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Virtual Primary Care Visits

I’m a virtual primary care physician seeing my patients while traveling. I call myself a digital nomad physician and most of my patients are remote workers or nomads of some kind.

As a California-licensed doctor, I can only see patients who are located in California which limits my reach but it’s better than having no access at all.

Practicing Medicine Virtually

My physician mentors always say that we’ve been doing telemedicine since the 70s except now health institutions can bill for it. Any time you talk to a patient on the phone about their health it’s telemedicine. Except now the rules have changed.

My patients prefer virtual care because they are generally healthy and prefer to see the same physician no matter where they are in the world.

I prefer to run a virtual primary care practice because I don’t want to be tied down to the same chair in the same zip code. From Spain to Germany to Mexico, I am grateful that I can travel and continue my relationship with my patients.

Primary Care Medicine Online

As a family medicine doctor, I see all ages and often help patients prevent chronic diseases or manage chronic conditions. Admittedly, most of my patients are healthy which is a bit of a selection bias for the traveling lifestyle.

It’s not difficult to get lab tests and medications when necessary. The tough part is to know whether you need it in the first place.

My job is to make sure that my patients don’t get unnecessary pain meds, antibiotics, or imaging studies that they don’t need.

Virtual Primary Care Visits

Each of my appointments is 1 hour long. We leave enough room for idle chit chat and we can dive deep into medical conditions from prevention to home remedies to the latest research.

Traditionally, you call the office and book an appointment. After parking your car you have to check in and get your vitals done by the nurse. You wait for the doctor to show up and 10 minutes later you walk out with a new diagnosis or prescription.

This isn’t how I interact with my own doctor so I don’t want that for my patients. I want to get along with my primary care doctor and feel comfortable and not rushed.

I can text my patients, leave voice messages, and we can send images and videos back and forth. It’s like a real conversation and it’s not constrained by a physical location or a short time limit.

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Chronic Disease Care

It’s tough and time-consuming to try to be your own doctor. Of course, it’s best to feel connected to your body and educate yourself regarding its ins and outs. But when it comes to chronic disease care, it’s good to have someone else involved.

Common Chronic Diseases

The top chronic diseases we deal with are mental health issues, metabolic problems, and pain-related medical problems.

Hypertension, high cholesterol, osteoarthritis, and depression are the most common issues I deal with. Not all of these require medications. In fact, many are better managed through lifestyle changes.

Saving Money on Care

In the traditional insurance model income is generated when the patient is seen by the doctor. And the more complex the case the more money is earned.

This is likely why we call the US healthcare system a disease-based model. Of course, it has incredible upsides as well. If you suffer major trauma or anything acute, a US hospital is likely going to do quite well.

In my practice, I sell my expertise on an hourly basis. The patient is who pays me and that’s who my customer is.

I save my patients money because we think about chronic disease care from all aspects, not just which treatment to offer but how to prevent it. It’s also important to factor in how a particular medical condition affects your long-term health outcome.

Cash-Based Healthcare

I charge a flat hourly rate for my expertise. I answer directly to my patients and not an insurance company. This incentivizes me to keep my patients healthy instead of generating profits from coming up with new ICD-10 codes for new chronic medical conditions.

This isn’t the perfect solution for everyone. If you need expensive IV infusions or specialist care, the cost can rapidly get out of hand when you pay cash.

However, 90% of chronic diseases can be managed through a simple conversation with your doctor and the occasional prescription medication. With the ultimate goal of using the least number of interventions possible.

1. Hypertension

Instead of immediately starting anti-hypertensive medications, chronic diseases like high blood pressure benefit from breathing exercises, stress management, a functional approach to nutrition, and some natural remedies.

I love the work of Dr. Weil and Dr. Low Dog when it comes to natural remedies for common chronic medical conditions. It’s rarely dangerous to try these options first.

If necessary, I prescribe medications such as ACE-Inhibitors or Calcium Channel Blockers in order to control high blood pressure. Always with the goal of stopping these eventually once the blood pressure is controlled naturally.

2. High Cholesterol

Your cholesterol may be high but if your diet, stress, and inflammation is controlled and you do not have a strong family history of cardiovascular disease the question is whether you’d benefit from a statin or PCSK9 inhibitor.

The ever-popular atorvastatin drug can be paid for cash for as little as $15 for a 1-month supply through GoodRx. But, again, just because it’s cheap, it doesn’t mean you need it.

A lipid panel test needs to be done but every few years won’t cost more than $60 through Quest Direct.

3. Osteoarthritis

My main concern with osteoarthritis isn’t to wait until my patient needs a joint replacement. Rather, how can I prevent them from ever needing surgery?

Joint injections and prescription medications will only expedite the time of surgery. Instead, my patients benefit from a change in their diet and meeting with movement specialists and physical or occupational therapists.

