During the pandemic, we are encouraging everyone to use our telemedicine system whenever possible.
Please note that we won’t see messages or receive calls through Signal except during the time you have scheduled an appointment. Use regular email, texts, or phone calls unless it’s during a scheduled appointment.
You can call (on the regular phone) and talk to Amy if you want to practice with Signal before your first appointment (I recommend you do so!). As always, do all your scheduling through Amy.
Please read through the rest of this post at least once so you know what to expect.
Update 08June2020: An interesting post from the developer of Signal on privacy issues in an age when we're protesting racism and police brutality.
Update 29March2020: If you don't like Signal or would prefer using a laptop or desktop computer instead of a mobile device, or if you need to have more than two people (me and you) in the appointment, I have re-activated the old Jitsi Meet telemedicine server (at a new address). Just follow the instructions on the Alternate Telemedicine Platform page.
Update 25March2020: The DEA has officially waived the rules regarding face-to-face visits for prescribing controlled medications. A telemedicine visit now counts as an in-office visit during pandemic stay-at-home rules. It has to be an audio+visual telemedicine system. Phone calls are not acceptable.
Update 15March2020: In order to reduce the velocity of the spread of novel coronavirus SARS-CoV-2, we are going to encourage more use of telemedicine in the coming weeks. If you would like to have a telemedicine visit instead of coming in person, please read below and let us know if you would like to try it. We have suspended the request that initial telemedicine visits be scheduled for a full hour, and we no longer ask that you have exceptional need before scheduling for telemedicine. Just wanting to avoid public exposure is sufficient.
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 now using Signal – Private Messinger, 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 – Private Messenger from your Android or iOS app store to start, then use Signal to call our phone number at your appointment time (916-282-0889 for Ron Risley; 916-266-6372 for Sonny Cline).
You make a telemedicine appointment the same way you make any appointment: by calling, texting, or emailing Amy directly, not through Signal.
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.)
- I need to 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.
- Signal is for scheduled telemedicine visits ONLY. Please do not ever use our Signal address for any reason unless you have a telemedicine appointment. I will not see, and thus cannot respond to, text messages, voicemail messages, or unscheduled video calls sent via Signal.
In addition to all that, there are things that simply won’t work by telemedicine, such as new prescriptions for DEA-controlled medications (opioid pain medications; tranquilizers like Xanax, Valium, or other benzodiazepines; stimulants for treating ADHD) or issues that require a physical examination (such as upper respiratory symptoms). In general, we are going to reserve telemedicine for established, stable patients who need to avoid an in-person visit.
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.