September 14, 2026 3:16 PM
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ADHD evaluation
“If your ADHD evaluation plan is, ‘I’ll spend ten minutes on video and leave with an Adderall prescription’… SelfPayMD is probably not the right place for that.”
ADHD is a real medical condition, but diagnosing it properly usually requires more than a quick conversation.
A good evaluation may include your childhood and adult history, symptoms in more than one setting, school or work functioning, mental health history, sleep, substance use, medications, and other conditions that can sometimes look like ADHD.
For that reason, SelfPayMD generally does not perform initial ADHD diagnostic evaluations. We recommend establishing care with an appropriate in-person or specialty provider who can complete a thorough assessment.
And SelfPayMD does not prescribe or refill controlled ADHD medications such as Adderall, Vyvanse, or Ritalin.
However, if you already have a documented ADHD diagnosis and take a non-controlled medication such as atomoxetine—Strattera—, we may sometimes be able to consider a bridge refill after reviewing your records, medication history, and whether continued treatment is medically appropriate.
A refill is never automatic, and some patients may still need in-person follow-up.
So if you need a new ADHD diagnosis or ongoing stimulant treatment, please establish care with a clinician who provides that service.
SelfPayMD.com, Nationwide Telemedicine.
https://youtube.com/shorts/FpFqHMAxjNw?feature=share
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Social Security or Military Disability evaluations - generally not appropriate for telemedicine evaluation.
“If you’re applying for Social Security or military disability and your plan is, ‘I’ll meet a doctor online for ten minutes and get a disability letter’… that’s usually not enough.”
Disability evaluations are different from routine medical visits.
For Social Security disability, the decision often depends on detailed medical records, the severity and duration of your condition, and—most importantly—how it affects your ability to function and work.
For military or VA-related disability claims, evaluations may also require specific documentation, review of service and medical records, and sometimes a formal examination designed for the disability process.
Some parts of these evaluations may occasionally be done remotely, but many claims require hands-on examination, objective testing, or a clinician who is specifically performing a formal disability evaluation.
That’s why a brief telemedicine visit with a doctor who has never treated you is generally not the right setting to determine whether you meet disability criteria.
Telemedicine may still help with your ordinary medical care, medication management, or reviewing existing records—but that is different from certifying disability.
For a disability claim, work with your treating clinicians, the appropriate government program, or a qualified disability evaluator.
SelfPayMD.com, Nationwide Telemedicine.
https://youtube.com/shorts/ruX8pKyoZi8?feature=share
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Handicap Parking Placard
“If your plan is to meet a doctor online for ten minutes and walk away with a handicap parking placard… that’s usually not how this should work.”
A handicap parking placard is a medical certification, not just a convenience form.
Eligibility rules vary by state, but they generally require a healthcare professional to certify that you have a qualifying condition that significantly limits mobility or otherwise meets that state’s criteria.
That can be difficult to determine responsibly during a single brief telemedicine visit, especially if there’s no prior medical history, examination, or documentation supporting the disability.
But a renewal may be different.
If you already have an established handicap placard, it’s expiring, and you can provide your previous certification and medical records showing that you were properly evaluated and the placard remains medically appropriate, a physician may be able to review that information and consider completing the renewal.
That still isn’t automatic. The physician has to make an independent medical judgment, and state-specific rules still apply.
So think of it this way: telemedicine may sometimes help with documented renewals, but it shouldn’t be a shortcut around a proper disability evaluation.
Come talk to us! SelfPayMD.com, Nationwide Telemedicine.
https://youtube.com/shorts/Evx3lBwGDI8?feature=share
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Emotional Support Animal Letters
“If your plan for getting an emotional support animal letter is, ‘I’ll meet a doctor online for ten minutes and they’ll certify my dog’… unfortunately, medicine doesn’t come with an ESA Easy Button.”
An emotional support animal letter isn’t supposed to be just a form somebody signs.
For housing purposes, an ESA can qualify as an assistance animal under the Fair Housing Act when the animal provides emotional support that helps with the effects of a disability. When that need isn’t obvious, a housing provider may request reliable disability-related information supporting the accommodation.
That means it’s generally not appropriate for a physician who has never treated you to make that determination after one brief ten-minute telemedicine visit.
However, if you’ve already been properly evaluated, you already have an established ESA letter, and your apartment or housing provider needs updated documentation, that may be a different situation.
If you provide your previous letter and relevant medical documentation, a physician may be able to review the records and determine whether renewing the letter is clinically appropriate and permitted under your state’s requirements.
But a prior letter doesn’t guarantee a renewal. The physician still has to make an independent professional judgment.
The goal is to provide legitimate documentation for patients who actually qualify—not sell somebody a certificate after clicking three boxes on a website.
Come talk to us! SelfPayMD.com, Nationwide Telemedicine.
https://youtube.com/shorts/56bm8oTT8Ww?feature=share
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Uncontrollable Hiccups
“If you’ve had hiccups so long that everyone around you has stopped saying ‘bless you’ and started Googling exorcisms… it may be time to get them evaluated.”
Most hiccups disappear within a few minutes or hours.
But hiccups lasting more than about 48 hours deserve medical attention because, occasionally, persistent hiccups can be associated with medication effects, reflux, metabolic problems, or disorders involving the brain, chest, or diaphragm.
Treatment depends on the suspected cause.
And here’s something that sometimes surprises patients: a medication called chlorpromazine may be used for severe, persistent hiccups.
Chlorpromazine is an older antipsychotic medication, but it also has an FDA-recognized use for intractable hiccups.
So if a doctor prescribes it for your hiccups, it does not mean we secretly diagnosed you with a psychiatric disorder.
Medicines often have more than one medical use.
Chlorpromazine also has important potential side effects—including sedation, dizziness, low blood pressure, and movement-related reactions—so it isn’t appropriate for everyone and should be prescribed only after reviewing your medical history and other medications.
And if persistent hiccups occur with chest pain, severe headache, weakness, confusion, trouble breathing, or other concerning symptoms, you need prompt in-person evaluation.
So if your diaphragm has been yelling “HIC!” for two straight days, maybe stop trying to scare yourself with a paper bag.
Come talk to us! SelfPayMD.com, Nationwide Telemedicine.
https://youtube.com/shorts/Vz7ZXYC-__w?feature=share
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I Moved and My Prescription Ran Out
“New state, new house, new grocery store… and somehow your prescription ran out before you found a new doctor. Excellent timing, right?”
This happens all the time after a move.
If you take an established, non-controlled medication and you’re between primary-care providers, a short-term bridge refill may sometimes be appropriate.
A physician still needs to review the medication, dose, diagnosis, allergies, recent labs when relevant, and whether continuing it is medically safe.
Some medicines are straightforward to bridge. Others may require blood pressure checks, lab monitoring, an in-person exam, or follow-up with a specialist before they should be continued.
And controlled medications are a different category. SelfPayMD does not prescribe controlled substances by telemedicine.
A bridge refill also isn’t meant to replace long-term primary care. The goal is to help avoid an unnecessary interruption while you establish care locally.
So if your moving boxes made it to the new house before your medical care did, you may still have options.
Come talk to us! SelfPayMD.com, Nationwide Telemedicine.
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Forgot Your Medication While Traveling?
“Made it all the way to your vacation destination and then realized your medication is still sitting comfortably on the kitchen counter at home?”
It happens more often than you might think.
If you forget a routine medication while traveling, the first step is to figure out what medication it is, how long you’ll be away, whether missing doses is risky, and whether a short-term replacement is medically appropriate.
Sometimes the easiest solution is simply calling your usual pharmacy or prescriber. In other situations, a physician may be able to provide a short-term bridge refill after reviewing your medication list, medical history, dose, and indication.
But not every prescription can be replaced remotely. Controlled substances, certain specialty medications, medications requiring close monitoring, or drugs with important safety concerns may need to be handled by your regular prescriber or an in-person clinician.
And if you’re having symptoms because you’ve already missed several doses—especially with medications where abrupt interruption can be dangerous—don’t wait until the end of the trip to address it.