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All Posts Urgent Care

When to Call 911 for a Health Emergency

I see many patients with non-urgent health issues in my urgent care practice. And so, in the ED, doctors see patients who don’t have health emergencies. So how do you know when a health issue is an emergency and when to call 911?

Driving Yourself to the ED

If you are feeling faint, dizzy, or could be having a heart attack or stroke, it’s too dangerous to drive yourself.

You would also delay your care since patients brought in by ambulance will have a higher care priority.

The worst thing would be to drive to an ED that’s full or on divert or may not have the specific specialty services you may need.

When you call 911 for a health emergency, they know where to take you for what condition.

The Cost of the Ambulance

Sometimes in your life, the price of something should be ignored. It’s hard to put a price on your health, and my patients regret not doing something sooner.

Sure, you could call an Uber or Lyft instead, but even an $800 ambulance fee is better than getting stuck in the ED for 6 hours.

Paramedics in an ambulance are also quite experienced in handling an emergency. They administer life saving medication immediately and relay important information to the doctors.

Long Wait Times in the ED

In my urgent care, the wait times are 2 hours which is the new normal after the pandemic.

Many emergency departments are experiencing 6-12 hour waits. These wait times in the ED happen because many remain uninsured or underinsured in the US.

Because emergency care cannot be denied, the person can go to the ED for a medication refill or a persistent cough and obtain treatment.

Paramedic Evaluation

The best part of calling 911 for a health emergency is that the paramedics evaluate you on the spot.

They can run basic tests and check your vital signs. If something is off, you’ll be alerted immediately. If you aren’t as sick as you feared, they can tell you what other options you have.

When in Doubt, Call 911

How much do you value your health? That’s not an easy question to answer. But many of us value it highly because it affects our day-to-day enjoyment of life.

If you feel a sudden pain, suffer trauma, or experience anything out of the ordinary that puts you on alert, call 911 because it could be a health emergency.

It’s better to let healthcare experts decide what needs to be done than sit there and guess.

Common Emergencies that are Often Missed

Headache

Severe headaches can be emergencies, especially if you’ve never felt them before. Often, most end up being migraines or tension headaches.

A headache that wakes you up in the middle of the night or worsens with exertion is worrisome and should be evaluated immediately.

Sudden Pain

Sudden chest pain, jaw pain, and back pain that seems unprovoked deserve a visit to a clinician. If it’s ongoing and causing sweating or nausea, I recommend calling 911.

If it came on and is resolving, perhaps an urgent care visit will suffice.

Laceration

Many will suffer cuts on the feet, face, and hands from the day-to-day stuff. If it’s a job site-related injury, it’s better to go in because you may need thorough cleaning and a tetanus injection.

Most EDs have a fast-track where you can be seen faster for the non-acute stuff.

Abdominal Pain

Sudden abdominal pain with nausea or tenderness needs an evaluation. Things can go wrong quickly in the intestines. From perforation to obstruction to bleeding.

If the pain is tolerable, then the urgent care will suffice. If the pain is severe and you’re immobile, then 911 is better than driving yourself to the ED.

Weakness

Sudden weakness or difficulty with speech or movement is always a 911 health emergency. Time is everything when it comes to such neurovascular emergencies.

Vomiting

Vomiting associated with chest pain or abdominal pain that starts suddenly could be a heart issue but often ends up gastrointestinal.

If you are at risk for heart conditions, then 911 is the best option. If it seems intestinal, then the urgent care would be a better option.

Bloody Stool

Bloody diarrhea often happens from intestinal infections. This differs from small blood spots, often due to hemorrhoids or anal fissures.

If massive bleeding is mixed in with the stool, it’s better to get evaluated immediately. Especially when having severe abdominal pains and multiple bowel movements daily.

Call 911 if your instincts tell you it’s serious – no need to doubt yourself.

Coughs and Colds

For sudden shortness of breath, calling 911 is the right action. But it’s often safe to wait to see your primary care doctor or go to a walk-in clinic or urgent care for coughs and colds with or without fevers.

Visions Changes

Sudden double vision, blurred vision, or flashers and floaters that aren’t going away deserve immediate evaluation.

We want to rule out damage to the retina or the optic nerve.

This can’t be adequately done in the urgent care; the ED is a better place for this.

Trauma

Any potential fracture or laceration should ideally be managed in the emergency department. Sure, I can handle most of it in the urgent care.

But in the urgent care, sometimes we don’t have access to x-rays or I cannot perform specific procedures.

If it’s minor trauma, it’s best to do a Google Maps search for nearby urgent care. Call them ahead and ask if they can handle your particular trauma.

All significant head trauma deserves an ED visit.

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Does Diverticulitis Require Antibiotics?

