Phoebe Gutierrez and Dr. Leo Damasco sits down with Dr. Mark Chmiela, a double board-certified anesthesiologist and pain-management physician practicing in Las Vegas, for a candid look at how COVID accelerated telemedicine, why reimbursement and regulatory pressures later forced a return to mostly in-office care, the real patient benefits of virtual visits for chronic-pain management, and practical lessons on using telemedicine as a tool rather than a total replacement.
In this repurposed episode of Telemedicine Talks, hosts Phoebe Gutierrez and Dr. Leo Damasco welcome Dr. Mark Chmiela, as he describes how COVID turned telemedicine into an essential lifeline, reaching 80–90% of his group’s chronic-pain patients, while also exposing access barriers for elderly and lower-income patients.
He walks through the post-2024 shift: insurers stopped or sharply cut reimbursement, credentialing hurdles multiplied, and the practice gradually transitioned patients back to the office, landing at roughly 95% in-person visits. Mark stresses that telemedicine remains valuable for stable medication management, patients with mobility or transportation challenges, and certain follow-ups, but cannot replace hands-on exams when new red-flag symptoms appear.
The conversation covers the practical realities of chronic-pain care (opioids, non-opioids, interventional procedures, lifestyle counseling), the risk of fraud that made payers cautious, the human connection that in-person visits still deliver better, and Mark’s optimistic view that technology should augment, not replace, thoughtful medicine when used for the right patients.
Top 3 Takeaways:
About the Show:
Telemedicine Talks explores the evolving world of digital health, helping physicians navigate new opportunities, regulatory challenges, and career transitions in telemedicine
About the Guest:
Dr. Mark Chmiela is a double board-certified anesthesiologist and interventional pain-management physician practicing with a multi-physician group in Las Vegas. His practice serves a broad mix of Medicaid, Medicare, commercial, personal-injury, and workers’-compensation patients and focuses on comprehensive chronic-pain care.
Website: https://health.usnews.com/doctors/mark-chmiela-1414283
LinkedIn: https://www.linkedin.com/in/mark-chmiela-1a5802194/
About the Hosts:
• Dr. Leo Damasco – Pediatrician and emergency medicine doctor turned telemedicine advocate, helping physicians transition to digital health.
• Phoebe Gutierrez – Former state regulator turned telehealth executive, specializing in compliance and sustainable virtual care models.
Connect with Phoebe Gutierrez:
https://www.linkedIn.com/in/pkgutierrez/
phoebe@telemedicinetalks.com
(mailto:phoebe@telemedicinetalks.com)
[00:00:00]
Hey, welcome back everybody. Aloha and hello. Aloha means hello. Today we have Dr. Mark Miela. He's a practicing pain doctor living in Vegas, double board certified in anesthesia and pain management. He wanted to jump on "Telemedicine Talks." Love it. Love everybody jumping on "Telemedicine Talks." If you want a voice, please come on and ask.
But he listened to the non-telemedicine talk that we had and was like, "Hey, I'd love to raise my thoughts and what I was thinking," and we were like, "Yeah, absolutely, all about it." So Mark, dude, thank you so much for jumping on. Yeah, let's talk. Let's "Telemedicine Talks." Ooh, that's a good one.
Awesome. Leo, Phoebe, thank you so much for having me on.
I am super excited to talk with you guys tonight. And let me start by saying I am super jealous of all that greenery I see in- ... behind you guys. I'm in arid Las Vegas. It's dry, it's getting hot. I would love to be out there with you guys and enjoying that beautiful weather you have there. So once again, thanks for having me on.[00:01:00]
Yeah. No, it's horrible out here. 75 degrees all year round. Hate it. No, awesome.
The, the funny thing with Leo is when it does drop under 70, he's in a really puffy North Face jacket. Oh,
man. So I screech at him. Cold. Cold. Total
de- total, like,
dead
giveaway. Frigid. You know the copper
greens? Miserable. Sounds, sounds miserable.
No, it's horrible.
Horrible.
Mark, you're a pain doc. We were talking earlier, and when COVID hit, you were practicing telemedicine. But now you're not. Tell us about that and why you moved away, and the progression there and yeah.
Sure, yeah. I think COVID was a stepping stone for telemedicine. It really gave physicians an opportunity to see patients during a time where social contact was restricted.
