Our First Anniversary

Pre-R has weathered the first year, and we plan to carry on. New businesses typically face “dips” in their first months of life. Cautiously, I feel safe to say we’ve emerged from ours. It would be highly premature for me to drop emergency medicine and recommend other doctors jump on the Pre-R bandwagon, but we’re at a point now where income consistently exceeds expenses month after month. Most importantly, patients do seem pleased.

After a year of experimenting, our suggested fees approach finally feels like it has the right mix of fair and balanced now. We point patients to our suggested fees, but then accept what they’re able to pay. Vanessa is particularly skilled at keeping us in line here.

On the topic of telemedicine, interestingly, in the past few months some patients have requested use of Facetime/Skype. If you recall from previous reports, interest in telemedicine using Facetime or Skype, rather than simple “telephone-medicine,” used to be zero. However, something has changed. Perhaps it’s because patients are calling us more from outside of SLO when they read our reviews in Google or Yelp. Whatever the reason, I love it, especially when it saves a drive to Los Osos, Grover Beach or elsewhere.

As a side note, I can also report a completely new perspective on the common cold as a result of Pre-R telemedicine. When patients check into ERs with sniffles I have to confess some level of exasperation. They pull me away from patients with heart attacks, while threatening to hand their nasty bugs to other patients and staff, along with me and my family. In addition, after a prolonged ER wait, it’s much more difficult to say “I’m sorry, but your problem is caused by a virus and antibiotics won’t help,”… while thinking “I’m also sorry that your bill in 3-5 weeks could be $1000.” More irritation comes from my lack of interest in typing a prolonged medical record to convey essentially: “This patient has a cold.”

With Pre-R telemedicine, I’m happy to chat about the futility of antibiotics in treating viruses as long as needed. I’m happy to ponder with patients the merits of Ricola, neti pots, Sudafed, Afrin, Emergen-C, chicken soup and long hot showers. I’m also happy to type concisely in my record stating “Mr. X seems to have a cold. He’ll call me tomorrow if he feels worse or if he wants an X-ray or a house call, or if he wants to reconsider antibiotics.” Honestly, if Mr. X pays me or not is irrelevant. In fact, I’m generally psyched to be able to help someone without catching their cold, or having to document an absurd medical record about it!

I suppose thats more than a side note. Back to Pre-R.

House calls continue and the range of requests is ever expanding. Thanks to my close FP friends from residency, I’m learning quite a bit about primary care topics as well now. (Not many ER docs get to order the “Urease Breath Test” to chase down H. pylori and then treat it, but that’s now part of my repertoire!)

Our year in tech…

As for our website, Vanessa keeps tuning away. Our Anxiometer is up to 34 entries, with at least 50 more to go. We’ve also incorporated a products page, which will grow this year with a few new and exciting additions.

Our Cal Poly computer engineering team is making great progress on their Pre-R app as well. I’ve worked with many Cal Poly teams through the years, but this may be the one where the end of the year could reveal a finished product! If we were flooded with cash I’d love to hire each of these students today. Sadly, we’re competing with Apple, Google, Facebook, and the rest of Silicone Valley.

Looking forward to…

Just as exciting as the expansion of our virtual services is the expansion of our hands-on services. In February we hope to launch our “Pre-R Hydration Team.” Very few urgent cares or PCPs will insert IVs to infuse saline. So emergency departments frequently take the load. It’s surprising that our healthcare system sends exhausted, nauseous, dehydrated patients who just want to stay in bed, to ERs “for a bolus.” Traveling either by private vehicle or by ambulance, these patients may include pregnant women, pukey kids, drunk college students, or elderly folks who simply forget to drink… Kooky I say! Our Pre-R Hydration Team aims to fill that gap.

Kelsey Dunn and Summer Garcia are two friends and nurses who will soon be available (between their hospital shifts) to race to your homes to place IVs to run saline. Kelsey will cover South County, and Summer, North County. Very little that I’ve done in this past year has seemed to make patients feel better faster than running saline. Adding Kelsey and Summer to the mix will be wonderful.

Lastly, if you call with OB or peds questions, thanks to this past year of Max immersion training, we can promise you much more sympathy.

Here’s to year 2!

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