Those with a diverticular disease can occasionally develop a flare-up called diverticulitis. But does diverticulitis require antibiotics?

This recent article by Dr. Jill caught my attention, and I wanted to share it with my patients.

Diverticulitis

The American Gastroenterological Association recommends managing each diverticulitis case uniquely.

No need for everyone to immediately start on oral antibiotics. However, it’s a bit of an art to determine who benefits from a conservative approach versus the immediate use of antibiotics.

Conservative Managemment

I manage my patients conservatively by having them switch their diet immediately when they feel a diverticulitis flare-up coming.

I address the decision of antibiotics and diverticulitis if I don’t see improvement with the following steps.

Diet

Most patients benefit from switching to a low-fiber diet. But low fiber doesn’t tell us much, does it? I eat a bowl of fruits daily along with a primarily whole-plant-based diet. For me, a low-fiber diet would be cutting out the bowl of fruits.

My patients know I’m a stickler for data. Track how you feel when you try a particular diet during a flare-up. We make adjustments for the next flare-up and get it dialed in.

Hydration

I prefer hydrating with water, and others prefer to get their hydration through food.

Regardless of your style, you’ll have less water available in your circulation during colon inflammation. Adding a little more will help.

Exercise

I like my patients to walk around and engage in gentle resistance training during a diverticulitis attack.

They are to avoid anything that will exhaust their system or dehydrate them.

Movement improves gut peristalsis and improves enteric blood flow.

Inflammation

Inflammation is a new-age word similar to stress. I get it, some are averse to using it. But it remains a big deal in medicine.

Antibiotics for diverticulitis are effective, primarily because of their anti-inflammatory properties.

If I lower inflammation in my patients, they often respond favorably. As Dr. Jill points out in the article, the initial stages of diverticulitis are an inflammatory process.

With the lining of the diverticular pouch inflamed, it loses its protection against bacteria. That’s how an infection can set in.

Getting Treatment

If these steps fail or high fevers and worsening pain develops, it may be time to treat diverticulitis with oral antibiotics.

If you’re traveling and won’t have access to the proper medications, it’s best to have some antibiotics on hand.

I often aim to treat with a less broad-spectrum medication and only escalate to a double-antibiotic regimen if this fails.

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All Posts Primary Care Telemedicine Urgent Care

Telemedicine for Digital Nomads

I’ve been a remote worker since 2016 and a digital nomad since 2017. As a wild rock climber, I collect injuries, and as a middle-aged man, I need primary care. Telemedicine for digital nomads was born out of this need.

My home base is in Portland, Oregon, but I spend a lot of time in Europe. Specifically, in Spain.

Telemedicine for Digital Nomads

Most of my patients are young and generally active. They have little need for primary care. But they definitely need urgent care services.

If my patients are in California, I can prescribe them medications there since I have a state medical license.

But oftentimes, my patients are abroad. They have diarrhea in Cambodia or fevers in Egypt. Knowing the common pathogens in those areas is important and having connections on the ground for good quality care is critical.

Different countries manage illness differently. It’s not my way or their way. But if you are US-based, then there is a standard of care you’re accustomed to. That’s what I deliver.

Lab Tests Abroad

Even in the US, you can get lab tests done for quite cheap. It’s just that the cash prices aren’t advertised, and most of us are only familiar with how much our insurance is billed.

I can get a full STD panel or cholesterol panel for my patients for less than $50. Often even less than that with my Telemedicine for Digital Nomads practice.

Overseas, lab tests are far cheaper, except in parts of Europe. Often you won’t need a prescription for a lab test, nor do you have to be seen by a doctor first.

A visit with me saves you the headache of spending money on a lab test you never needed in the first place.

Emergency Care

Outside of the US, healthcare is quite affordable. Rarely will you need to go to the emergency room for anything. Most clinics or urgent cares can handle even basic emergency needs.

When in doubt, it’s always safer to call an ambulance. But when your life isn’t in immediate danger, I prefer that you contact my telemedicine for digital nomads service so that we can discuss your options.

Many countries offer home calls where the physician and their team visit you.

Overseas Imaging Studies

Imagine you are abroad and suffer a knee injury. Do you need an x-ray, an MRI? That’s the first thing to figure out.

Next, where do you get this done? Usually, you can go to a private hospital and request the study. But you might save money if you visit a doctor and have them order it for you.

Telemedicine

My digital nomad telemedicine services include primary care for ongoing chronic issues. Things like high blood pressure or diabetes are common.

But the bulk of my care is urgent care. During our telemedicine visit, we can discuss your symptoms, and I’ll assess the severity of them, and we can discuss what to do next.

Prescription Medications

Even though I don’t have to prescribing rights overseas, many pharmacies will honor your own doctor’s prescription even if it’s not in that country.

I have talked to pharmacies internationally to get my patients the care they need.

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