You saw plenty of platforms pop up with telemedicine opportunities, and we jumped on that. This allowed continuity of care. We had multiple patients who needed to be seen monthly for their medical care, and it just was not feasible to have them come to the [00:02:00] offices and sit in the waiting room and whatnot.
So telemedicine was definitely used, and it was used frequently. I would say 80 to 90% of our patients were incorporating telemedicine. There was some obviously technical difficulties with some of our elderly patients and perhaps some with lower socioeconomic status, and access was an issue. But it was a tool that we relied on.
It was wonderful at that time, and we did continue to incorporate it up until about 2024. In 2024, we saw a noticeable shift. First and foremost, certain insurance companies stopped reimbursing for it altogether, so we weren't able to-
Mm ...
incorporate it for their, for their patients. Second was reimbursements began to be cut.
Initially pretty reasonable, and then some insurance companies were cutting it by half or even more than that. From working in private practice, obviously we're here to serve the community, but you have to balance your budget. And unfortunately, it's just if you want to deliver appropriate medical care, then you have to [00:03:00] spend time with patients and give them the appropriate time, and if your, you know, revenue is getting cut in half, then it's just not going to work.
So that was another thing that really did influence our shift in paradigm. And then there were some regulatory issues, too, about having to sign up and get credentialed with certain platforms and whatnot, and it just was not feasible. And with COVID restrictions being lifted and patients getting used to it, we had to transition.
So initially we didn't go straight from telemedicine to an office visit. We did, "Okay, you get to telemed, telemed, in office." You know? And then so we warmed them up to it, and now we're pretty much all back to in-office. I do have some patients which I still see through telemed, mainly if they're living in another city or if there's some other issues or some other specific patients.
But, uh, I would say we're back to about like 95% in office.
And so during COVID, what kind of conditions, what exactly were you doing in telemedicine?
Yeah. Pretty much almost the same [00:04:00] thing that we would be doing as we'd be doing in office visits except for physical exams. So a- many of our patients-- To give you an overview of what I do specifically, I'm a part of a, a fairly large pain medicine group here in Las Vegas.
We have four locations all across the city, and currently we are at four physicians. We are bringing on a fifth physician later this year. We have at this time, I gotta double check now 'cause one's going on maternity leave, one, two, three, four, five... We're going six mid-levels, and everyone's pretty much fully booked, so we see, as you can imagine, tons of patients.
So in the telemedicine sphere, what we were doing is mainly managing chronic pain patients. We have a fairly significant and large under-serviced population here in Vegas. That's a big reason why I'm here in Vegas, is that it's an underserved community. It is really difficult to get quality care here in Las Vegas.
It's difficult to [00:05:00] get quality specialist care, not only from a perspective of access, but not everyone who is qualified and great takes Medicaid and certain insurances. And so we as a practice, we open our doors to pretty much everyone. There are a s- select few insurances that we don't take despite us trying to negotiate reasonable contracts with them, but we try to service everyone.
We deal with Medicaid patients. A significant population is Medicaid, Medicare patients, private insurance. We do personal injury and workman's comp, and so we pretty much service any and everyone that we can, and we're happy to do it, and that's what we wanna do. We wanna make a name stamp in our city. We wanna make sure that we take care of everyone.
Coming back to the initial question which you mentioned, what do we do? We manage these patients with chronic pain. As you can imagine, chronic pain is an epidemic. It is an epidemic in itself. It is a disease in itself. Chronic pain is not just a symptom, it is a disease. And with an aging population, you have more people developing [00:06:00] osteoarthritis.
You have more people developing neck and back issues. You have young patients, old patients, rich and poor, who all deal with some form of chronic pain or at least some form of pain throughout their life, and we are there to help. And because primary care physicians are stressed here in the city, the number of my patients who don't have a primary care physician and who can't be seen or can't be seen reasonably or within a reasonable time is, like, insane.
And despite me being an anesthesiologist and interventional pain management, like, some of the stuff that I'm doing is just managing their chronic non-pain related disease states. I have to always talk about blood pressure and diabetes and exercise, and I have to tell them to go see this specialist 'cause you really need to go get this checked out.
And fortunately, I have a good network of providers that I work with who, we help each other out. It's, "Hey, can you get this guy in?" So that's pretty much what I do on a day-to-day basis. So when it comes to chronic pain, we're managing pain conditions, and that involves anything [00:07:00] from being a quarterback to, like, making sure patients are eating healthy and exercising and going to physical therapy and dealing with their depression and anxiety and having a zest for life and hobbies and making sure that they just don't sit at home and don't do anything.
