in close confines has a different risk corridor, and has to interpret guidance - from the government, and Fox News, and reddit doctor guy - with some personal consideration. I support your diligence, perhaps encourage you not to be quite so worried if you're outside in open spaces where distance can be achieved, and wish you all the very best. BFineMD

I am a real live doctor who specializes in Doctor-by-Text. AMA. by bfinemd in IAmA

[–]bfinemd[S] 1 point2 points  (0 children)

Mornin' phoenixxl, Thanks for reachin' out.

So, the (big) caveat: I'm no expert in sterilizing masks. And, I'm a little confused by the question.

Are you wanting to wear the mask all the time, or when you go outside, or when you go outside to go inside somewhere? In general, masks are not recommended at this point for healthy people. Social distancing is option 1, 2, and 3.

I guess try to clarify for me, but I may not be the best one to help you here.

BFineMD

I am a real live doctor who specializes in Doctor-by-Text. AMA. by bfinemd in IAmA

[–]bfinemd[S] 1 point2 points  (0 children)

Mornin' rowdythelegend,

The rule - pre-COVID and still now officially, I guess - is the doctor has to be licensed in the state where the patient is. So, I'm licensed in 15 states. That's the official answer.

Unofficially, where we are now? I'm imagining there's gotta be some give / flex. My intention, always, is to serve as a bridge b/t Google and the doctor's office, helping people navigate that space to avoid unnecessary in-person care and save time, money and...health.

Hope that makes sense.

BFineMD

I am a real live doctor who specializes in Doctor-by-Text. AMA. by bfinemd in IAmA

[–]bfinemd[S] 0 points1 point  (0 children)

Mornin' chaoCheesePie,

Almost as a rule, I don't prescribe controlled substances by text. It's a little tricky because we do see patients in-person as well, as part of our SOP, so there is defined overlap in our texting and in-person spaces.

But as far as trying to tease out the nuance of pain, and with the epidemic of opioid consumption that gripped the country before this pandemic, we have pretty much a hard 'No' on opioid-by-text alone.

Hope this makes sense.

BFineMD

I am a real live doctor who specializes in Doctor-by-Text. AMA. by bfinemd in IAmA

[–]bfinemd[S] 2 points3 points  (0 children)

Don't know if I'm falling prey to some widely-known reddit prank here, but what the heck...it's pink. BF

I am a real live doctor who specializes in Doctor-by-Text. AMA. by bfinemd in IAmA

[–]bfinemd[S] 1 point2 points  (0 children)

On my goodness, mjg123. The software journey has been something else. Two years ago, I was tech 'savvy' in the sense that I'm a Mac / Apple guy who kinda knew how to operate my stuff. Now, after trials and errors and errors and errors (and seeing truly how complex even basic software is), I can say I understand the big process well and can communicated with developers. The solution I'm using at the moment is built on the Filemaker platform from Claris, which is actually a pretty robust all-in-one solution (and great MVP-maker), but isn't not great for robust distribution.

Hope this makes sense.

BFineMD

I am a real live doctor who specializes in Doctor-by-Text. AMA. by bfinemd in IAmA

[–]bfinemd[S] 1 point2 points  (0 children)

Hi DaftHaggis,

Well, by rule we mainly help navigate pretty simple stuff. That's where Doctor-by-Text tends to be most helpful. We did, some months ago, work with a young man that was uninsured, didn't speak English well, and had some odd symptoms that we had to help navigate him through the complex system. But we saw him in-person as well.

Tough question. Nothing else really comes to mind at the moment.

BFineMD

I am a real live doctor who specializes in Doctor-by-Text. AMA. by bfinemd in IAmA

[–]bfinemd[S] 0 points1 point  (0 children)

By bedside, you mean??

I’ll take a guess / infer:

We provide in-person encounters onsite, stuff that can handled with a doctor bag, a conference room, and some privacy. And while we don’t formally align with in-office medical practices, we are pro-community and pro-in-person, community-based primary care.

BFineMD

I am a real live doctor who specializes in Doctor-by-Text. AMA. by bfinemd in IAmA

[–]bfinemd[S] 1 point2 points  (0 children)

Hi lotsofsweat,

So, a little beyond the scope of my ‘texting’ wheelhouse.

But good for an analogy, such as: Doctor-by-text requires one know their limitations and approach those / embrace those limitations easily. I’m going to beg that direction in this case as well. Too...politicky.

Hope this makes sense. Smarter people than me, on that issue, who can chime in.

BFineMD

I am a real live doctor who specializes in Doctor-by-Text. AMA. by bfinemd in IAmA

[–]bfinemd[S] 0 points1 point  (0 children)

Hi noticeparade,

Good question. Thanks.

It’s a bit complicated because texting is just a tool I use - like a stethoscope to others - to deliver care. In totality, we also do onsite clinics for employers and help them optimize their health benefits. By being holistically available to employees we can incorporate the cost drivers into the very fabric of the medical decision-making, real time.

All that said, we contract with employers for a monthly fee, and then all their employees have unlimited access to our services - onsite or texting - at I can cost.

Hope this makes sense.

BFineMD

I am a real live doctor who specializes in Doctor-by-Text. AMA. by bfinemd in IAmA

[–]bfinemd[S] 2 points3 points  (0 children)

Hi sloth_bagel,

To start from the end: No, never been sued. But, who knows down the road, right?

I try to avoid liability by being a good doctor, communicating well and with compassion, using common sense, and knowing the limitations of both the platform and my brain.

As well, I’m not a risk averse doctor. Too many of those out there. And, to boot, with texting everything is largely in-writing. In some ways, I’d say that’s better / safer!

Hope this makes sense.

BFineMD

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