So before you spend your vacation calling every pharmacy within fifty miles of the hotel…
Come talk to us! SelfPayMD.com, Nationwide Telemedicine.
https://youtube.com/shorts/4YG8Oys4X6k?feature=share
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Tracking Pixel Stranger Danger: Be careful if you are a covered entity under HIPAA
https://youtu.be/_HLvR0g3JSY?si=X6P8zaGVIxW-dDpf
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Why Won’t Telemedicine Prescribe My Adderall, Xanax, or Opioid Pain Medicine?
“If you ask a telemedicine doctor for Adderall, Xanax, or an opioid pain medication and hear, ‘We don’t prescribe controlled substances’—it’s not because your computer has suddenly become judgmental.”
Medications such as Adderall, alprazolam—Xanax—and many opioid pain medications are controlled substances, which means prescribing them involves additional federal and state requirements, safety considerations, and monitoring.
Here’s an important distinction: federal law currently allows some appropriately registered clinicians to prescribe certain controlled substances through telemedicine when all applicable requirements are met. But that does not mean every telemedicine practice has to offer that service. Current federal telemedicine flexibilities run through December 31, 2026, and prescriptions must still comply with DEA requirements and applicable state law.
Some practices—including SelfPayMD—choose not to prescribe controlled medications through telemedicine.
That doesn't mean we think you don't need your medication. It means these medicines may require a level of monitoring, continuity of care, examination, testing, or regulatory compliance that is better handled by an appropriate local or specialty provider.
And remember, not every pain medication is controlled—there may sometimes be other treatment options depending on the problem.
So if you need ongoing treatment with a controlled medication, establish care with a provider who specifically offers and appropriately monitors that service.
SelfPayMD.com, Nationwide Telemedicine.
https://youtube.com/shorts/dt215GT23XA?feature=share
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Tick Bite: Do I Need Antibiotics to Prevent Lyme Disease?
“Found a tick attached to you and immediately thought, ‘Great… do I need antibiotics now?’ Maybe—but not every tick bite needs them.”
For Lyme disease prevention, the details matter: what kind of tick was it, where were you when you got bitten, how long was it attached, and when was it removed?
Current guidelines consider preventive antibiotics mainly for a high-risk blacklegged tick—or deer tick—bite in a Lyme-endemic area, when the tick was attached for about 36 hours or longer and treatment can be started within 72 hours of removing it.
For appropriate patients, prevention is usually a single dose of doxycycline—not a week or two of antibiotics.
And watch for symptoms. An expanding red rash, fever, headache, unusual fatigue, joint pains, or other new symptoms after a tick bite deserve medical evaluation. The classic Lyme rash does not always look like a perfect bull’s-eye.
So if a tick decided you were an all-you-can-eat buffet, don’t panic—but don’t automatically raid the antibiotic cabinet either.
Come talk to us! SelfPayMD.com, Nationwide Telemedicine.
https://youtube.com/shorts/liY0TyYA4yM?feature=share
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What Telemedicine Cannot Do
“Telemedicine can do a lot—but if what you really need is an EKG, a CT scan, stitches, or somebody’s hands actually examining you… unfortunately, your phone has not learned those tricks yet.”
Telemedicine works well for many routine medical problems, but there are situations where in-person or emergency evaluation is the safer choice.
Chest pain, severe shortness of breath, new weakness or numbness, facial drooping, difficulty speaking, severe allergic reactions, major injuries, uncontrolled bleeding, or other potentially life-threatening symptoms belong in the emergency department.
Significant head injuries and possible concussions may also require hands-on neurologic examination and sometimes imaging—especially with worsening headache, repeated vomiting, confusion, loss of consciousness, seizure, or unusual behavior.
And after physical assault or sexual assault, telemedicine cannot perform the examination, injury documentation, forensic evidence collection, preventive treatment, or testing that may be needed. Please seek prompt care at an emergency department or a specialized sexual-assault treatment center.
Sometimes the most important thing a telemedicine doctor can tell you is:
“This should not be treated by telemedicine.”
Knowing the limits of virtual care is part of practicing good medicine.
SelfPayMD.com, Nationwide Telemedicine
https://youtube.com/shorts/9jvGgxtiyII?feature=share
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The $3 Medication vs. the $300 Medication
“Ever go to pick up a prescription and hear, ‘That’ll be $300,’ when you were expecting something closer to lunch money?”
Medication prices can vary dramatically, even when there are multiple clinically reasonable treatment options.
Sometimes the difference is brand-name versus generic. Generics contain the same active ingredient and must meet FDA standards, but they can cost far less than the brand version.
Sometimes the issue is your insurance formulary. Your plan may strongly prefer one medication over another—or require prior authorization—even when both could be medically appropriate.
And cash prices can vary from one pharmacy to another. The same prescription may have a very different price depending on where you fill it, whether you use insurance, or whether a legitimate discount program is available.
That doesn’t mean you should automatically choose the cheapest medication. The right choice still depends on your diagnosis, allergies, other medications, medical history, and what actually works for you.
But if a prescription seems surprisingly expensive, ask whether there’s a generic, therapeutic alternative, different pharmacy, or other reasonable option before giving up on treatment. Also check coupon websites like GoodRx.com or the manufacturer’s website to see if you are eligible for discounts.
Because sometimes the most expensive part of a prescription is simply not asking the right question.
Come talk to us! SelfPayMD.com, Nationwide Telemedicine.
https://youtube.com/shorts/Yg2GlqKK7yI?feature=share
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Rabies Concerns — Bat & Raccoon Bites
“If a bat or raccoon just bit you, this is not the time to schedule a telemedicine visit and ask, ‘Do you think I should worry about rabies?’ Yes — you should get evaluated in person.”
Rabies is uncommon in people in the United States, but once symptoms develop, it is almost always fatal. The good news is that it is preventable when appropriate treatment is started before symptoms begin. Bats and raccoons are among the animals considered higher risk for rabies exposure.
If you’re bitten or scratched by a bat, raccoon, or other potentially rabid animal, wash the wound thoroughly with soap and water for about 15 minutes and seek urgent in-person medical care. Your local health department may also help determine whether rabies post-exposure treatment is needed.
And bats deserve special attention because their bites can be tiny and sometimes difficult to recognize. Direct physical contact with a bat should be evaluated even when you’re not certain you were bitten.
When indicated, rabies post-exposure prophylaxis may include wound care, rabies immune globulin, and a series of rabies vaccines.
So if Batman’s distant cousin just had an unexpected encounter with you, please don’t wait for symptoms and don’t try to handle this entirely online.
Go to an emergency department or other appropriate in-person facility for prompt evaluation.
SelfPayMD.com, Nationwide Telemedicine.
https://youtube.com/shorts/0q5S6tirZB4?feature=share
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Yellow Fever Vaccine
“Need a yellow fever vaccine for international travel? Unfortunately, this is one thing telemedicine cannot magically beam through your phone.”
Yellow fever vaccination is different from many routine travel-medicine services.
In the United States, the vaccine must be given at a designated yellow fever vaccination center. State and territorial health departments designate these centers and issue the official Uniform Stamp used to validate the International Certificate of Vaccination or Prophylaxis—the yellow WHO card.
The certificate also requires the clinician’s handwritten signature and the official stamp from the vaccinating center. That documentation may be required for entry into certain countries, and the certificate becomes valid 10 days after a primary yellow fever vaccination.
So while telemedicine can help with many travel-health questions, yellow fever vaccination itself needs to be handled through an authorized vaccination center or travel clinic.
And this is definitely not the travel document you want to discover you’re missing while standing at immigration after a ten-hour flight.
Check your destination requirements well before departure, and if yellow fever vaccination is recommended or required, schedule with an approved travel clinic.
SelfPayMD.com, Nationwide Telemedicine.
https://youtube.com/shorts/IKuKTSIR4iw?feature=share
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Sinus Infections
“If your face feels like somebody filled your sinuses with concrete… you may be dealing with a sinus infection.”
Sinus infections can cause facial pressure, congestion, thick nasal drainage, headache, reduced sense of smell, and sometimes fever.
