My archives might be a little outdated especially the older blogs. My links above are all new and current.

I have only positive things to say about Permission to Mother, an autobiographical account of a thoughtful mother and clinician who courageously writes from her heart, soul, brain, and personal experience; who is open to change in her views and opinions and is not guided by the safety of rules of any group or the status quo; she is guided by love and openness to the experiences life brings her and her family. Her process benefits her and those around her and those who read her words. And to add to that, the writing style and story telling ability here make it a very enjoyable read speckled with both the humor and seriousness of life. ~Laura Keegan RN FNP, author of Breastfeeding with Comfort and Joy

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E-care 2014

February 9, 2013 at 6:13pm
E-care 2014 Reassurance from Dr. Punger is just an e-mail away! 

E-care may be for you  if you want to e-mail me directly and after hours.

E-mail can be used to improve communication. I know my families without their charts. I have access to my schedule and your records from my home. Therefore, many routine questions can be handled with e-mail when it is the most convenient and needed by you. I can fine tune a treatment between appointments; and facilitate the start of a new treatment along with expediting the next office visit. Patients enjoy the convenience of having expanded access and receiving an electronic copy of medical instructions. The anonymity of on-line exchanges often reduces inhibitions about describing problems. I enjoy benefits such as the ability to thoughtfully respond, more productive office visits, and easy documentation of correspondence. All of us appreciate not playing phone tag. I can guide you  if you must go to urgent care and desire a second opinion on all options.

Almost all insurance is structured to pay for office visits and a physical, and we will gladly bill your insurance when you are seen. However, physicians rarely receive third-party payment for care and research provided without face-to-face contact, despite the obvious benefits such communication brings.  My electronic preference for communication is e-mail (a full keyboard!), but many of my patients prefer text, Facebook, and a combination of other non-secure networks to communicate. Often I am willing-- Insurance definitely does not cover those services.

A low annual fee of $300.00 will include about 12-15 E-mail contacts/problems per year per household. A one-time payment in full is appreciated.  This fee is pre-paid.

It is your responsibility to schedule an office visit following E-care contact for problems that go beyond E-mail including prescriptions, scheduling labs or procedures, and referrals. Providing concise information, legal names, correct pharmacy phone number and your phone number can help keep your cost down and speed response time. Use sensible hours and expectations for questions that are not emergencies.   You are responsible for coming in at least annually (or so). For complex after-hours care, copay/insurance may still apply. Fees are due annually on the month you opted in or your benefit will expire. If you need to make arrangements to pay later your intention is appreciated, but it is still dated back to your annual and you must get approval. This is not Sam’s Club where you can renew the next time you come in. You also need to provide ONE e-mail address that I will use.

If I will be away from e-mail for any period of time (which is rare, like my Guatemala trip.), you will have fair warning to plan ahead.  
The nature of my practice includes social networking and real life friends. It also involves many one-time consults. I have good electronic skills which may make it tempting to approach  me. I appreciate you understanding why “everyone” can’t e-mail me whenever. Over time, the volume of contacts and the complexity has increased. During peak season in 2013, I received 20 or messages a day. You will need to opt-in if you decide you want to continue e-mailing me.

What if I want to remain a patient in your practice, but don’t want to participate in E-care this year? This service is optional.  It your responsibility to schedule your wellness visits to remain a patient  So you know, I am  not concerned with one e-mail related to a specific office visit. As a courtesy there is no fee for questions that are truly “quick” questions or updates that take under 2 minutes to read and answer. For those not participating: to contact the office call (772-466-8884) or use pungerfamilymed @ gamil. Martin Memorial in SLW is excellent as well as your local urgent-care if it can’t wait. If you need a physician’s office with extended hours, local, or you feel like you have out-grown my niche, I totally understand.

A crisis (when you need immediate help, but can’t come in) involving the protection of your birth plans and baby, rescuing your breastfeeding, NICU or DCF threats or involves a combination of issues while under the care of another physician (or avoiding the care of another physician) that may involve my phone or on-going support or interventions is not E-care, but support may be available. Separate fees apply and do not included annual E-care.
All patients will continue to receive exceptional office-based care with me at scheduled visits or first available (Nurse Practitioner or me) for same-day appointments requests. Most babies and for now ALL initial lactation will be scheduled to see me.

 This is not a replacement program for the uninsured.  *Notify me if your insurance changes or is dropped.  

Jan 1, 2014 – December 31, 2014
Terms subject to change


"Thank you, Denise! I've always appreciated your willingness to be available and interested in our medical needs. You are the only physician I know who goes to these lengths to provide patient care in times of need. Truly you are a physician of the people! Again, thank you. Be blessed!" bc

"I text you for antibiotics on New Year's Eve when I was out of town. My friends were amazed I could reach my doctor quickly." la

"I received your letter regarding your availability for your being accessible without office visits. I think this is fantastic, well deserved and want to sign up. My family is leaving Friday for a summer camping trip until the 1st week in August, so I'm SURE that means we'll need you. Like I said before - it's just not a vacation unless someone gets sick & we need to contact Dr. Punger!" jj  

"You've always been there for my family. We are glad to have this service." pp 

"It is just wonderful to have you available via email.   It has been a huge help with a young toddler and with breastfeeding.  As nervous first time parents it is a lifesaver. We also know you aren't going to just tell us to run to the pharmacy and we love that about you. We trust you and it is fantastic to have your attention via email also when times get rough." lp

"We couldn't be happier to be a part of your "E-Care" program. Living more than an hour away, it is a relief to know that we can reach you with any concerns and that you respond in such a timely manner to those concerns without us having to pack up the little ones who are under the weather and drive down to the office (although we would have if you felt it was necessary). Thankfully, we have only had to contact you a few times this year and thankfully you were able to provide more than sufficient care thru e-mail and a call to the pharmacist if needed. It has worked out extremely well for our family. 

Prior to this program I was pondering whether we should try to seek out a Dr. who is more local "just in case" all the while knowing that I would have a hard time finding a local physician who takes on a holistic/integrative approach, who is well versed in HEALTHcare, and who knows us without our charts the way you do. I am very thankful that this program allows us to keep a family Dr. who understands and promotes those ideals. I was also impressed that after the last time I contacted you for care, you took the initiative to contact ME a day later to find out how he was feeling." bk

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