Yeah. 'Cause all of those are just, like, risk factors for developing pain. We do a lot of pharmaceutical prescriptions, right? We do non-opioid medications. We do opioid medications for those who qualify for that. And then a large portion of our practice is interventional pain management, and that involves seeing if some injection therapies can help relieve some pains in patients who, who have those pains.
As patients come in, whether it's in person or telemedicine, we are focused on trying to assess the burden of their pain, the intensity of their pain, how it affects their quality of life, their activities of daily living, and we try to obtain reasonable goals of care. That's it. What are our patient's goals of care?
What do they wanna do? Vegas is a-- It's-- I golf. I got a lot of patients, a [00:08:00] lot of my older patients love to golf. It's great golfing here in Las Vegas, and some- Right ... of these patients come and say, "Hey, I just wanna go play nine holes." Well, let's see how we can do that. Yeah. And the mode, the medium in which we provide that service, whether it's telemedicine or in person, I think there's some subtle differences, but the end goal is the same.
Let's try to better our patients' lives.
Now, so COVID hit. You can't see anybody, right? You can't see anybody face to face. So how did you... Question one is, how do you-- A lot of the stuff you were just talking about doesn't have to be face to face, right? Or not necessarily face to face, but in person, right?
'Cause you can use video, so forth and so on. So what did you see? How did you evolve your practice to fit within those w- within telemedicine? And you mentioned also, too, your payers were paying out, right? You were getting paid by your payers. How did they figure the change out? How-- Once COVID stopped and they're like, "Okay, we're not gonna pay you for this service that you're probably doing so [00:09:00] well."
It's probably the same kind of service. What kind of reason did they give you, if they gave you any- They- ... to stop the payments?
They didn't give us any specific reason. Now, I can understand where there's potential for abuse, right? And like- Yeah ... any system can be abused. Like, telemedicine can be abused. You can do a telemedicine visit in a minute if you wanted to.
You literally can do it. "Hey, how you doing? What are you here for? Med refills? Okay, bye." Is that proper medicine? Is it? I, I don't think so. I think there's a standard that has to be set. This is how I wanted to phrase the pros and the cons, the benefits. Telemedicine is a tool. It is a tool to augment your practice for the right patient.
That's what it is. It's a wonderful tool. I have patients in wheelchairs that I feel horrible for them that they have to lug themselves across the city to come see me for stable medication management. That's really what it is. They have to come in, sit in the lobby, fill out a [00:10:00] form, get wheeled into a room, have my medical assistant ask them questions that I can frankly ask them myself, update the medical chart, which doesn't play a part in my medical decision-making.
Like, all of that, like, if you ever see a medical chart, it's, like, ridiculous. Everything that I'm looking there, I'm like, "Who cares?" Quite frankly, I'm being facetious. Let's be honest. Oh, no. I'm being facetious. I mean- No,
absolutely. I agree.
But-
I agree. When I look at a medical chart, it's the first line's the HPI- Yeah
and the MDM. Yes. And everything else is billing junk.
Billing junk. But you have to do it. I, I only look at what I write. What I write is what matters because it's my th- train of thought, right? And you have to have things listed. But what, like, why are we doing this to some patients? It's so much better for these patients to come in, it, And that doesn't mean it's a replacement for a yearly physical.
It's not a replacement for doing a proper physical exam on patients who have new findings that warrants putting your hands on them. But for certain patients, for certain consultations, it's a wonderful tool. So they didn't really give us an answer about why it is, but you [00:11:00] can Google it. There was fraud.
Yeah. There were groups that were taking advantage of telemedicine. How do you prove that someone showed up to a telemedicine appointment? Like, how do you prove it? You can't. I can prove that a patient came to see me. They filled out a sheet. You know? That's their handwriting. That's their name at the top.
They circled their butt- Mm-hmm ... 'cause they have butt pain today. And, and so they came and see me, and we bill accordingly. I saw the patient and I provided care. With telemedicine, it's rife for abuse if it's not standardized in some way or monitored in some way. Yeah. So I can understand. But realistically, because you're cutting out a lot of that administrative portion, you're cutting out a lot of the fact that these patients have to be roomed and sit there- Yeah
and all that stuff, like, you cut down on the time.
Yeah.