But here’s the important part: most sinus infections start with a virus, so antibiotics usually aren’t needed right away.
A bacterial sinus infection becomes more likely when symptoms last more than about 10 days without improving, are severe with high fever and significant facial pain, or get better and then suddenly get worse again.
Treatment may include saline rinses, nasal steroid sprays, fluids, pain relievers, and other symptom-directed medications. Antibiotics may be appropriate in selected cases.
Telemedicine can often be helpful for reviewing the pattern of symptoms and deciding whether treatment is reasonable.
But if you develop severe swelling around the eye, vision changes, severe headache, confusion, stiff neck, or rapidly worsening symptoms, you need prompt in-person evaluation.
So before asking for antibiotics on day two of a cold because your mucus changed color…
Come talk to us! SelfPayMD.com, Nationwide Telemedicine
https://youtube.com/shorts/4VDSQZpGJgs?feature=share
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UTI & Bladder Infection
“If you’ve suddenly become best friends with the bathroom and every trip burns like a personal insult… you may have a urinary tract infection.”
A UTI, or bladder infection, commonly causes burning with urination, urinary frequency, urgency, and lower abdominal discomfort.
In many otherwise healthy adults with typical symptoms, telemedicine can be a convenient way to review the history and decide whether treatment is appropriate.
Sometimes a urine test may be helpful, especially if the symptoms are unusual, keep coming back, or the diagnosis isn’t clear.
And antibiotics are not one-size-fits-all. The right choice can depend on allergies, pregnancy status, kidney function, previous infections, local resistance patterns, and prior culture results.
But if you have fever, chills, vomiting, significant back or flank pain, worsening symptoms, or feel seriously ill, the infection may have moved beyond the bladder and you may need prompt in-person evaluation.
Pregnant patients, children, and some men with urinary symptoms may also need a more thorough evaluation.
So if your bladder has suddenly turned every bathroom trip into an emergency meeting…
Come talk to us! SelfPayMD.com, Nationwide Telemedicine.
https://youtube.com/shorts/EcBY_WSogZI
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Cough & Cold
“If your cough has been hanging around longer than some of your relationships… it may be time to figure out what’s actually causing it.”
Most coughs and colds are caused by viral infections, which means antibiotics usually won’t help.
Symptoms can include congestion, sore throat, runny nose, fatigue, and cough—and that cough can sometimes linger even after the rest of the cold improves.
Treatment usually focuses on symptom relief: fluids, rest, saline, honey for appropriate patients, and over-the-counter medicines depending on your symptoms and medical history.
Sometimes a persistent cough is being driven by postnasal drip, temporary airway irritation, asthma, or reflux, rather than an ongoing infection.
Telemedicine can be useful for reviewing your symptoms and deciding whether prescription treatment or further evaluation may be appropriate.
But if you have shortness of breath, chest pain, coughing up blood, high or persistent fever, low oxygen levels, confusion, or symptoms that are getting worse instead of better, you may need prompt in-person evaluation.
So if your cough has officially become your most consistent daily companion…
Come talk to us! SelfPayMD.com, Nationwide Telemedicine.
https://youtube.com/shorts/ZkmzT7FKXOc?feature=share
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Sore Throat & Strep
“If swallowing feels like your throat has been lined with sandpaper… the question is whether it’s just a sore throat or something like strep.”
Most sore throats are caused by viruses, which means antibiotics usually won’t help.
Strep throat, on the other hand, is caused by group A Streptococcus and may need antibiotic treatment when properly diagnosed.
The tricky part is that symptoms can overlap. Fever, swollen glands, tonsil redness, and pain with swallowing can raise suspicion for strep, but testing is often needed to confirm it.
Telemedicine can be useful for reviewing symptoms and helping decide what the next step should be.
But if strep is strongly suspected, an in-person rapid strep test or throat swab may be the best way to confirm the diagnosis before treatment.
And if you have trouble breathing, difficulty swallowing liquids, drooling, severe neck swelling, a muffled voice, or rapidly worsening symptoms, that needs prompt in-person evaluation.
So before declaring every sore throat “strep” and requesting antibiotics…
Come talk to us! SelfPayMD.com, Nationwide Telemedicine.
https://youtube.com/shorts/M7jnoxFcyEc
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Pink Eye
“If one eye looks normal and the other looks like it stayed up all night arguing with somebody… you may have pink eye.”
Pink eye, or conjunctivitis, can be caused by viruses, bacteria, allergies, or irritation.
That matters because not every red eye needs antibiotic drops.
Viral conjunctivitis often comes with a cold or upper respiratory infection and may improve on its own. Allergic conjunctivitis is more likely to cause itching and watery eyes, often in both eyes. Bacterial conjunctivitis can cause more discharge and crusting, but the diagnosis depends on the full picture.
Telemedicine can often be useful because the eye can usually be seen clearly on video or in photos.
But if you have significant eye pain, light sensitivity, vision changes, eye injury, severe swelling, or you wear contact lenses and have a painful red eye, you should be evaluated in person promptly.
And yes, wash your hands. Pink eye is one of those conditions that can turn one family member into a household group project very quickly.
Come talk to us! SelfPayMD.com, Nationwide Telemedicine.
https://youtube.com/shorts/-iG-XbX1Gfg
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Allergies & Rhinitis
“If you’ve sneezed twelve times before breakfast and your nose has officially become a full-time faucet… allergies may be winning.”
Allergic rhinitis happens when your immune system reacts to things like pollen, dust mites, mold, or pet dander, causing sneezing, congestion, runny nose, itchy eyes, and postnasal drip.
Treatment often starts with avoiding triggers when possible and using medications such as antihistamines or steroid nasal sprays.
For many patients, nasal steroid sprays work especially well when used consistently and correctly, rather than only on the worst day of allergy season.
Telemedicine can be useful for reviewing symptoms, discussing treatment options, and helping determine whether this sounds like allergies or something else.
Because not every stuffy nose is allergic rhinitis. Viral infections, sinus problems, medication side effects, and other conditions can look similar.
And if you have significant trouble breathing, facial swelling, wheezing, or signs of a severe allergic reaction, that needs urgent in-person care.
So if spring, fall, your cat, or apparently the entire outdoors has declared war on your sinuses…
Come talk to us! SelfPayMD.com, Nationwide Telemedicine.
https://youtube.com/shorts/YCZOgTpY0ok
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Asthma
“If your lungs are wheezing like they’re trying to play a harmonica solo… asthma may be the problem.”
Asthma is a condition where the airways become inflamed and narrowed, which can cause wheezing, coughing, chest tightness, and shortness of breath.
Symptoms can be triggered by things like allergies, viral infections, exercise, smoke, cold air, or environmental irritants.
Treatment depends on how often symptoms occur and how severe they are. Some patients may use a rescue inhaler such as albuterol, while others need a controller medicine, often an inhaled corticosteroid or another long-term therapy.
Telemedicine can be useful for medication review, mild flare-ups, and routine asthma management when the diagnosis is already established.
But if you’re having significant trouble breathing, difficulty speaking in full sentences, blue or gray lips, severe chest tightness, or your rescue inhaler isn’t helping, that is not a routine telemedicine problem. You need urgent in-person care.
And if you’re reaching for your rescue inhaler more often than usual, that may be a sign your asthma is not as well controlled as it should be.
Come talk to us! SelfPayMD.com, Nationwide Telemedicine.
https://youtube.com/shorts/HRVuGD908CE?feature=share
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High-Deductible Health Plans & Self-Pay
“Have a huge health-insurance deductible? Congratulations—you have insurance… and you may still be paying for the whole doctor visit yourself.”
More and more patients with high-deductible plans are discovering that, until they meet that deductible, they may be responsible for much of the cost of routine care.
So it can make sense to compare the insurance price with a straightforward self-pay option.
And here’s something many patients don’t know: federal privacy law gives you an important right when you pay completely out-of-pocket:
HITECH Act §13405(a); 42 U.S.C. §17935(a); 45 C.F.R. §164.522(a)(1)(vi).
