Specialty Telemedicine Practice

 

Why choose Telemedicine?

    The convenience is of course one the major reasons people choose a "Talking Head" doctor. Not having to lose wages by taking time from work is both a savings for you and your business.

    The cost is likewise typically reduced in half when "seeing" an online physician. You can shop around and compare prices. "The Alliance for Connected Care concludes that a Telehealth visit for acute care represents $126 in savings over an in-person visit."  If you have no insurance then the cost savings can be dramatic.

    A 10 minute visit in So CA would cost a Medicare patient around $50 vs about $25 virtual, 20 min $85 vs $40, 30 min $125 vs $60, 45 min $185 vs  $90, 60 min $230 vs $115.

    You don't have to pay for gas, fight traffic or sit in a waiting room with coughing, sick people

       

    If you live in a rural region with few doctors or even if your new insurance makes you drive a distance to see an in network doctor, Telehealth is a solution and an alternative. International options exist.

    Odd hour visits can be scheduled..

    You have the same benefits of ePrescriptions, Lab and Imaging.

    Mine will be a solo practice. You will deal only with me. The concept that I am considering is a limited Concierge practice meaning I will not be caring for a lot of people. My approach will be Evidenced Based following guidelines. 

    The Electronic Health Record that I am using is Practice Fusion and your privacy is fully protected using HIPAA standards. The videoconferencing software, Vsee was developed for NASA by Stanford coders. It too is fully HIPAA compliant. Both software sets are entirely free which limits my overhead allowing my rates to reflect a discount. You are not dealing with a Multispecialist Group or Hospital Network, just with me.

     

    These are some of the services that I envision:

    Colds, Sinusitis, Soar Throats
    Skin rashes
    Minor urgent care
    Bladder infections
    Second opinions and research
    Patient Education
    End of Life Care
    Help you find the right doctor.
    Sleep Apnea diagnosis and treatment
    Diabetes
    COPD
    Bronchitis
    Asthma
    Many more
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What are the down sides of Telemedicine?

    Insurance conglomerates  haven't yet established criteria. My practice is a cash only business. You may not be reimbursed by insurance. I no longer work within the Medical Industrial Complex which has been decimating the Doctor-Patient Relationship for years. I am able to prescribe and order tests for CMS. Otherwise I am nonparticipating.

    There can be no Physical Exam or The Laying on of Hands. In my experience most diagnoses are made by taking a complete history. There are circumstances when an examination is important, so you will need a local physician in those instances.

    States have different regulations for Telemedicine and I may not be able to provide care in certain areas. There are also varying malpractice insurance criteria.

    Various illnesses are not appropriate for Virtual  Medicine. You and I must recognize the limitations of this type of practice as we are at a disadvantage. I cannot manage narcotic prescriptions online.

     

    I have constructed an electronic stethoscope for about $15.00 USD. Anyone can make one. Amazon.com has the miniature microphone and the cheap stethoscope. This will be ideal for telemedicine at any distance. It's a heart, lung, stomach and arteries examination. Of course I will have to teach you how to examine yourself. You then send the mp3 file to me through Vsee in a secure fashion.  I cannot do any interpretations in the US due to liability concerns but overseas even in poverty stricken countries I can.

    Sign up for an appointment if you want.

     

    I made this for about $12.00. It is a poor man's stethoscope. The head cost $6 and the mic about $6 too. This is my solution to the physical exam at a distance for my telemedicine project. It works on my PC where I can boost the mic volume.

     

    Electronic stethoscopes run around $800 and they're high quality for doctors. Http://Store.thinklabs.com/

     

    With a little practice people can record a complete cardiac and respiratory exam, check their arteries for bruits and listen to their abdomen. An mp3 can be sent and reviewed by me.

     

    Thinklabs has a free version of audacity which emulates a phonocardiogram on their website. I'll post my heart sounds at the mitral area.

     

    This could be taped to someones chest all night and using sound activated recording to suggest obstructive sleep apnea.

Hello.

I am Warren S. Goff D.O and I am offering a range of Telemedical (Telehealth) Services for your consideration.

I am a Board Certified Internist and Pulmonologist. I started practice as a Family Physician (FP/GP) in 1980, in Arizona and Florida. At that time, GPs were delivering babies and managed patients in the hospital including in the Intensive Care Unit (ICU). My internship was very heavy in Critical Care Medicine and I wanted to manage and care for  the critically ill. I went back for training and completed an Internal Medicine, Pulmonary Medicine and Critical Care, residency and fellowships respectively

I the joined  the College of Osteopathic Medicine located in the Des Moines University. I was an Associate Professor and taught Pulmonary Medicine to medical students, Physician Assistant (PA) students and Podiatry students while practicing my specialties. Throughout my career, I have taught and mentored Medical Students, Interns and Residents from around the country.

Thereafter, I moved back to Florida, where my entire family was, and started a busy hospital based, Specialty referral practice. I returned to medical education in 1996 and stopped clinical practice in Florida.

We then moved to San Diego CA and I returned to practicing Primary Care Medicine, which really was my first love. I worked at The Volunteers In Medicine clinic in El Cajon CA, taking care of indigent people and those who couldn't afford insurance. We had no resources as only a small grant and modest donations kept us afloat. I learned very quickly to use a cost effective approach and applying Evidence Based Medical guidelines. These days were the most rewarding experiences I've had in my 36 years  practicing medicine.

I have been a computer nerd since the 1970s. I started  programming with Fortran, Pascal and Basic. I originally used a Cray supercomputer  in college with punch cards to program. Today a PC is 40 times more powerful and a smart phone is 3  times faster than the Cray which filled an entire building. I continued to write medical computer programs assisting my clinical practice, even  the original handheld devices that I used at the bedside. These programs are available on my original website site.

I opened, perhaps the first medical reference website, The Cyberjournal of Medicine, in 1991. Doctors at that time were, and some still are, computer phobic.

Telemedicine seemed like a natural progression for me in medicine. I am a physician with 36 years of experience. I can provide computer skills and develop webpages. I am a proficient Internist with General Practice and Primary Care experience. I provide subspecialty care in Pulmonary Medicine. I am Board Certified and most importantly I am a teacher. I can educate you and answer your questions in easily understood words and not "medical jibberish". In addition I am an Osteopathic Physician who, like many other D.O.'s, applies a holistic approach and uses a philosophy behind patient care. (In college I majored in Philosophy at Vanderbilt University in Nashville Tennesee.) To me, the doctor patient relationship is sacrosanct.  It has been challenged and is losing to the Medical Industrial Complex.

 

 

 

 

 

 

 

These are my heart sounds recorded in the mitral area. I used Thinklabs free phonocardiogram software to touch it up and the $12.00 electronic stethoscope I made. It is way cool and cheap. The stethoscope tubing is too small to fit the mic head so you will have to improvise and find other tubing.

You need to use headphones  to listen to heart and  especially lung sounds. The sounds are low frequency and the ear is relatively insensitive to them. This called the Fletcher Munson Phenomenon

You can make your own electronic stethoscope. A tiny condenser microphone (http://tinyurl.com/h9clo5j) and a cheap stethoscope (http://tinyurl.com/jm49ckl). It costs about $15.00. I can show you how to examine your heart and lungs and take a listen to your bowel sounds.

 

Unfortunately for my US friends I cannot comment on the results as liability issues and malpractice threaten even free, volunteer medical doctors. It's sad that the system prevents free physician services to those without access or finances. It makes me sick.

 

Schedule an Appointment below,

Provide your information

and when approved you will receive

An encrypted link to the emaill provided

install the application

which is HIPAA compliant

and we can Video Conference

Vsee

    

 

 

 

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