Query by the Washington Academy of Family Physicians re telehealth:

1. How many follow up calls do you do per week?

I put 1-3. (Well, it's really zero now because I am fucking disabled from family medicine. I have had more than one person call me at home. "You will always be my doctor," said one. "Then you are paying me in wine and dinner, damn it." He did bring me a bottle of wine. No record of that telehealth visit. It was covid travel and vaccine advice and sick advice. Jesus. Disabled and I still fucking have to work.) (Actually I don't know what they mean by "follow up call". WTF? I am sure medicare has documented what it is in 6 pages of governmentese, the fuckers.)

2. What are some aspects of telehealth that have proven helpful, even if they were unexpected?

Well, I got my fourth pneumonia from patients who took their masks off in the room, (about half, and now I am disabled from doing family medicine, which sucks. So I suppose if I had been 100% telehealth, I would still be practicing. On the other hand, early in covid I saw a man with "constipation" who actually had appendicitis. On telehealth it would have been damned easy to miss. He was reluctant and afraid to go to the emergency room until he got there. His appendix was removed that day. He called and thanked me the next day. Yeah.

3. What would you want policymakers to know about your experiences (individually or organizationally) with telehealth?

It's a pain in the ass. It is harder to tell what is going on, I can't do an exam, my patients averaged about age 75 and were highly variable in their technology skills. I have retired Boeing and UW professors, and so half my patients could figure it out* and the other half were rather a nightmare. Because I was a solo family doctor in rural places on a really tight budget, I used messenger when I had to. You can connect through Facebook without friending someone and if a person had a Facebook page they could access, I could usually walk them through connecting on messenger. It isn't hipaa compliant, but I told the patients that and documented it in the chart and well, you do what you fucking have to to try to take care of people. I did switch over to phone and just not get paid when I had to. I also used the free version of one of the telemedicine platforms, which I think was sort of kind of hipaa compliant. My clinic was so small that I am in the 5% that never got hacked, I just wasn't worth it, but I had 650 active patients when I closed, the oldest of whom was 98. At one point I had 5 people over 100 and two who were 104, so I am a very skilled geriatrician. Once people are over 90, the physician should let them steer the boat and give as little medication as possible and stop medicines at any opportunity. Aren't you sad that people not wearing their masks shut me down for good? By the way, the insurance companies need to be closed down and medicare for all, I am one of the infamous Mad as Hell Doctors (madashelldoctor.com) and I could have taken care of twice as many seniors if we had medicare for all. And I took veterans too even though the fucking VA would change their goddamn rules every 3 months. I loved my veterans but the VA is incredibly heavy duty for fucking paperwork. Damn them. If you policymakers don't vote for single payer medicare for all, I predict that fully 1/3 of doctors and nurses are going to quit due to covid-19 and burnout from fucking insurance and paperwork. And it could be 50%. That is the silver fucking lining to covid-19: I think it will get us single payer in the US. After half the doctors and nurses quit and there is no one to take out a god damned appendix.

Have a nice fucking day.

I forgot to add that the insurance companies should pay for phone calls to patients. Actually, that has passed already, because, hey. Some people can't fucking afford fucking internet.

*The Boeing engineers mostly could and the UW professors mostly couldn't.

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