Update 10February2019: We had to give up on the Jitsi Meet teleconferencing server. It was just too unreliable: it would break in new and interesting ways every time the developer issued an update. We're going to try using Signal. Read everything below if you think you might want to try it.
I do not get along with telephones. At all. I have a terrible time understanding what people are saying, even with perfect connections on high-end equipment. With real-world wonky cellular connections, it seems hopeless. To make matters worse, people often seem to misunderstand what I have told them during a phone call. That might be okay if I’m setting up a lunch date, but when I’m trying to give people medical advice and tell them how to manage potentially life-threatening conditions, it just isn’t acceptable. After too many near disasters, I have simply given up using phones altogether.
Nothing, and I mean nothing, substitutes for being in the same room with someone.
So what if you’re an established patient whom I know well, and you need to have an appointment, but you just can’t make it into the office? We are experimenting with using Signal, the only publicly-available video conferencing system that meets our standards for privacy, security, and confidentiality.
Signal requires that you have an iPhone or Android phone (or iOS and Android tablet) and a phone number. Install Signal from your Android or iOS app store to start, then link it to our phone number (916-282-0889).
Know these things:
- I absolutely will not do a telemedicine visit for a brand-new patient. You must be an established patient before I will consider using telemedicine. (This is a legal requirement as well as being necessary for me to be confident that I’m giving you appropriate treatment.)
- Your first telemedicine visit using Signal must be scheduled for an hour. There just isn’t time to troubleshoot a new Signal connection and have a decent patient visit in a half-hour window.
- I absolutely must know a day in advance if we’re doing a telemedicine visit. The hardware I need to use Signal lives at my home, and I need to know to bring it to the office if it’s going to be needed.
In addition to all that, there are simply things that won’t work by telemedicine, such as new prescriptions for DEA-controlled medications (opioid painkillers; tranquilizers like Xanax, Valium, or other benzodiazepines; stimulants for treating ADHD) or issues that require a physical examination. In general, we are going to reserve telemedicine as a last resort for established, stable patients who have no other options. Please don’t ask for a telemedicine visit just because it isn’t convenient to come into the office.
If you have Signal installed and have linked to our phone, make an appointment by calling (916-282-0889), texting (916-282-0889), or emailing (firstname.lastname@example.org). Be sure that Amy knows you’re asking for a telemedicine appointment before she schedules it — she might have to check with me first if we’ve been having problems. And be sure you’re scheduling for an hour if you have never done a telemedicine visit with us before using Signal.
Above all, please remember that this is new and experimental. It simply might not work. I will update here as we get more experience with Signal and telemedicine.