Maybe I'd spend 15 minutes with a patient in person. Maybe with telemedicine I can do it in eight minutes or 10 minutes. So should I be able to bill the same as a in-patient visit? And that's an argument that someone can be for or against. But I'm empathetic t- enough to know that, like, you, new systems, especially [00:12:00] ones that are brought on by necessity, like COVID, this was not a planned decision.
This was like- Yeah.
Sure ... "
Oh my goodness- We're forced ... what the heck are we gonna do? We're forcing this." Yeah. Mm-hmm. So we wing it. I think we winged it pretty darn good, and now everyone is trying to figure out what's a reasonable approach.
Yeah.
And I think, too, like your point, and, like, I always try to emphasize, like, from a regulator stance, like- To your point, if something is so large that they can't monitor it, then like insurance is a little bit more lenient, right?
Look at how like they monitor DME. Look at how they monitor certain things that are just like they actually have no way of monitoring it, therefore they're actually gonna say it's not allowable. Now, that's one of the big things, like Leo, you and I have talked about. Yeah. Yeah Like telemedicine for Medicare, for example.
Like it's just like it's rife with fraud. They lack the effective oversight to be able to like oversee and manage it, and because of that we're just gonna have to put a kibosh to it- Yeah ... because like we can't spend taxpayer dollars [00:13:00] and not actually have an effective monitoring tool. Yeah.
They go to the lowest denominator, right?
Yeah. So yeah, if they're not able to do it for all, then they're stuck. And you're right, it is ripe for fraud, and we've seen it. And we've talked about kind of certain cases of fraud and whatnot. But you're right, it's hard to argue against how valuable it was. And you're right, it's not for everybody. It's not for every case, yes.
There's a time and place for it. But yeah, I think using it, utilizing it appropriately and for the right patients will definitely and could augment your practice and really good for the patient, really, really good for the
patient. It can augment nearly every practice. Yeah. Now, I honestly don't think-- I can't think off the top of my head that like a certain specialty can't take advantage of it.
I can contact a dermatologist and be like, "Hey, I got this, uh, I don't know, rash." They don't need to touch the rash. Yeah. They just need to see it. If I have a good quality camera on my phone, I can take a picture and send it. I can get a diagnosis right there. I can go to a family physician. Mm-hmm. And, uh, again, [00:14:00] as I mentioned before, I don't think it's a replacement for certain aspects of medicine which requires you to go see the physician and actually have them put their hands on you.
I think there's... As an aside, I can tell you I saw a patient during COVID who was coming to see me a few times. I saw him like maybe once or twice in clinic, but I saw him on telemedicine, and one of the days he came into clinic, he was coughing in front of me, and I was like a little bit concerned And I noticed that he had significant clubbing in his fingers.
And I said, "How long you been coughing?" And he said something like, "Six or eight months. I don't remember." "Are you losing weight?" "Yes." "How much weight?" "I don't know, 30 pounds." "Not intended?" "No." And I said, "Did you talk to your PCP since then?" "Yeah, I've seen them a couple times." It's telemedicine, telemedicine.
It's okay. Here, having someone in front of you with these symptoms warrants further investigation, right? Yeah. I ordered CT chest, abdomen, and pelvis, and what do you think he had? A diffuse metastatic cancer. Stayed with me for about four or five months, and then he died. He was a young guy, late 40s, early 50s.
And [00:15:00] so again, that's not anything against telemedicine. I think it augments your practice, but you still have to do proper medical screening. You know, it's preventative medicine. As long as you are using telemedicine to augment your clinic, I think it's great. Have your patients come in. You have a family practice, have the patients come in for their yearly physical.
They wanna set up a telemedicine in between to talk about XYZ, their diabetes control. I don't need a s- primary care physician does not need to see a patient for diabetic control in the absence of other systemic symptoms that edema, wound, wound issues that they may be developing. If it's just, "Hey, my sugar's a little bit wonky, what can we do?"
That's like a medication titration issue. That's like a discussion and education, and that can be done over the phone But come in every year, get auscultated. Make sure you haven't developed a murmur. You're a smoker? Let's make sure you don't have some aortic aneurysm that could be palpated or auscultated.
I don't even remember. I don't do that.
I was
about
to say. But it,
but it has nothing to do with me. Yeah. It has to do with what are [00:16:00] we here to do. I'm here to practice medicine. I wanna do it well. I wanna do it well. And I hope that any tool that we... I'm not a lu- like, and another thing, going back to why we should look at this in an optimistic light is we can't be Luddites.