Under the HITECH Act, if you pay a healthcare provider in full for a particular service and request that information about that service not be disclosed to your health plan for payment or healthcare operations, a HIPAA-covered provider generally must honor that restriction, unless disclosure is otherwise required by law.
Now, that law doesn’t force every medical practice to offer you a cash-pay appointment. Some offices may still have their own contractual or administrative policies.
But if you're paying the bill yourself anyway and your doctor's office doesn't offer a workable self-pay option, it may be worth comparing an independent cash-pay provider.
Because sometimes having insurance doesn't necessarily mean using insurance is the simplest way to get routine care.
Come talk to us! SelfPayMD.com, Nationwide Telemedicine.
HITECH Act and Deductibles
https://youtube.com/shorts/Z05FZZOQjR0?feature=share
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Bronchitis
“If your cough has lasted so long that your family has started naming it… you may be dealing with bronchitis.”
Acute bronchitis is usually caused by a viral infection, which means antibiotics often won’t help.
The cough can linger for two to three weeks, sometimes even after the rest of the illness has improved. That doesn’t necessarily mean the infection is getting worse.
Treatment depends on your symptoms and medical history. Fluids, rest, and over-the-counter medications may help. In some patients, a physician may consider a prescription cough medicine, and if there’s wheezing or bronchospasm, an inhaler such as albuterol may be appropriate.
But bronchitis isn’t always the whole story. Pneumonia, asthma, COVID, influenza, or other conditions can cause similar symptoms.
Telemedicine can be useful when symptoms are mild and improving, but if you have shortness of breath, chest pain, high fever, coughing up blood, low oxygen levels, or symptoms that are getting worse instead of better, you may need an in-person examination and possibly a chest X-ray.
And if your cough has become the loudest member of the household, it may be time to get it evaluated.
Come talk to us! SelfPayMD.com, Nationwide Telemedicine.
https://youtube.com/shorts/SdmAAkexhp8
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Rashes & Skin Irritation
“If your skin suddenly looks like it’s trying to communicate in a language you don’t understand… welcome to the world of rashes.”
Rashes can come from a lot of different things—allergic reactions, eczema, fungal infections, insect bites, poison ivy, medications, viral illnesses, or bacterial infections.
And unfortunately, many of them can look surprisingly similar.
That’s why the first question usually isn’t, “What cream should I put on this?” It’s what caused it in the first place.
A physician may look at where the rash started, whether it itches or hurts, how quickly it’s spreading, new medications or products, recent illnesses, exposures, and whether anyone else around you has the same thing.
Telemedicine can often be useful because skin problems are visual, especially when you can provide clear photos in good lighting.
But if a rash comes with trouble breathing, facial swelling, high fever, severe pain, blistering or peeling skin, involvement of the eyes or mouth, or is spreading rapidly, get urgent in-person medical care.
And maybe don’t treat every mystery rash with the random tube of cream you found in the bathroom drawer.
Come talk to us! SelfPayMD.com, Nationwide Telemedicine.
https://youtube.com/shorts/2YcHaaLETVg
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Acne
“If your face suddenly looks like it’s trying to recreate your high school yearbook photo… acne may be making an unwanted comeback.”
Acne isn’t just a teenage problem. Adults can get it too, and hormones, genetics, stress, certain medications, and skin-care products can all play a role.
Treatment depends on the type and severity of acne. Options may include benzoyl peroxide, topical retinoids, prescription creams, oral antibiotics, or hormonal treatments for appropriate patients.
But acne treatment usually takes time. Switching products every three days because TikTok promised overnight results can actually make things worse.
Telemedicine can often work well because acne is usually visible, and good-quality photos can help a physician assess the pattern and severity.
But if you have deep painful cysts, significant scarring, rapidly worsening acne, or treatment-resistant symptoms, an in-person dermatology evaluation may be more appropriate.
And some acne medications have important pregnancy precautions, so your medical history matters before starting treatment.
So before buying your seventh “miracle” serum and declaring war on every pore you own, get a real treatment plan.
SelfPayMD.com — Nationwide Telemedicine. Come talk to us!
https://youtube.com/shorts/DcF4bcbLhZE?feature=share
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Eczema
“If your skin is dry, itchy, red, and acting like it has a personal grudge against you… eczema may be the reason.”
Eczema—often called atopic dermatitis—is a common inflammatory skin condition that can cause itching, redness, scaling, and sometimes cracking or thickened skin.
It often flares with things like dry weather, heat, sweating, irritating soaps, fragrances, stress, or allergens.
Treatment usually starts with protecting the skin barrier: regular moisturizers, gentle cleansers, and avoiding known triggers.
For flare-ups, topical medications such as corticosteroid creams or other prescription anti-inflammatory treatments may be appropriate, depending on the location and severity.
Telemedicine can often help when the rash is clearly visible and the history is typical.
But if the skin becomes very painful, rapidly worsening, draining, crusted, associated with fever, or involving the eyes, an in-person evaluation may be needed to rule out infection or another condition.
And if you’ve been scratching the same spot so long it practically has its own ZIP code, it’s probably time to get it checked. Come talk to us!
SelfPayMD.com — Nationwide Telemedicine.
https://youtube.com/shorts/E3B0aeGIbKI
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Cold Sores
“If your lip suddenly develops a painful little blister right before a date, vacation, or family photo… cold sores have excellent timing.”
Cold sores are usually caused by herpes simplex virus type 1, or HSV-1. They often begin with tingling, burning, or itching, followed by grouped blisters around the lips.
They are contagious, especially when active lesions are present, so it’s smart to avoid kissing, sharing drinks, lip products, or other close contact while a sore is active.
The good news is that antiviral medications such as valacyclovir or acyclovir can sometimes shorten an outbreak—especially when started early, ideally at the first sign of tingling.
Telemedicine can often be appropriate when the symptoms are typical and the location is easy to see.
But sores near the eye, severe or widespread outbreaks, frequent recurrences, pregnancy, or a weakened immune system may require more careful evaluation.
And remember: a cold sore is not the same thing as a canker sore. Cold sores are viral and contagious; canker sores are inside the mouth and are not contagious.
So if your lip is sending an unwanted viral notification… Come talk to us!
SelfPayMD.com — Nationwide Telemedicine.
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Impetigo
“If that little skin spot suddenly develops a honey-colored crust and starts recruiting neighboring skin… it may be impetigo.”
Impetigo is a contagious bacterial skin infection, most commonly caused by staph or strep bacteria.
It often starts as small red sores or blisters that break open and develop that classic yellow or honey-colored crust. It commonly affects the face, especially around the nose and mouth, but it can occur elsewhere.
Treatment depends on how extensive it is. A small, localized infection may sometimes be treated with a topical antibiotic, while more widespread cases may require an oral antibiotic.
Telemedicine can sometimes be helpful when the rash is clearly visible and good-quality photos are available.
Because impetigo spreads easily, avoid sharing towels, washcloths, razors, or other personal items, and wash your hands after touching the affected area.
But if the redness is rapidly spreading, very painful, associated with fever, significant swelling, or involving the eye area, an in-person evaluation is more appropriate.
And try not to pick at it. Your fingernails are not an FDA-approved treatment.
SelfPayMD.com — Nationwide Telemedicine. Come talk to us!
https://youtube.com/shorts/YI0qxvxVoYs?feature=share
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Canker Sores
“If one tiny sore inside your mouth somehow hurts more than your entire dental bill… congratulations, you may have a canker sore.”
Canker sores—also called aphthous ulcers—are small, painful ulcers that usually develop inside the lips, cheeks, or elsewhere in the mouth.
Unlike cold sores, canker sores are not caused by herpes and they’re not contagious.
They can sometimes be triggered by things like minor mouth trauma, stress, certain foods, or illness—and sometimes they simply show up without sending an invitation first.
Most heal on their own within a week or two. For discomfort, options may include salt-water rinses, topical numbing medicines, protective pastes, and in some cases prescription topical corticosteroids.
Telemedicine can sometimes help when the sore is clearly visible and the history sounds typical.
