Tuesday, August 5, 2008

Live too far away?

Since I've restarted my practice, many people have asked me how they can access my services if they can't come to Amesbury, Mass. Until now my answer has been consistent---I need to see the patient in person if I am to treat him. However, I'm now offering a new service---internet consultation. It may sound a bit unorthodox, radical, or downright crazy, but it's starting to make sense. Think of it this way: you live far away, so I'm not going to be your child's doctor, no matter what. It's bad medicine if we're too far apart, and you may have a very good doctor that you're already seeing. However, he/she may not have much experience treating fragile X. I have tons of experience treating fragile X, but only so many people live within range of my office.

Now, usually the biggest problem with treating patients from afar is ensuring proper diagnosis. A doctor may be very skilled at the best possible treatments, but if he's treating the wrong thing, it's not likely to help, and may do harm. In the case of fragile X, however, there is a difference: the diagnosis is quite precise, and the condition is remarkably consistent (despite the emphasis in the literature on the wide range of presentations.) Therefore, I believe it is appropriate and potentially helpful to offer consultations via internet/email for any individual with previously diagnosed fragile X. Because I can do this at my convenience, with no overhead, I can also do this at a substantially lower rate ($150/hr) than office consultations or long-term outpatient treatment.

A few disclaimers are in order. First of all, I will not be prescribing anything for anyone over the internet. You need to have a local doctor you trust who is willing to work with you and me, and who can make use of any recommendations that I make through our consultation. You should not expect that any other doctor will follow my recommendations slavishly---this is a good thing! There are many charlatans out there, and I could be one of them; I expect that I will need to communicate any recommendations in a sensible way that justifies that course of action. This service should not be used for any kind of medical or psychiatric crisis; clearly, you'll be looking for advice at a time when things aren't going well, but I won't be of any use to you in a truly dire situation. Few psychiatric treatments work quickly, and emergency measures cannot be implemented long-distance.

Finally, to clarify, I'm talking exclusively about psychopharmacology consultations for people with fragile X---just meds! To clarify even further, I'm expecting to be paid for this service (already gotten a few requests for free medical advice since I posted this!)

If you're interested or have questions, just email me at fraxa@comcast.net . I'm planning to have a PayPal button installed soon to buy time directly.

UPDATE: I've added PayPal buttons to the left to buy consulting time. For most simple questions about medications, or follow-ups from previous consultations, a half hour should suffice. For more complex problems, especially initial evaluations where you'd like me to review a significant volume of medical records, a full hour is suggested. Generally speaking, I'll generate longer write-ups from longer consultations (1-2 pages for an hour.)