Telemedicine promises convenience, but what happens when speed and marketing outpace good medicine? Join Host Dr. Leo Damasco and Phoebe Gutierrez on this episode of Telemedicine Talks as Phoebe shares her personal experience as a patient navigating asynchronous hormone replacement therapy, and why the lack of live consultation left her over-prescribed and unwell.
What if the ultra-convenient telemedicine experience you signed up for actually put your health at risk because no one ever spoke to you?
In this candid episode of Telemedicine Talks, hosts Phoebe Gutierrez and Dr. Leo Damasco dive into the consumer side of trendy wellness treatments in telemedicine. Phoebe recounts her recent experience as a 38-year-old woman seeking hormone replacement therapy (HRT) through a major asynchronous telemedicine platform. She filled out a dynamic questionnaire, selected her preferred treatment, and received estradiol patches shipped to her door after a quick physician review, with no live consultation required.
Phoebe and Leo explore the broader tensions in telemedicine wellness, the pressure of competitive marketing, the rise of self-directed care, asynchronous “store-and-forward” models, and the fine line between patient convenience and responsible medicine. They discuss how some platforms disincentivize thorough follow-up or pushback from providers, the predatory nature of wellness marketing targeting perimenopausal women, and why even highly compliant companies can still fall short when human conversation is removed from the process.
The episode stresses that while telemedicine offers incredible access, patients, especially those pursuing hormones, peptides, or longevity treatments, must be cautious about what “convenience” really costs.
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Telemedicine Talks explores the evolving world of digital health, helping physicians navigate new opportunities, regulatory challenges, and career transitions in telemedicine.
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[00:00:00] Hey, welcome back everybody to Telemedicines Talks. It's always awesome to see everybody here.
Thank you for joining. And as always, we have Phoebe Gutierrez and Leo Damas. So Phoebe, what are we talking about today?
Well, today I wanted to talk a little bit about, some of the misconceptions or like the consumer perspective in telemedicine, especially in what I consider some of the new like trendy.
Wellness, healthcare kind of things, especially stuff that's, just being big and talked about on the internet.
Yeah. it's huge, right? The wellness craze is out there and I get a lot of questions about it, weight loss, hormones, peptides, right? And, what's going on and what's going around.
it seems like everybody's doing it right.
Yeah, it's really hot. so it's always kind of difficult for me 'cause I'm like, oh, am I in like a social media vortex that I can't get out of, or are everybody my age seeing the same stuff [00:01:00] that I'm seeing. But for me as a woman, I am almost like inundated with information about peptides, longevity, biohacking, hormone changes, perimenopause, menopause, like all the things.
Right. And so one of the things that I do for a lot of clients is, I help them launch, programs that are doing, let's say an TRT or an HRT program, hormone replacement therapy, testosterone replacement therapy. And interestingly enough, like for me, one of the things that I really try to avoid in all aspects is.
I am a patient, when I go through these experiences, I do not want to pretend that I understand the compliance side, like I'm coming from it from a paying patient. And so, mm-hmm. As I get to work with different companies, I get to also like test different workflows, try different things.
And what I have to say, probably one of the worst clinical experiences. And I. Wanted to share that because I think that [00:02:00] as companies are getting more and more competitive with their marketing strategies, consumers need to be aware of some of these tactics.
yeah, walk us through what's going on or what happened?
Yeah. So interestingly enough, I mean, and I think we've all spoken about it on the show, but it's the idea of how do I comply with the state requirements? Do I need to have like a face-to-face visit before I prescribe? Mm-hmm. Do I not need to have a face-to-face visit before I prescribe?
What questions do I need to ask? Do I need to collect this? Do I need to collect that right
now as a consumer, how often, like consumers don't necessarily know, right? Like these are the requirements, right? there's nobody saying, Hey, you live in this state. This is what to expect, right?
So, yeah,
I think that it is . Interesting to me that there's such a hot topic of like when people wanna get something prescribed, do they need to have a live consult? Right now working in [00:03:00] private practice, it's so funny because none of the clients that I have on the private practice side would dream of prescribing anything without having a 15, 30 minute, live intake.
And we're gonna talk about it and we're gonna make sure everything's sorted out. And in my experience, it's like I got into probably one of the bigger, telemedicine companies. you fill out a quick form, you tell some, side effects. I'm a 38-year-old woman.
yes. I'm tired. Yes. I'm moody. Yes, I think I'm going through perimenopause. Absolutely. then it gets the time of like, well, what treatment do you want? And I'm like, well, I forget. So I'll do estradiol patches or estrogen patches. And they get shipped to my house.
