Family telemedicine

Yesterday, I took a very long, slow walk to the mailbox at the end of our driveway. Regardless of my emotional state, it was going to be a difficult trip. A fresh 6 inches of snow on top of the several feet we already had received meant that I had to choose my footsteps carefully and climb the Continental Divide that the town plow guys had thrown up. Before I fired up the snowblower, I wanted to get this letter mailed, lest I have a change of heart.

It was time to renew my license to practice medicine, and my choices were to pay a hefty fee and scramble to collect enough Category I CME credits or check the box that said “withdraw reapplication.” It wasn’t a drop-dead decision because withdrawal would put me in limbo for another 5 years during which I could reapply. But I hadn’t seen a patient in the office for 2 years. I make frequent social visits to chat up the staff and bathe in the glow of having someone tell me how much they miss me. Apparently, they assign this task to different employees on a rotating basis. They seem to enjoy telling me how the place has gone in the toilet since I left. Of course, this observation has nothing to do with the fact that my departure coincided with the adoption of a new electronic health records system that they all hate with a passion.

Other than writing a prescription for amoxicillin on one of my social visits when they couldn’t find the doctor who had forgotten to do it, I hadn’t practiced office medicine in 2 years. I missed the patients and the camaraderie badly for the first 6 months, but I had crossed over the bridge. Well almost, this trip to the mailbox would complete the crossing.

But I was pretty sure that even without a license I would still be able to practice the kind of pediatrics that was keeping me busy. For the last 9 years, I have been practicing family telemedicine. You may have a similar practice. The requirements are simple. The basic requirement is at least one grandchild (a niece or nephew will do); having four grandchildren spices up the variety of the practice. They can live around the corner, but it is helpful if one family lives on the opposite coast. Each family must have a computer with a camera or a smartphone, and of course, a Skype or FaceTime contract.

The next ingredient is critical. Each grandchild’s medical home must be served by a phone tree and a triage system that guarantees that calls about acute problems will be returned in no less than 2 hours. And the chances of speaking directly to the child’s primary care physician before the following day’s afternoon should be slim to none. The child’s family should have the alternative of going to an emergency room that is at least a 45-minute drive away and may involve a copay that is on the order of a down payment on a small car.

Given these options, the parents (a.k.a., my children) have little choice but to call Dr. Grampy for an opinion. Needless to say, my family telemedicine practice is booming ... and I love it. When my wife’s smartphone rings (I have a dumb phone), it might be a hastily e-mailed picture from California of a molluscum lesion. “Dad, is this infected or is it just one of those that is dying.”

“She just fell in the bath tub. Does that front tooth look okay?” On two consecutive Thursday afternoons at exactly the same point in a doubles-tennis match, I had the opportunity to consult on a lacerated chin ... the same chin and the same child. “Band-Aid or a trip to the ED?”

There has been a bit of a learning curve for the photographers. But, once they understood how helpful it was to give me some frame of reference as to size of the lesion/wound and a hint as to what part of the body I was being consulted about, a picture or two has been worth a thousand words. And more than a thousand dollars that would have been wasted on copays for unnecessary visits.

As I trudged back up the driveway – still not convinced that giving up my license was the right idea – the family room door swung open and my wife yelled, her breath forming a frosty cloud, “Jenn is on the computer. Ada woke up with a rash, and she wants you to take a look!” No license is required.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping With a Picky Eater.” E-mail him at [email protected].

Yesterday, I took a very long, slow walk to the mailbox at the end of our driveway. Regardless of my emotional state, it was going to be a difficult trip. A fresh 6 inches of snow on top of the several feet we already had received meant that I had to choose my footsteps carefully and climb the Continental Divide that the town plow guys had thrown up. Before I fired up the snowblower, I wanted to get this letter mailed, lest I have a change of heart.

It was time to renew my license to practice medicine, and my choices were to pay a hefty fee and scramble to collect enough Category I CME credits or check the box that said “withdraw reapplication.” It wasn’t a drop-dead decision because withdrawal would put me in limbo for another 5 years during which I could reapply. But I hadn’t seen a patient in the office for 2 years. I make frequent social visits to chat up the staff and bathe in the glow of having someone tell me how much they miss me. Apparently, they assign this task to different employees on a rotating basis. They seem to enjoy telling me how the place has gone in the toilet since I left. Of course, this observation has nothing to do with the fact that my departure coincided with the adoption of a new electronic health records system that they all hate with a passion.

Other than writing a prescription for amoxicillin on one of my social visits when they couldn’t find the doctor who had forgotten to do it, I hadn’t practiced office medicine in 2 years. I missed the patients and the camaraderie badly for the first 6 months, but I had crossed over the bridge. Well almost, this trip to the mailbox would complete the crossing.

But I was pretty sure that even without a license I would still be able to practice the kind of pediatrics that was keeping me busy. For the last 9 years, I have been practicing family telemedicine. You may have a similar practice. The requirements are simple. The basic requirement is at least one grandchild (a niece or nephew will do); having four grandchildren spices up the variety of the practice. They can live around the corner, but it is helpful if one family lives on the opposite coast. Each family must have a computer with a camera or a smartphone, and of course, a Skype or FaceTime contract.