We have to understand that technology is advancing. Everything is getting scary. I'm getting older. Everything is scary to me. Everything new is scary. No, it can't be scary. Yeah. I have to learn how to incorporate it, because if I don't do it, somebody else will. And somebody else will do it better if I wait and delay.
So if there's new technology, take advantage of it. Learn it. Don't be scared. Find out how it fits your practice and how it fits your life, and how you can use it for its advantage, and then don't use it for the things that isn't appropriate. And- Oh,
ab- totally agree. Totally. And, and this is the way it's going, right?
The, God, I'm gonna sound like an old man now. The o- the younger generation, I am getting old here. But the younger, this is what they expect, right? They expect, yes, annuals have to go in, but they expect instantaneous. I, I wanna get on, I [00:17:00] wanna get on now. I wanna talk to a doctor now. Let me talk to a doctor.
I don't wanna wait in a waiting room. I don't wanna drive 20 minutes away, just like you're saying. Let me talk to somebody in my lunch break. Let me talk to somebody on my way home from work. Keep your eyes on
the road. Oh, it doesn't stop there. Yeah, right. I've had telemedicine ba- visits with patients in their bed.
Oh, absolutely. It's like, it's like- Absolutely. And there's some, I'm like, "Just please put some clothes
on." Put some clothes on, geez.
Just, it's, I don't wanna see that.
I, I swear to you, I'm not joking. I had someone do a telemedicine visit with me while they were showering.
From the patient perspective-
Yes
you don't know when the telemedicine visit's gonna start, and so you're just going on with your life.
Got it. Yeah, I know.
So I'm gonna side with the first- What if
you, you don't go
anymore? I've never done that, but I'm just saying. Yeah. You don't know. Yeah.
You're
on the other end, like, when is this video thing gonna start?
Sure. Sure.
Yeah, exactly. No, but I, I understand. That's the benefit of it, too. Like, you can't do much when you're sitting in a lobby. No. I try to keep, I try to keep a pretty timely clinic. Yeah. But you can't predict everything, and sometimes patients have to wait. No. Now, they don't wait as [00:18:00] long as sometimes they wait at a surgeon's office, where I've heard hours of waiting.
But people wait. And if you're waiting in an office for hours, you have better things to do than just sit there and scroll your phone. You know, you have a way to live. And so yeah, I think identifying the patients who are, who ha- have transportation issues- Yeah ... which are numerous, at least in my practice, numerous patients who have transportation issues- Mm
who have a difficult time getting into clinic. They take the public bus. Yeah. They miss a bus, they're late for their clinic. And what am I supposed to do, ca- I'm supposed to cancel their clinic? No, I can't, because then I've just made their already hard life harder. So what do I do? Yeah. I fit them in. Yeah.
Take a seat, fit them in. Could this be solved- Well,
that's a good point. That's a good
point ... could it be solved with a telemedicine visit? Absolutely.
Yeah.
Some people end up Ubering. They're worried that they're gonna be late for their appointment. That just cost someone 20 bucks. That's 20 bucks they don't have.
And for some of my patients, 20 bucks is a lot of money. It's a lot of money.
Yeah. Absolutely. They have to take off of work. They, some are working two, three jobs, right? Mm-hmm. They don't have that time. They have to find [00:19:00] childcare. They don't have that money. So yeah, absolutely roll, and definitely one of my biggest arguments for being a proponent of telemedicine, for sure, so.
Yeah. It's just, again, the way that I always try to frame it is just because, again, like I come from like the Medicaid world, where- Yeah ... why is it that like you and I and everybody else can get a telemedicine visit through private insurance, but we're gonna make the, the people with the hardest lives, the medical conditions, the unemployed, the lower income Jump through hoops and travel three hours to go to a doctor.
I mean, in like, in where I'm at, California, like there are people that have to travel hours to get to a doctor. And so to me, I can't make heads or tails of it from just the policy side of like why you would not wanna make... Like we need to reduce the barriers, not add more. Yeah. And then again, like of course like there's gonna be the instances where, no, you need to go see somebody or something seems a little, I don't know, suspicious.
It doesn't seem right, like you wanna see somebody in, in person. That's a different story. [00:20:00] But I don't know, trying to encourage getting care versus the idea of let's make it as difficult as possible, to me is just, I don't know.
I agree. And coming back to what do we... What-- As a physician, what do I do mostly?