Super convenient. A physician reviewed it, you know, all was well. Was I able to talk to a doctor? No. Did I have to talk to a doctor? No. was the experience overall convenient? Hell yeah. Super convenient. So I get my treatment, [00:04:00] I put my, patch on. And in a matter of like two days, I was sick, I was moody, I was irritable.
I was not myself, I was not doing well. And luckily, Leo, as you know, I work with a lot of clinicians and have that like one-on-one conversation and I spoke to one of my, hormone providers who does it in a different state. I'm in California, she's in, Massachusetts.
And they prescribed me the same amount as a 61-year-old woman. I got prescribed the same dosage, the same everything for somebody who'd like already gone through menopause. And at that point I was like. No, I needed the visit, I needed the medical education. Why didn't they require it for somebody of my age, I'm only 38.
So I started to get like really upset because, you know, again, I've helped a lot of companies build Regulatory compliant workflows that followed the same thing as this, right? The patient's gonna understand they're gonna [00:05:00] get their education and we did everything we had to do.
We had a provider review it, but the very end of it, it was like I was over-prescribed. I paid a grand and I didn't even get the piece that I actually paid for, which was like the personalized nature of the medical education. Around like me and my body and my labs. And so it got me really thinking about this concept that so many companies and physicians and clinicians are so worried about the compliance side, when in reality it's like, did they comply or break any law or any rule?
Absolutely not. Do I feel like. It was slight malpractice. Yeah, I do feel a little slighted, like a provider should have had a conversation or they should have been forced or you know, I felt like I should have gotten a little bit more care than I received. And my biggest issue is that you have 99% of consumers that don't have a person in [00:06:00] Massachusetts that they could pick up the phone and call and go, I feel wonky, or I feel this, or I feel that.
And they're kind of stuck in this. Self prescribing mode.
Now I'm pretty accustomed to a lot of these asynchronous platforms. Right. and that's what you're talking about, right? You filled out a questionnaire and I'm assuming the questionnaire was quote, tailored to you, right?
Because what we're talking about is store and forward kind of practice, right? Yeah. And the physicians listening to this, right? there's different types of practices and if you've listened to this long enough, we've talked about it, but so you're going through this storm forward asynchronous platform and the questionnaires that you were filling out should have been tailored to you.
Basically, it should have been kind of a live form where, It's almost like choose your own adventure, right? It wasn't just a strict form where you're filling in the blanks, but if you answered one way, then you know, the question stem would branch out into another way, so forth and so on.
Did [00:07:00] you feel like, the questionnaire was tailored to you? Or like, I'm assuming it asked your age, it asked, have you gone through menopause or early menopause or anything like that? And I'm wondering, what kind of protocols were in place like. when you filled the questionnaire, was there any confirmation like, Hey, this is the information.
Does this seem right? Are you good with that?
Yeah, all the boxes were checked, right? Yeah. It was a dynamic questionnaire. There wasn't any like leading, they had the medical education in there to kind of talk about like the pros and the cons of each thing. Yeah, yeah. Again, It passed
the compliance hat. And again, this is a massive company that I can guarantee has a bigger compliance budget than like any company probably on this earth right now.
and
knowing the company, yeah, I know they have a big compliance. I know they're really good in terms of compliance, as a provider, when you start working with these companies, and as we talked about it before, you should have the ability to grade who you're [00:08:00] working for and making sure that they're very compliant.
And I know this company, in terms of that compliance piece, is pretty good. I'm very comfortable working with them, knowing that they're not throwing me into the mix. Now, there may be some questions. They had questions in the past about leading questions, so forth and so on, but I think that was also mixed as well.
So what was your biggest rub then? Is it. You know, you had the side effects. Is it because you couldn't then get in touch with anybody or?
I think it was a combination of a few things. I think that one of the things is that if you talk to a hormone specialist or anybody technically who should be prescribing, you know, these things, they would probably have had questions around my age.
ordering. These prescriptions, right? Yeah. So usually women are doing this and they're like middle to late forties. There's a bunch of what I would consider like step therapy that could be prescribed earlier on to try and like curb certain things. again, I [00:09:00] personally come from like old fashioned, like I don't think that any consumer should be able to click and buy when it comes to treatment.
So for me, like having to. Pick what kind of treatment I wanted, I think was a little problematic. I think the second thing is that, from my perspective and the other providers that I spoke to, I was given like the max dose versus like a starter dose or like, I guess in GLP one world it's called, titrating up and all of that.
Yeah, yeah. So there was none of that kind of explained, I think. what's interesting is when you go through the experience, you're perfectly fine. 'cause you're like, oh, it's really convenient. It's not until you actually talk to a good provider where you're like, oh crap, I got none of this.
Right? Yeah. And I could have been doing what to myself and I could have, to me it is that scary thing where treatment is something that we lead the professionals to, the [00:10:00] physicians the trained individuals to be able to prescribe to us versus the whole self prescribing thing.