But if an ulcer lasts more than about two weeks, is unusually large or severe, keeps coming back frequently, or comes with fever, weight loss, swollen glands, or difficulty eating and drinking, it deserves a closer evaluation.
So before you declare war on your toothbrush because one tiny ulcer has ruined your entire day… Come talk to us!
SelfPayMD.com — Nationwide Telemedicine.
https://youtube.com/shorts/ZJtdIFJmB1g
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Fungal Skin Infections
“If your rash is round, itchy, spreading, and apparently trying to establish its own ZIP code… fungus may be involved.”
Fungal skin infections are common and can show up as ringworm, athlete’s foot, jock itch, or other itchy, scaly rashes.
Despite the name, ringworm has absolutely nothing to do with worms. It’s caused by a fungus—which is good news for anyone who was already imagining something much worse.
Many mild fungal infections can improve with topical antifungal medications, but not every red, itchy rash is fungal. Eczema, psoriasis, bacterial infections, and other skin conditions can sometimes look similar.
Telemedicine can often be helpful when the rash is clearly visible and good-quality photos are available.
But infections involving the scalp, nails, a large area of skin, significant pain, drainage, fever, or a weakened immune system may need in-person evaluation or additional testing. Some oral antifungal medications also require closer medical supervision.
And if you’ve been using a steroid cream and the rash keeps spreading, that’s another reason to get it checked—steroids can sometimes make fungal infections harder to recognize or even make it worse.
So before you keep treating a mystery rash with whatever happens to be in the medicine cabinet… Come talk to us!
SelfPayMD.com — Nationwide Telemedicine.
https://youtube.com/shorts/xAd3s_CjvXU?feature=share
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Poison Ivy & Insect Bites
“Went outside for ten minutes and came back looking like nature filed a complaint against you?”
Poison ivy and insect bites can both cause itching, redness, swelling, and irritated skin—and sometimes it’s hard to tell what you’re dealing with.
With poison ivy, the rash usually comes from contact with urushiol, the plant oil that triggers the reaction. Washing the skin and clothing soon after exposure may help reduce spread of the oil.
For mild cases, cool compresses, calamine, or certain over-the-counter treatments may help. More severe poison ivy may sometimes require prescription medication.
Insect bites are usually minor, but some can cause larger local reactions, infection, or occasionally a serious allergic response.
Telemedicine can often be useful when the rash or bite can be clearly seen and the symptoms are otherwise mild.
But if you develop trouble breathing, facial or throat swelling, rapidly worsening redness, severe pain, fever, or signs of infection, get urgent in-person medical care.
So whether it was a mosquito, a mystery bug, or one very unfriendly plant… Come talk to us! SelfPayMD.com — Nationwide Telemedicine.
https://youtu.be/evpFHF3sMiM?si=cq2h_7Hiy4ZTzRAf
https://youtube.com/shorts/T-Nxr5svyR8?feature=share
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Shingles
“If you’ve got a painful, burning rash that seems to be traveling in a stripe on just one side of your body, your skin may be staging a very unpleasant reunion with chickenpox.”
Shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox. Years later, it can reactivate and cause a painful rash, often with burning, tingling, or sensitivity before the blisters even appear.
Treatment may include an antiviral medication such as valacyclovir or acyclovir, and it works best when started early—ideally within the first few days of the rash.
Telemedicine can sometimes be helpful when the rash and history are typical, especially if good-quality photos are available.
But shingles near the eye, forehead, or tip of the nose, severe headache, confusion, widespread rash, significant weakness, or symptoms in someone who is immunocompromised should be evaluated promptly in person.
And one more thing: shingles can be contagious to someone who has never had chickenpox or the vaccine—so keep the rash covered and avoid high-risk contacts until the lesions have crusted over.
If shingles may be starting, don’t just wait for it to “declare itself.”
SelfPayMD.com — Nationwide Telemedicine. Come talk to us!
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Birth Control
“If your birth-control plan is ‘I’ll just remember every single day forever’… your calendar may be more optimistic than your actual life.”
There are a lot of birth-control options, and the best choice depends on your health history, preferences, and how much you want to think about it every day.
Options can include birth-control pills, the patch, the vaginal ring, progestin-only pills, and longer-acting methods such as IUDs or implants, which require in-person placement.
Before prescribing hormonal birth control, a physician should review things like blood pressure, smoking history, migraine with aura, blood-clot history, certain medications, and whether pregnancy is possible.
That matters because estrogen-containing birth control is not appropriate for everyone.
Telemedicine can be a convenient way to discuss options, review your medical history, and prescribe appropriate birth control when it’s medically reasonable.
And if you’re having new severe headaches, chest pain, shortness of breath, leg swelling, or other concerning symptoms, that needs urgent medical evaluation—not just a routine refill.
The goal is simple: find a birth-control method that is safe, effective, and actually fits your life.
SelfPayMD.com — Nationwide Telemedicine. Come talk to us!
https://youtube.com/shorts/5aYnAmcJ0BU?feature=share
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Vaginal Infections / Bacterial Vaginosis
“Vaginal discharge changed, there’s a new odor, and now you’re wondering whether your body is trying to send you a strongly worded memo?”
Vaginal infections are common, but the symptoms can overlap.
Bacterial vaginosis, or BV, can cause a thin discharge and a noticeable odor. Yeast infections are more likely to cause itching, irritation, and thicker discharge. And some sexually transmitted infections can look very similar.
That’s why guessing based on symptoms alone isn’t always reliable.
For patients with a typical history and no concerning symptoms, telemedicine may sometimes be appropriate for evaluation and treatment.
But an in-person exam and testing may be the better choice if symptoms are unusual, keep coming back, you’re pregnant, there’s pelvic pain or fever, there’s concern for an STI, or the diagnosis simply isn’t clear.
And please don’t keep treating yourself for “yeast” over and over if the treatment isn’t working. Sometimes the problem isn’t yeast at all.
The goal isn’t just to make the symptoms go away—it’s to treat the right condition.
SelfPayMD.com — Nationwide Telemedicine. Come talk to us!
https://youtube.com/shorts/qa7-wn0vAes?feature=share
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Period Delay
“Wedding next week? Beach vacation? Big event? And your period apparently got the invitation too?”
For some patients, it may be possible to delay or postpone a menstrual period using hormonal medication.
The best option depends on your current birth control, your medical history, when your period is expected, and whether pregnancy is possible.
If you already use certain hormonal birth-control methods, sometimes the schedule can be adjusted to delay bleeding. In other situations, a prescription medication may be considered for short-term period postponement.
But this is not appropriate for everyone. A physician should review things like pregnancy risk, blood-clot history, migraines with aura, smoking history, certain medical conditions, and medication interactions before recommending treatment.
And period delay is different from evaluating unexpected, very heavy, painful, or abnormal bleeding. Those symptoms may need a different workup or in-person evaluation.
So if your calendar and your menstrual cycle have decided not to cooperate, there may be options.
SelfPayMD.com — Nationwide Telemedicine. Come talk to us!
https://youtube.com/shorts/CzemKgfk7j8?feature=share
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PrEP
“If your PrEP plan is, ‘Just give me the pill and we’ll skip all that testing stuff’… that’s not really a PrEP plan.”
PrEP—pre-exposure prophylaxis—is medication that can greatly reduce the risk of acquiring HIV when taken appropriately.
But before starting PrEP, you need to confirm that you do not have HIV, and proper care also involves other laboratory testing and STI screening. Depending on the medication and your situation, that may include kidney function, hepatitis B testing, blood work, urine testing, or swabs.
That’s why, for many patients, an in-person clinic is the simplest way to start PrEP. You can get the evaluation, testing, and follow-up organized in one place.
Telemedicine can still work—but it needs a system for getting those required tests done.
If you don’t have a convenient option locally, there are specialty telemedicine services such as MISTR—M-I-S-T-R. They arrange online PrEP care along with required testing, including at-home or in-person testing, and they report that their consultations, labs, STI testing, and PrEP medication can often be provided with little or no out-of-pocket cost.
So don’t skip HIV prevention because getting to a clinic is inconvenient. There are options.