The next ingredient is critical. Each grandchild’s medical home must be served by a phone tree and a triage system that guarantees that calls about acute problems will be returned in no less than 2 hours. And the chances of speaking directly to the child’s primary care physician before the following day’s afternoon should be slim to none. The child’s family should have the alternative of going to an emergency room that is at least a 45-minute drive away and may involve a copay that is on the order of a down payment on a small car.

Given these options, the parents (a.k.a., my children) have little choice but to call Dr. Grampy for an opinion. Needless to say, my family telemedicine practice is booming ... and I love it. When my wife’s smartphone rings (I have a dumb phone), it might be a hastily e-mailed picture from California of a molluscum lesion. “Dad, is this infected or is it just one of those that is dying.”

“She just fell in the bath tub. Does that front tooth look okay?” On two consecutive Thursday afternoons at exactly the same point in a doubles-tennis match, I had the opportunity to consult on a lacerated chin ... the same chin and the same child. “Band-Aid or a trip to the ED?”

There has been a bit of a learning curve for the photographers. But, once they understood how helpful it was to give me some frame of reference as to size of the lesion/wound and a hint as to what part of the body I was being consulted about, a picture or two has been worth a thousand words. And more than a thousand dollars that would have been wasted on copays for unnecessary visits.

As I trudged back up the driveway – still not convinced that giving up my license was the right idea – the family room door swung open and my wife yelled, her breath forming a frosty cloud, “Jenn is on the computer. Ada woke up with a rash, and she wants you to take a look!” No license is required.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping With a Picky Eater.” E-mail him at [email protected].

Yesterday, I took a very long, slow walk to the mailbox at the end of our driveway. Regardless of my emotional state, it was going to be a difficult trip. A fresh 6 inches of snow on top of the several feet we already had received meant that I had to choose my footsteps carefully and climb the Continental Divide that the town plow guys had thrown up. Before I fired up the snowblower, I wanted to get this letter mailed, lest I have a change of heart.

It was time to renew my license to practice medicine, and my choices were to pay a hefty fee and scramble to collect enough Category I CME credits or check the box that said “withdraw reapplication.” It wasn’t a drop-dead decision because withdrawal would put me in limbo for another 5 years during which I could reapply. But I hadn’t seen a patient in the office for 2 years. I make frequent social visits to chat up the staff and bathe in the glow of having someone tell me how much they miss me. Apparently, they assign this task to different employees on a rotating basis. They seem to enjoy telling me how the place has gone in the toilet since I left. Of course, this observation has nothing to do with the fact that my departure coincided with the adoption of a new electronic health records system that they all hate with a passion.

Other than writing a prescription for amoxicillin on one of my social visits when they couldn’t find the doctor who had forgotten to do it, I hadn’t practiced office medicine in 2 years. I missed the patients and the camaraderie badly for the first 6 months, but I had crossed over the bridge. Well almost, this trip to the mailbox would complete the crossing.

But I was pretty sure that even without a license I would still be able to practice the kind of pediatrics that was keeping me busy. For the last 9 years, I have been practicing family telemedicine. You may have a similar practice. The requirements are simple. The basic requirement is at least one grandchild (a niece or nephew will do); having four grandchildren spices up the variety of the practice. They can live around the corner, but it is helpful if one family lives on the opposite coast. Each family must have a computer with a camera or a smartphone, and of course, a Skype or FaceTime contract.

The next ingredient is critical. Each grandchild’s medical home must be served by a phone tree and a triage system that guarantees that calls about acute problems will be returned in no less than 2 hours. And the chances of speaking directly to the child’s primary care physician before the following day’s afternoon should be slim to none. The child’s family should have the alternative of going to an emergency room that is at least a 45-minute drive away and may involve a copay that is on the order of a down payment on a small car.

Given these options, the parents (a.k.a., my children) have little choice but to call Dr. Grampy for an opinion. Needless to say, my family telemedicine practice is booming ... and I love it. When my wife’s smartphone rings (I have a dumb phone), it might be a hastily e-mailed picture from California of a molluscum lesion. “Dad, is this infected or is it just one of those that is dying.”

“She just fell in the bath tub. Does that front tooth look okay?” On two consecutive Thursday afternoons at exactly the same point in a doubles-tennis match, I had the opportunity to consult on a lacerated chin ... the same chin and the same child. “Band-Aid or a trip to the ED?”

There has been a bit of a learning curve for the photographers. But, once they understood how helpful it was to give me some frame of reference as to size of the lesion/wound and a hint as to what part of the body I was being consulted about, a picture or two has been worth a thousand words. And more than a thousand dollars that would have been wasted on copays for unnecessary visits.

As I trudged back up the driveway – still not convinced that giving up my license was the right idea – the family room door swung open and my wife yelled, her breath forming a frosty cloud, “Jenn is on the computer. Ada woke up with a rash, and she wants you to take a look!” No license is required.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping With a Picky Eater.” E-mail him at [email protected].