I, I listen. At least in my practice with pain is so subjective. Yes, I rely on imaging findings, and I rely on the physical examination to help work through differential diagnoses. But if you put me in a room with a patient and I let them talk, like nine times out of 10 they'll tell me what's wrong with them.
I don't need to put my hands on them to confirm it. Now, I do, and it's always that additional piece of information. But most people, you can get the information you need as a provider just by listening to them, for most cases. And so I... And agree, lowering barriers to entry is paramount. And we gotta make sure that it's [00:21:00] reasonable.
And we gotta make sure, we gotta trust ourselves, and we gotta trust everyone that everyone will take advantage of this tool and not abuse it. And because there's a rife... It's easy to just be mediocre. Like it's easy to be mediocre. It ac- you actu- you actually put a little bit of effort in if you wanna be good.
And you should, and I think in, at least in our field, we should actually always strive to do that. We should always strive to do our best. Because for me, patients sitting in front of me, they are patient. They are Joe, they're Mary, they're Sue, and yes, when I'm in the room and I'm listening to their complaints and their concerns, like I'm empathetic and I understand them.
But that empathy doesn't last very long because as soon as I leave the room, I'm over to the next patient, and I have to deal with whatever is bothering them. And for my own sanity, I can't take that home. I can't take that home to my wife and kids. Yeah. I have to leave it at work But I always have to remind myself, that person sitting in front of me could be my mom, could be my dad, you know, could be [00:22:00] my wife, could be my kids.
So with any type of tool, as I mentioned, we have an obligation to take advantage of it for what it gives us and not abuse it.
Now- Yeah ... with telemedicine, I've heard from a bunch of people, because of the extra time, right, you have extra time to sit there. People are more comfortable delving deeper into their personal lives.
The doctors feel actually a stronger connection because they're-- they can now take a little bit more time to talk to the patient and, and sit there, right? 'Cause, you know, it, well, it's primary care. You sit there, it's 15-minute appointments, and you knock it out. Five minutes, you're only in front of the patient for five minutes, right?
But with telemedicine, because of the lack of the other barriers, you're there longer. Did you find that kind of in your case as well? Or how did you think-- how can you compare your interactions with your patients via telemedicine versus-
Yeah ...
brick and mortar?
I have to be honest with you, and I have to actually disagree with you.
All right. I, I do think that with telemedicine you [00:23:00] can, you can spend more time with patients under telemedicine, but I don't think you actually do because there's nothing more personal than an in-person evaluation. And I can only speak for myself, but I shoot the ish with my patients. I, before I dive down to what's going on- Yeah
I love to ask, "What's going on? You do any-"
Yeah ... "
fishing? Did you go golfing? Did you travel anywhere? How's so and so?" Because I have little notes that I put into their chart, because for some of my patients, I'm one of the only people that they interact with throughout their daily life. Yeah. And some people really just come just to talk.
Yeah.
Yeah.
And I don't like the real physical distance, and I actually think, like, an emotional distance with telemedicine. That's the only thing that I think is, in disagreement with you, is that I really enjoy the in-person experience. Shaking someone's hand, right? I think for some people- Yeah ... it's nice.
Looking them in [00:24:00] the eye is nice. Just having a presence I think is nice. That doesn't mean that has to be the case with every visit. But I do think that there's something nice. It's the same thing like when you go to a restaurant, and you're sitting with your friends, and everyone's on the phone. What the hell is this?
What is going on? Put the phones down. Put it down. Let's talk.
Yeah.
And that, I might be aging myself. I don't think I'm old, but maybe I'm an old soul. But there's an aspect of technology that can border like depersonalization in some sense, right? Like it can- Yeah. Absolutely ... it, it really does pull away.
And so I
w- I, I don't know. I get ... So I see both sides a little bit. I see your perspective in terms of like having the in-person connection, but I also see like certain ve- like very specific industries where I think telemedicine has just changed the game. Like last week we talked to- Yeah ... two OBs that started menopause clinic, and it's like for somebody like again, like my age who's been gaslit by every doctor who, "No, you're not going through the change," and then it's like you talk to doctors who know what they're doing, and it's, "Oh, you are."
Like, I think there's [00:25:00] like these certain industries where it could, I think it does take some stigma away, and I think people are a little bit more willing to embrace it. Like I think like addiction medicine is like another- Yeah ... field where like most people wouldn't wanna go in person to a clinic because there's like a weird stigma.
But if you allow telemedicine, it takes that away. Like I know like that was Mister's big thing. Yeah.