SelfPayMD.com — Nationwide Telemedicine.
https://youtube.com/shorts/oQ8YMN2IwNI?feature=share
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STI
In most cases STI/STD treatment should be done in person for proper evaluation. Gonorrhea, in particular, really needs to be treated in person as the recommended treatment is a shot of ceftriaxone which we cannot prescribe via telemedicine. However, in some states you can receive expedited partner therapy for chlamydia or bacterial vaginosis depending on the circumstances.
SelfPayMD.com, Nationwide Telemedicine. Come talk to us!
https://youtube.com/shorts/UHLI88MbuUU?feature=share
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Erectile Dysfunction
“Having trouble getting things to stand at attention? Before blaming age, stress, or your partner—sometimes erectile dysfunction is your body trying to tell you something.”
Erectile dysfunction is common, and it can have many causes.
Blood-flow problems from high blood pressure, diabetes, high cholesterol, smoking, or cardiovascular disease are common contributors. Medications, low testosterone, stress, anxiety, depression, and relationship factors can also play a role.
That’s why ED shouldn’t automatically be treated as just a performance problem.
A physician can review your symptoms, medications, medical history, and cardiovascular risk factors to help determine what may be contributing.
For appropriate patients, medications such as sildenafil or tadalafil can be effective—but they aren’t safe for everyone. In particular, they should not be combined with nitrate medications, because blood pressure can drop dangerously low.
Sometimes laboratory testing or an in-person evaluation is also appropriate, depending on your history.
And if an erection lasts more than four hours, that’s not a victory lap—that’s an emergency. Seek immediate medical care.
If erectile dysfunction is becoming a recurring problem, it’s worth getting evaluated rather than just ignoring it.
SelfPayMD.com — Nationwide Telemedicine.
https://youtube.com/shorts/tpIXXgMSNjA
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Hair Loss
“Finding more hair in the shower drain than on your head? Before you declare war on your shampoo, there may be a medical reason.”
Hair loss can happen for a lot of different reasons.
The most common is pattern hair loss, which can affect both men and women. But shedding can also happen after illness, major stress, rapid weight loss, pregnancy, certain medications, thyroid problems, iron deficiency, and other medical conditions.
That’s why the first step isn’t automatically buying whatever supplement has the best commercial.
A physician can review when the hair loss started, the pattern of thinning, your medications, medical history, and other symptoms to help determine what might be causing it.
Depending on the situation, treatment may include topical medications such as minoxidil, prescription options for appropriate patients, or laboratory testing when an underlying medical cause is suspected.
And if you’re developing sudden bald patches, scalp inflammation, scarring, or very rapid hair loss, an in-person dermatology evaluation may be more appropriate.
So before your bathroom drain becomes your unofficial hair-counting laboratory, get it evaluated.
SelfPayMD.com — Nationwide Telemedicine.
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Low Testosterone Lab Testing
“Feeling tired, gaining weight, or losing your mojo? Before blaming everything on ‘low T’ because the internet told you to—let’s actually check.”
Symptoms associated with low testosterone can include decreased libido, erectile problems, reduced energy, loss of muscle mass, and other changes.
But here’s the problem: those symptoms aren’t specific to testosterone. Sleep problems, medications, thyroid disease, stress, depression, obesity, and other medical conditions can cause similar symptoms.
That’s why diagnosing low testosterone starts with the right history and proper laboratory testing—not just symptoms.
Testosterone is generally checked in the morning, and if the result is low, it usually needs to be confirmed with another morning measurement. Depending on the results and your history, additional testing may also be appropriate.
And one abnormal number doesn’t automatically mean you need testosterone replacement therapy. It means you need to understand why it’s abnormal.
SelfPayMD can help determine whether testing is appropriate, order laboratory studies, and review the results with you.
SelfPayMD.com — Nationwide Telemedicine.
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Lab Result Review
“Ever open your lab results and immediately think, ‘Great… I have absolutely no idea what any of this means.’
“Your lab result says ‘ABNORMAL.’ Your brain says, ‘I have 48 hours to live.’”
You’re not alone.
Blood tests can be useful for things like cholesterol, blood sugar, thyroid function, anemia, kidney and liver function, vitamin levels, and other medical concerns—but ordering the right tests matters just as much as interpreting them correctly.
A physician can review your symptoms and medical history, help decide which labs may actually be appropriate, and then go over the results with you in context.
Because one number marked ‘high’ or ‘low’ doesn’t automatically mean something is wrong. Lab ranges are only part of the picture, and results sometimes need to be repeated, compared with prior testing, or followed up in person.
And please don’t order 47 random blood tests because someone on social media told you to ‘check everything.’ More testing doesn’t always mean better medicine.
If you need help deciding what labs may be appropriate—or you already have results and want a physician to review them—SelfPayMD may be able to help.
SelfPayMD.com — nationwide telemedicine.
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Medication Questions & Review
“If your medication list is starting to look more like a chemistry final than a treatment plan, it may be time for a medication review.
“If your medication list needs its own spreadsheet… we should probably talk.”
It is always best to see your primary care doctor for this, but if you are between doctors or have other access issues then come talk to us.
People often take prescriptions from different doctors—and sometimes nobody has looked at the whole list together.
A medication review can help answer questions like:
‘Can I take these together?’
‘Could this be causing my side effect?’
‘Do I still need this medication?’
or the classic, ‘Wait… am I taking two medicines that basically do the same thing?’
A physician can review your medications, medical history, possible interactions, dosing concerns, and whether something should be discussed with the clinician who originally prescribed it.
Sometimes the answer is simple. Sometimes the safest answer is lab testing or an in-person evaluation.
And if you’re having a severe reaction—like trouble breathing, facial swelling, fainting, chest pain, or other serious symptoms—don’t schedule a routine telemedicine visit. Seek urgent medical care.
But for everyday medication questions and review, SelfPayMD may be able to help.
SelfPayMD.com — nationwide telemedicine.
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Bridge Medication Refills
“Ever look at your pill bottle and realize you have two tablets left… and your new doctor can see you sometime next month?
A bridge refill is a short-term prescription refill intended to keep you from unexpectedly running out of an important medication while you’re between doctors, traveling, recently moved, or waiting for a follow-up appointment.
But it isn’t automatic. A physician still needs to review your medication, your medical history, how long you’ve been taking it, and whether it’s safe and appropriate to continue.
Some medications may require lab monitoring, an in-person examination, or specialist follow-up. And controlled substances generally aren’t appropriate for a simple telemedicine bridge refill.
So if you’re almost out of a routine medication, don’t wait until the bottle sounds like a maraca.
A short-term bridge refill may be an option while you arrange ongoing care.
SelfPayMD.com — nationwide telemedicine. Come talk to us!
https://youtube.com/shorts/HdYOJqQ8AEI?feature=share
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Malaria Prevention
Going somewhere tropical? Don’t let mosquitoes choose your itinerary.
Planning an international trip? You probably remembered your passport, your charger, and twelve outfits you’ll never wear.
But did you check whether your destination has a malaria risk?
Malaria is spread by infected mosquitoes, and in some parts of the world it can cause serious illness. Prevention starts with avoiding bites: use an effective insect repellent, wear long sleeves when practical, and consider mosquito nets or screened sleeping areas.
Depending on where you’re traveling, how long you’ll be there, your medical history, and local malaria resistance patterns, a prescription preventive medication may also be recommended.
Common options can include medicines such as malarone or doxycycline, but they’re not interchangeable, and each has different precautions, side effects, and timing requirements.
That’s why it’s best to plan before your trip—not while you’re standing at the airport wondering if mosquitoes accept boarding passes.
And if you develop a fever during or after travel to a malaria-risk area, seek medical evaluation promptly.
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Motion Sickness Prevention
Nothing ruins a cruise faster than discovering your stomach strongly disagrees with the Atlantic Ocean.
Motion sickness happens when your eyes and inner ear send your brain conflicting information about movement. The result can be nausea, dizziness, sweating, and sometimes vomiting.
The good news is that motion sickness is often easier to prevent than to treat once it starts.