Yeah.
So to me it was, not having the full, understanding of. The dosing. And interestingly enough, I tried to go into the app and understand like the dosing multiple times and like it just was missing. And so finally it was like, oh, okay, I'll look at the patch. And it was like, oh, the max dose.
and yeah. And then, the inability to kind of talk with a live person and everything needing to be asynchronous, I think also was pretty problematic.
Yeah. And it's interesting to see where. This broke down. I'm wondering, you know, what kind of protocols they followed because Yeah, they should have strict protocols.
Hey, this is, the starting dose per age. and a lot of different platforms out there, especially the asynchronous platforms, they're very, very strict about the protocols they follow and what starting dose you have because of this. Right. And I know a lot of the doctors that work on the asy platforms, [00:11:00] they really are very conservative.
For the most part , right? they wanna start low. And, actually, my personal kind of medical practice, and I know a lot of the people I know is we're very conservative, right? and if there's pushback, we're like, no, no , this is where you're gonna start. And after discussion, hopefully, through joint decision making, we all agree.
Usually we do, right? Because Yeah, after some education back and forth. So it's interesting that you didn't necessarily have that opportunity to do so.
Yeah, I thought it was really interesting. 'cause again, whenever I think about regulations or compliance, my brain always goes back to there, there's a purpose and a reason.
It's honestly not to make everybody's life hard or inconvenient. Like there is a real reason behind it. And, I guess probably very similar to how I feel like AI making medical decisions. Like, I feel that, untrained individuals also making medical decisions without. what I would consider the full [00:12:00] understanding of how to go about making those medical decisions is like equally as harmful.
so again, to meit was really interesting. I don't take any prescriptions, so I have not actually had a prescription in probably like 15 years. So for me, The whole idea besides like eye drops or, like some random things.
it's always kind of like been an interesting and foreign concept to me. So, as like it was so simple to do this again, I kind of go back to like the LPs Is it in the best interest of everybody to not have that education on weightlifting and the muscle mass and how to, double protein and, I don't know.
Yeah, it's funny, the conversation always comes up, right? it's the balance between efficiency, expediency and, the patient convenience. But then, yes. You know, with that you do sacrifice, the personalized touch and It depends what the patient wants, right?
it's [00:13:00] also, for the providers practicing method, you just gotta watch out, right? Because some patients don't know what they don't know, and they think this is what they want. And it's hard to find that mix. when I started this, I was almost a little hesitant.
To push back a little when I was like, yeah where does customer service end? like you wanna be customer service and I almost hesitate to say customer service. 'cause this is medicine, right? Yeah. This is Not McDonald's. the patient isn't always Right.
Yeah, so where does that line cross and where do you cross it? Especially in telemedicine, yes, people are coming to you and doing telehealth because it is more convenient. It is, more accessible. But then you know, you have to kind of skirt that fine lines, Hey, this is where good medicine runs in, and how forceful are you pushing back and can you push
back or .
Does the company allow you to push back and, we've said it before, if they don't allow you to do that, or if you're working for somebody that penalizes you for practicing good medicine, maybe [00:14:00] that's not a company you wanna work for .
Yeah. and I do have to say that I think that more often than not, that's probably the fear that goes through.
I mean, I've heard rumors from physicians that if they. Don't prescribe, or they ask questions that they get kicked off these platforms. So to me, it is this kind of like, interesting concept to think about. because I've also heard like physicians only get paid if they prescribe on these platforms.
So to them it's like you could review an async, screener and if you don't actually prescribe, or you need to follow up with that person, like you don't actually get compensated. So it's really disincentivized for the physician to kind of.
I don't know. I mean, I don't wanna say that there's like a weird moral ground, but I can see where, it does blur the line a little bit.
Yeah. you talk to the doctors that haven't gone telehealth or, that have criticisms about telehealth is like, Hey.
you're a telehealth doctor, you're just slinging meds, right?
yeah,
you're just a pill pusher [00:15:00] and they're knowing the community and knowing, most of us do want to practice good medicine, right? We do. Yeah. We wanna keep good medicine in mind. But unfortunately, just like anywhere else, there are some bad actors that have done that and that's perpetuates that kind of the stereotype.
Yeah. But yeah, no, it sucks that you had that kind of bad experienceknowing what company it was, I know a lot of people on the Converse side are like, oh, they did great, but, their course was uncomplicated. And I think, that's where the big hole in some of these companies and these asynchronous services have, is, if you need something.
More, involved. You're not necessarily gonna find that. Right. And with the async too, like, if you're the patient and you're gonna go message the doctor, the Dr. May not be there for another, hours, days even, right. And won't see the response. So, definitely don't expect an immediate response.
yeah, I think there's a lot of kind of like [00:16:00] issues, like I said, I also, don't think like doctors even get compensated for the follow up. So it's the messaging back and forth I think is also a little tricky.