I was- You know? ... just about to say, PrEP medicine and that community- Yeah, they tried to get- ... they're more apt to stay, reach out.
Yeah.
I think it's, you know- I actually, I agree. I do agree. I would say that I am only speaking through my personal experience.
Yes.
But I definitely can understand other industries or even other specialties in medicine where that type of personal like interaction isn't as important or that perceived distance is actually of benefit, right? Where you can feel, you can be a little bit more vulnerable to certain people because you're not there, they're not seeing you, you're just someone there on a screen.[00:26:00]
Definitely. I definitely understand that perspective. So again, finding the right opportunity- Yeah ... and the right circumstance to use it is great, and it should be offered. It's about choice, right?
Yeah.
It's about choice. Give patients choice- Yeah ... and they will make the right decision for themselves.
Yeah.
That's it.
Yeah. I've, I have a serious question for you. Very serious.
Okay.
What are your thoughts on IV hydration?
You got me. Does it work? You got me. Does it work? You got me. I got my ba- I got my... So shout out Pete here in Las Vegas. He's one of my best friends here. He is an interventional cardiologist, fantastic physician.
If you guys are ever in Las Vegas and suffer a heart attack because you win millions at the, at the table- ... then you're gonna go see Peter Blaschinsky, who is a wonderful interventional cardiologist, and he is getting married soon. So we are celebrating his bachelor [00:27:00] party actually next month. And yeah, so IV hydration is definitely wonderful in certain circumstances.
Oh, interesting. So whether or not I'll be providing such services or receiving such services are not to be disclosed on this podcast. But in terms of IV hydration, quite frankly, th- this comes down to another aspect of medicine where you are seeing an increase in certain niche services, some concierge-type services.
And I think for the most part, it's great. I think that it's wonderful that you can provide patients with treatment that they electively choose. I think there is always the concern that you improperly market those services or you make false claims, because there's a lot of patients who come and say, "Oh, I was promised this," and that's like- Yeah
where's the literature that supports that? On the other hand, it's, for me, especially with dealing with chronic pain patients, like placebo is real. Placebo is so real. I don't care what helps. I care, but- Yeah ... if you come and you tell me that like [00:28:00] you sleep with rocks in your hand at night and it takes care of your knee arthritis, like I am giving you two thumbs up and pretending to order those same rocks on Amazon.
Yeah. And so when it comes to like certain therapies like IV hydration or any type of NAD supplementation, like IV or glutathione or some, even some of the peptides like BPC-157 and CB-500, it's like there's evidence for a lot of these treatments, and I think that it's, for the most part, without getting too political, should be accessible to patients.
And if patients find benefit from it, and if the services are offered in an ethical way with patients well-informed. It's all about informed consent.
Yeah.
Informed consent. Yeah. That's what. It's like tell the patient what's actually gonna happen, what the risks are, what the benefits are, what the studies, and let the patient decide.
Set your price and see if, and see what the market is. Some people might do something similar cheaper. Some people might offer a better service and charge more, and great. There's co- It, it, you can do it in cosmetics, like tons of people go get Botox, right?
Yeah.
Botox prices are like, ugh, I know, expensive, cheap.
It's like same product. Like what are you really paying for? The hands? Okay, great. The outcome? [00:29:00] Fantastic. So I am realistically like all for it, for the most part, all for it.
Yeah.
Okay. Sorry to cut you, but wrapping it up, last thoughts.
I think I definitely spoke a lot tonight.
No,
not at all. You guys, you guys, and thank you for giving me a platform to speak my mind, but- Sure
I wanna loop back with how telemedicine is currently offered in the community. At least from my perspective, it's, it's really restricted, and I think we should have it available to providers and to patients. I think there are definitely clear benefits in certain circumstances, and I think it benefits the provider.
I think it benefits the patient. I think it benefits the system as a whole because all it comes down to is patient accessibility to appropriate healthcare and to reduce- Mm-hmm ... barriers to healthcare. So any way that we can do that I think is a plus.
Awesome. Awesome. Yeah. Thank you so much for your time.
Totally enjoyed talking to you, and yeah, hopefully we find [00:30:00] time to talk more.
Absolutely.
Thank you. And everybody definitely check on back next episode. If you have any questions, concerns, drop us a line at info@telemedicinetalks.com. Thank you, guys, so much.
Leo, Phoebe, thank you so much. Have a great night.
Thank you.