Simple measures can help: look toward the horizon, get fresh air, avoid heavy meals and excess alcohol before travel, and try to stay where there’s less motion—like the middle of a ship.
Medications can also help. Options may include antihistamines such as meclizine, and for some patients a prescription scopolamine patch may be appropriate.
But these medications aren’t right for everyone. They can cause side effects such as drowsiness, dry mouth, or blurred vision, and your medical history matters.
So if your upcoming vacation involves a boat, plane, or winding road—and you’d rather enjoy the scenery than inspect the inside of a motion-sickness bag—talk with a physician before you travel.
SelfPayMD.com — nationwide telemedicine. Come talk to us!
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Lingering Cough
Your cold is gone. Your fever is gone. You feel fine.
But you're still coughing up a lung.
Good news: you probably don't actually need a new lung.
A cough can hang around for weeks after a respiratory infection. Sometimes it's irritation and inflammation left behind by the virus. Sometimes post-nasal drainage keeps triggering the cough. Sometimes your airways become temporarily reactive — almost like asthma — and sometimes reflux can contribute.
So how do we treat it?
Well, we don't just throw an antibiotic at every cough.
Treatment depends on what's actually causing your symptoms.
For some patients, we may consider a cough suppressant like Tessalon. If you're wheezing or your airways seem tight or reactive, a bronchodilator such as albuterol may be appropriate. And in selected patients with significant airway inflammation, other treatments — sometimes including steroids — may be considered.
The important part is that **the treatment should fit the patient, not just the cough.**
And if you're getting worse instead of better — especially if you're short of breath, coughing up blood, having significant chest pain, or developing other concerning symptoms — you may need an in-person evaluation.
Still coughing after your cold?
Come talk to us at SelfPayMD.com
**We'll try to help you keep both lungs.**”
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Earache?
Here’s something you probably don’t expect to hear from a telemedicine doctor:
Sometimes, you really need someone to **look in your ear.**
I know… terrible business model for the telemedicine guy to admit that.
But ear pain can come from several different things — a middle-ear infection, swimmer’s ear, fluid behind the eardrum, wax, or other causes.
And one of the most important parts of figuring that out is actually **seeing the eardrum.**
Unfortunately, despite years of medical school, I still cannot see through your computer screen and around the corner into your ear.
Now, if you have a camera otoscope that can send us good pictures or video — or a device specifically designed for remote examination — that may give us useful additional information.
Otherwise, an in-person ear examination is often the best way to properly evaluate an earache.
But life isn't always convenient. If you're traveling, can't get to a clinic, or have other extenuating circumstances, come talk to us at SelfPayMD. We'll listen to what's going on, consider your individual circumstances, and help determine the safest and most appropriate next step.
**SelfPayMD.com — telemedicine when it makes sense, and honesty when it doesn't.**”
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Why Is Medical Care So Expensive? Medical Licensing Fees Are Skyrocketing!
When I was in high school there was no internet. Literally. Internet relay chat was just taking form back then. Now we are all interconnected and social media has changed the world. I really like watching car shows on social media like Hoovie’s Garage, Car Wizard, Royalty Auto Service. Check out their links in the comments.
I am not mechanically inclined but I find it fascinating how difficult it has become to fix cars and how expensive it has become to do so. I think I’m going to start making videos about medicine like that, explaining WHY things are so expensive. I have a feeling most people have no understanding of what has become of medical practice.
This week alone I received emails that many of my medical license fees are skyrocketing. Yes, I get it, everybody’s costs for everything are going up. But these are HUGE increases, sometimes 20 or 30 percent increases in one shot. Where does that money come from? YOU! The patient. One way or another, nothing is free. North Carolina is going from $400 to $550 overnight. California is increasing the fee to $1255. Want to get a new medical license in Nevada? Get ready for fork over $1475!
I’m going to show you what happens behind the scenes so you can understand why everything is so expensive. In the meantime, support SelfPayMD.com so we all have a choice in healthcare. You deserve it.
https://www.youtube.com/hooviesgarage
https://www.youtube.com/@CarWizard
https://www.youtube.com/@theroyaltyautoservice
SelfPayMD.com — nationwide telemedicine. Come talk to us!
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Health insurance premiums are skyrocketing, AGAIN!
As we all know, we have a huge health insurance problem in this country. Not to get political about it, but the reality is that the government subsidies are going away and insurance premiums are projected to rise another 11% next year. What I think will happen next year is an acceleration of what happened this year—the healthier people with insurance will just risk it and drop their coverage because it’s too expensive, leaving a smaller and sicker insurance pool that will have less and less people contributing to it to cover those who need it most. I don’t pretend to have a solution. This is a systemic issue and is problematic for all of us, sick or healthy, employer or employee, we are all paying more and more for less and less.
My primary message here is don’t sacrifice your own health because of health care systemic dysfunction. If you have high blood pressure, or diabetes, or high cholesterol, please do NOT stop taking your medicines because health insurance is getting too expensive. You are risking your life. If not for yourself then do it for your family, do it for your friends. Nobody wants to see you have a heart attack or stroke because you stopped your essential life saving medicines. Please don’t be that person. Come to SelfPayMD.com and get bridge prescriptions for your non controlled substance medicine refills to preserve your future good health.
SelfPayMD.com — nationwide telemedicine. Come talk to us!
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Don’t Ignore What Your Body Is Telling You
I was out watching a really cool touring musician duo (man and woman) who happened to have a stop in our town this past weekend. I don’t want to name them because of medical privacy concerns, but they were really nice. During the show he happened to mention that he couldn’t do Elvis impersonations anymore because he has had one sided facial paralysis for the past 13 years.
As a doctor, I immediately started to wonder what the cause was. At intermission I struck up a conversation and it turns out he just noticed this out of the blue 13 years ago, never went to get it checked out, never went to get it treated. He could furrow his brow on that side which made me worry as this could suggest it was more than simple Bell’s Palsy, which is what I assume he diagnosed himself with. I tried to be supportive but also gently suggested he go get checked out because there are other conditions that can cause these symptoms like Lyme Disease, myasthenia gravis, or even stroke.
Don’t ignore symptoms like this. I get it, I don’t like going to the doctor myself. But symptoms like this should not be ignored. It could represent something life changing for the worse. Get yourself checked out because half the battle to make sure you don’t have something dangerous.
If you are a You Tube fan you may have seen professional eater Joel Hansen and his public battle with Bell’s palsy complicated by Ramsey Hunt syndrome. Super nice guy who did a great job creating public awareness of how serious this can be. He is a fighter and is pushing through this best he can. Check out his channel link below.
Facial paralysis is better suited to in person care, preferably with a neurologist. But for minor issues that are not life threatening go to SelfPayMD.com — nationwide telemedicine. Come talk to us!
https://youtube.com/shorts/zrEJmXwHwBc?si=s3aXat5SNyfas9U4
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Dangerous Viral Social Media Challenges
I had a patient stick a pencil through her cheek. On purpose. Then she calls me a few nights later at 3 am with cellulitis and pus draining from her cheek. As part of my interview I ask her how this happened.
She says it was a Tik Tok challenge. Now I had heard about the Tide Pod challenge, which is also very dangerous, but I had not heard about the pencil though the face challenge.
What makes kids think this is a good idea is beyond me, but the next question she asked blew me away. She wanted to know if redness, swelling and pus draining from your face is ‘normal.’
Normal on what planet? Of course this is not normal. You impaled your face on a pencil! Please don’t be that person.
These social media challenges can be very dangerous. And I’m sure this warning will fall on deaf ears, but seriously, if you value your future good health and don’t want to be permanently disfigured don’t fall for this attention seeking behavior. You could wind up with more serious injuries than you bargained for. Even death. A few clicks of engagement is not worth risking your life!
If you have a mild medical concern that does not involve self destructive social media nonsense then come to SelfPayMD and be evaluated by a real doctor!
SelfPayMD.com — nationwide telemedicine. Come talk to us!
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For Patients New To GLP-1s
Oral GLP-1s are incredibly popular right now, very effective, and often less expensive than GLP one shots. They don’t have to be refrigerated, so travel is easier.