Oh yeah. No,
they don't, knowing most of the payment schemes for these asynchronous things.
No, they don't get compensated for the follow-up. You get compensated for a denial or you get compensated for a definitive, plan, like, a prescription or a denial, or you should, if people aren't paying you for a denial or referral, that's a red flag as well, right? Yeah. but no, the back and forth, no,
It's lost time if you think about it that way.
Yeah. Nope. I mean it was kind of eyeopening for me because to me, I really did think that I knew enough about this space that I could self-diagnose, I could self prescribe. I didn't self prescribe, but you get what I'm saying?
Yeah. Like, I could, I understood enough like, no,I need this. And again, it wasn't until I was like, oh my [00:17:00] gosh, I am wicking out. Like, why am I so irritable? This isn't normal. I don't feel normal. To me it made me sad of course, because I think that a lot of the marketing is a little predatory.
you're taking advantage of somebody in a very desperate moment.
like, I mean, you're a dude, so I'm sure if you asked your wife the process of aging is really hard on women and I think misunderstood and no two women feel the same.
You go through stuff at different ages and stages and have different symptoms and at the end of the day you don't feel like yourself and you'll do whatever you can to feel better.
Yeah,
and I mean, we should get Diane and Theresa back on and do a whole session about it because for me.
That's what's predatory in nature is my whole Instagram feed is hormones, peptides feel better, perimenopause, take estrogen, take this, take that. And without having a provider to go, [00:18:00] look, you're 38, I don't think it's a good idea. You have all these other things you could try. Have you tried all these other things giving me.
almost like a guaranteed of like, look, you just buy this thing, it costs this money. I mean, yeah, I clicked, I bought,
you're like, yes, perfect.
Oh, guys, mommy's gonna be,happy. You know,
mommy's not gonna be angry anymore.
Yeah. And then maybe it was also like a little mental thing.
I have no idea. But I did feel like almost a very instant. Influence on like how I was feeling for the negative.
Yeah.
And again, my concern is like I was able to, after three days, picked up the phone. Shout out North Star Integrative Medicine in Massachusetts. And, I had a conversation with one of my physician assistant, clients who like really walked me through, like basically poked holes in the whole workflow, said at this point you needed to do this.
At this point, you need to do that. They should have asked this question. They should asked that question. We spent like an [00:19:00] hour kind of really building what I would consider a. Personalized care plan that actually she told me she thinks I should have gotten testosterone. So Complete opposite.
But again, that's what I'm saying is like, it was a really interesting thing for me to go through because I have these conversations with people and I really thought that I was educated enough to do it and I'm not like we need doctors, we need clinicians to do this stuff, not robots.
And, apps.
Yeah, no, it's definitely a fine line there. And, I think we're gonna see more and more of this, right? It's just these companies are coming up and, a lot of people, because of the convenience are like, yeah let's go do it.
You
know? and you're right.
They know how to market real well . They do, right? ads on the Super Bowl everywhere, right?
Yeah, it's like you get sucked into a vortex and you know, at the end of the day, I think everybody just wants to feel better. I think, to my [00:20:00] point and. One of the problems with my issue with GLP is that at the end of the day, I qualify for glp do I need to take a GLP or should I maybe like actually go to the gym and like stop working so much?
Like Yeah, that's probably that. Well,
that's the easy answer, right? Like part of me is like, man, should I take a smaller dose? I'm like, and I could eat whatever I want.
yeah, it's exactly that of like, okay, well, I could get LPs from just about like anywhere if I really wanted to, and Yeah.
should I just do that? And again, to me, I'm so read up on the right way to do things that I would never, but I just feel like a lot of people don't. And again, in a world where we live in, everybody wants everything to be so easy. and. I just want people to, not be tricked into doing stuff that's gonna impact their health.
Yeah. It's so easy right now, right? Yeah. It's because information right or wrong is so available and Yeah, it's a lot of consumers out there don't know how, you're lucky, right? [00:21:00] Like you said, you have resources that a lot of people don't have and yeah.
Hey, this is interesting. and I'd love to hear about other people's experiences, either as a consumer, a patient, or even a physician working this. What your thoughts are and maybe, hopefully we could have kind of competing kind of ideas.
Please reach out, join the show if you want to come on I love hearing both of us talk, but it'd be awesome
to get a good conversation about what different people are doing and different experiences. So definitely reach out at info@telemedicinetalks.com or you could reach out at leo@telemedicinedocs.com and phoebe@telemedicinetalks.com.
Yeah, no. Thank you for joining, and we'll see you all again next time.
Thanks for joining.