I write prescriptions for these 10 times a day and these are the most common things people ask about:
How does it work? GLP-1s reduce appetite, increase satiety, they slow digestion to make you feel like you physically don’t want to eat as much volume as before, and many patients find a reduction in food “noise.”
How do you take it? One pill a day. Depending on which version you use, it might need to be taken on an empty stomach, but there are options that can be taken with food.
How do you stop? GLP ones can be stopped at any time for any reason. You can stop because you reached your goal, because you don’t like the side effects, or because it is getting too expensive. It is considered safe to stop cold turkey, no need to taper it off unless you want to.
How long until it starts working? This varies person to person but I usually say give it 6 weeks for a fair shake. The first month dosing is very low to get your system acclimated to the medicine, the dose is higher in month 2. Some do see results in the first month but I encourage you to go at least 6 weeks so you can see the impact of the higher dosing.
How much weight can I expect to lose? The window of what we consider healthy and sustainable weight loss is about 0.5 to 2 pounds per week, with the oral version I’d say a ballpark range would be about a pound a week. Lots of variables here though, like how much effort you put into it on your side and how your body chemistry reacts to the medicine, but about a pound a week is not unusual. Results do vary.
How long do I have to stay on the medicine? To a large extent this is personal preference. Some reach their goal and stop cold turkey, then try to maintain with diet and exercise. Some prefer to use smaller microdosing longer term for maintenance. At this point in time there is no arbitrary cut off dates for duration of treatment. Generally speaking if you are not doing anything medically dangerous, your body mass index is not dropping below 18.5 and you don’t have serious side effects, SelfPayMD will work with you to continue treatment or stop treatment according to your personal preferences.
Do I need blood tests? Labwork is generally recommended. You can self report lab results if you have them available in an existing patient portal, you can go to LabCorp or Quest and self order lab tests, or SelfPayMD can give you a generic lab slip at your first visit to get labs done locally. More details are on the SelfPayMD weight loss lab work page.
Do I qualify? This depends on your body mass index and past medical history. There is a pre-screener form on the Self pay MD dot com website where you can get a feel of whether you might be approved, but the final decision is made by your doctor at the time of your appointment.
How much does all this cost? SelfPayMD is one of the lowest priced physician led programs nationwide. Visits are required every 3 months at the published rate, right now that works out to be about $30 a month considering that follow up visits are $89 every 3 months. Medication cost is separate and is handled through your pharmacy.
If you don’t want to refill your GLP1 then just don’t make a follow up appointment. Other services will keep charging you membership fees every month even if you stop the medicine. With SelfPayMD you only pay when you are seen for follow up visits, that’s it. No subscription or membership fees. This is much more affordable compared to $149 a month subscription fees being charged elsewhere. Plus with SelfPayMD you can choose to see the same doctor each time, not start over with a new provider every visit -- we have better continuity.
What is the medication cost? Oral GLP ones start at about $149 a month as of today, but you can check the pricing at the manufacturer’s website for up to date pricing. Links are on the SelfPayMD website. All in, many patients can start brand name oral GLP1’s for about $200 a month based on today’s published pricing. Check the websites for pricing changes as prices have come down dramatically in recent years.
What are the side effects? Stomach related side effects are very common, but usually tolerable and often transient. Nausea, cramps, constipation, bloating, all these can occur. If you experience side effects concerning to you then reach out through messaging in the patient portal so we can help navigate any problems.
If you still have questions see the weight loss frequently asked question page on Self pay md dot com, or you can go to the public patient community bulletin board and ask specific questions there. Do not disclose private health information on the public bulletin board.
I have worked for multiple national companies and now offer medical care directly to you, bringing you better value. Come to SelfPayMD.com for your weight loss consultation and speak with a real doctor!
Intro GLP-1s, More Detailed Version:
https://youtu.be/UAxKUM9DgQg?si=ZNFWNBaRDY0cStoQ
Do I have To Take GLP-1s Forever?
https://youtu.be/TpmP9uULtrs?si=TJyJV-k6XiZVdtsN
Can US Military Use GLP-1s To Meet Fitness Guidelines?
https://youtu.be/8XfbK0jDhv0?si=XZVXylfR4LhZgE8L
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Health Insurance Blues
Health insurance companies have lost a lot of respect over the years. They are almost universally hated nowadays, almost like lawyers. And as a lawyer myself, that’s saying something.
At SelfPayMD we cater to those who don’t have insurance or who are between insurance plans so you don’t directly deal with insurance company hassles. But I could tell you some stories about how difficult it is as a doctor who is trying their best to help.
Patients often complain, well, if my doctor was a good doctor they would advocate for me!
Here’s a little secret, doctors do advocate! Constantly! When an insurance company requires a prior authorization for a needed CAT scan and demands a peer to peer phone review of the case that burns up 45 minutes of your day, you can see why appointments run late and patients get frustrated. The doctor is frustrated too!
And yes, this happens all the time across the healthcare system. The 45 minute peer to peer prior authorization call is a true story, it happened to me and my patient.
But worse than that, imagine being back in 2020 when covid first came out. I happened to be telemedicine licensed across the country and was on the front lines of covid because everything in person was shut down.
I was on duty, licensed in Washington state, and actually saw one of the very first patients in the US diagnosed with covid in Kirkland Washington.
This poor guy was an emergency medical tech on an ambulance taking one of those first nursing home covid patients to the hospital, this is back when the official strategy was containment and not surveillance.
The EMT was exposed to covid, developed respiratory distress and called me through telemedicine. I tried for 90 minutes to arrange in person care locally but guess what, in the throes of an evolving global pandemic the insurance companies were throwing up barriers and fighting between themselves, fighting between me and the patient, and fighting between the local hospitals. Why? Because they couldn’t agree on whether this patient should be taken care of under worker’s compensation insurance or regular health insurance. This single patient visit burned 90 minutes of my time and I believe I got paid about $24 for that visit! Now do you see why doctors are so bitter?
Now don’t get me wrong, it is tremendously important to have health insurance to cover catastrophic illness like cancer and things of that nature, but for sinus infections or UTI you can bypass insurance barriers to access and get the care you need, fast!
Have you noticed that your deductible has been rising each year for years on end? You’re paying for the minor issues yourself anyway! Let’s keep the insurance company out of it and get what you need quickly and efficiently at SelfPayMD.com where you will see a REAL doctor.
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Telemedicine Misadventures
In today’s episode of telemedicine misadventures, let’s talk about the patient visit itself. I don’t mind if you call from your car sitting in a parking lot, that’s very common and is completely ok. It’s probably best not to call while driving as we don’t want to distract you and cause an accident. But please be mindful of where you are calling from. Don’t call when you are actively taking a shower with your naked partner, don’t call while sitting on the toilet, don’t call while ordering your burgers from the drive through, don’t call about your bacterial vaginosis while checking out at the grocery store. Please don’t be that person. And no, I’m not making these up. Patients have actually called in each of these exact situations in real life. Respect those around you, respect your doctor, and you will find that life will be much easier. Come to SelfPayMD.com where we value mutual respect, and you will see a REAL doctor.
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Do You Want Your Vagina Picture Online?!?
Please don’t upload a picture of your vagina to AI and ask for a diagnosis. It doesn’t work. Plus your who-ha picture will forever be archived in a data center somewhere. AI cannot tell that you have a urinary tract infection from an external picture, it just doesn’t work like that. And no, I’m not making this up. A patient actually did this! SelfPayMD.com — nationwide telemedicine. Come talk to us!
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Not Appropriate for Telemedicine
In today’s episode of things telemedicine cannot treat ….. please do not call in with a gunshot wound. This always requires in person wound evaluation and assessment of the underlying structures. And no, I’m not making this up. I actually had a patient who got shot in the leg, went the emergency room, refused care and left. They then called me a week later through telemedicine and uploaded a picture of their x-ray showing a fractured fibula. We can do a lot of things through telemedicine but treating a fracture is not one of them. Please don’t be that person. The emergency room is there for emergencies, for non-emergency conditions come see a real doctor at SelfPayMD.com — nationwide telemedicine.
