Musings of a Distractible Mind
Thoughts of an odd, but not harmful primary care physician.
by Rob on August 15, 2010 · 19 comments
in Being a Doctor
Of course, I don’t think every email needs a response, maybe have someone, if not the practitioner, pick out a maximum # of emails to be read by practitioner and then respond. If your institution/office has a newsletter, pick out a few to be featured in each edition. A little pt ed idea … I’m a Dental Hygienist, so pt ed is big to me. I wouldn’t mind communicating via email with my pts, as long as legal parameters were in place. But, time is always a huge factor, unfortunately, as well & that’s just reality.
Hi Dr. Rob. I really enjoy your blog, and as a physician, I think this is an interesting question. Did you really want to take a survey and/or stimulate a discussion? Because your answer choices offer only 3 legitimate responses: great, dangerous, docs should get paid. The rest of the choices are just jokey. What if you think it’s neither great nor dangerous? What if you think there’s a place for email in some situations but not others? What if you would charge for medical advice but not for update info (i.e., look at that medicine bottle when you get home and email me the name of the medicine and the dosage…) I think you get the idea. Your survey just doesn’t cover the possibilities.
You are right. I realized that when I reread the poll that I had not put many serious options. Let me change it some. I figured that the previous two posts “Why I Don’t Accept Email” and “Luddism” covered most of these topics.
Professors field emails from students, as well as casual conversations and questions and pleas in hallways, parks, fields and parking lots, on campus and off. No extra payment. Part of the job. We don’t need to limit the patient-doctor interactions, but rather change the way in which doctors define their jobs.
I chose three options. When I hit the “Vote” button, I was told I could only choose one option. I don’t know what the deal is with that–if it’s my mail client, if it’s something within your control, or something where either or both of us would throw up our hands and say “whodathunk?” I went ahead and deleted two of my choices, but I thought you should know.
Fixed. I am kind of dopey with this one. Keeps coming out a little wrong. Sorry. Thanks for the heads-up.
You are paid on salary as a professor. I am paid on a “per encounter” basis. If I increase the number of unpaid encounters, I decrease my pay. For professors, the communication with students is just “part of the job,” while for docs it is the essence of what we do. Giving away that one-on-one communication is giving away our source of revenue. The IDEA of email communication is, in my opinion, a very good one. The problem is not in the idea, the problem is in the penalty we must pay to do what is a good thing.
I favor more morse code usage. But seriously, how can an Internet-based, tweeted and blogged post be used as any sort of survey about what people think about doctors using email?
If you really want to know or care what I think on this, see ML post – http://cmin.us/4p8H
Communication is a many faceted thing, and when it’s good…it’s a cornerstone of the ideal Doctor-Patient relationship. The tools for good communciation are changing to embrace technology, and docs are well known to be resistant to change.
So…get paid for allowing your patients to use email. There are plenty of ways in which you can make everybody happy. You’re a creative guy…right?
I am a physician and my opinion is that we need to communicate somehow outside the office visit. Email is a more direct (avoids tying up MA time) and efficient form of communication than the telephone. Additionally it does not require double documentation (having to transcribe the phone message and response into the EMR). I think the fear over 3rd party interception of such communication is far overblown.
I am a patient at the nations largest HMO and they have a great email system set up. Since they are not a fee for service business it serves them well to handle things with a quick (and the are brief) email. It might serve you set up an email service that would save you time and replace a phone call. Examples: rx refills, verification of something you said during a visit (for those who forget or fail to take notes) or other things that, during my tenure as a receptionist at a 7 Dr practice, I or the nearby nurse would have to answer.
Anything that requires medical advice unless it’s the “his temps 104 should I bring him in?” probably needs a visit. My Dr will increase dosage through an email, change a medication and even tell me if he wants me to come in because we need to talk in person but he doesn’t give “medical advice” unless we are face to face.
I hope that helps, if you’d like more detail, I’d be happy to, privately, send you examples.
Just because I am a pain that way..
The poll is set up to be answered a certain way when too many of the answers are obviously silly.
Yes, the polls all are basically silly. I was reading through old polls with my daughter (who was having scary dreams) and we were laughing about them. I was planning on doing a poll on this topic, so we made one. I have to confess that I had my 11 year old looking over my shoulders suggesting tacos and cheese dip. Really, these polls are more a vehicle for humor than they are a true attempt to learn or show anything.
My primary specialist allows me to email and responds within 24 hours. His emails take less than 5 minutes to write (far less time than me calling his office and him calling me back). Admittedly, he’s told me he only has 3 or 4 patients who email him, but for our relationship, it’s saved on a lot of unnecessary trips to the office, games of phone tag, and has made med adjustments really easy. I would pay him more, I wish he got paid more–not because of the email, but because he’s the best doctor I have and it seems tragic that great doctors get paid the same as jerks.
Maybe if you give doctors tacos or cheese dip they’d do it more. (11%)
No communication. It should only be done telepathically. (5%)
My doctor already sends me a bunch of emails offering V1agra. What’s with that?? (3%)
these were my answers and I did take it seriously……..
The answer featuring Viagra isn’t as ridiculously far-fetched as it sounds. I went to an urgent care clinic once about six months ago and have since got an email ever week or so from them hawking some skin cream products.
My PCP’s group (affiliated with a large non-profit hospital system here) has this absolutely crazy snail mail system that actually involves someone transporting by truck the mail to be processed at their own bulk mail system 30 miles away and then taken to the post office from there. I suppose they get great non-profit bulk mail rates or something… but it takes a week or more for me to get a lab report AFTER the office staff has sent it out. The staff knows this and generally calls me anyway so the letter is rather superfluous but nice to have as assurance that I heard everything correctly.
Email would be a HUGE improvement over that situation which is made even crazier by the fact they do use EMR! And it’s a great EMR system that assures my doc has access to records from specialists I see, as long as I see a specialist affiliated with the same hospital system (not a problem, generally). I love that part of it.
What I’m having trouble imagining is what sort of question I’d ask my doctor or her staff in an email other than request an appointment or a prescription refill. Perhaps a referral?
I can only think of one time that I’ve needed something quicker than an appointment would be available (but not anywhere near an emergency) that could have been handled by email. In that situation I’d have sounded like a nutcase… which I also did when I phoned to speak to the nurse, but at least she understood me and we both got a few good laughs out of the situation — and I got a prescription phoned in for klonopin. That situation involved a snake in my house, not exactly an ordinary medical situation.
Looking back, email wouldn’t have worked then because I was shaking so bad I could barely use the phone.
Fun survey, but as some of your other comments have addressed, not enough nuanced serious answers. As a doc myself, and a techie, I love email, websites, podcasts and blogs. I communicate a lot and learn a lot through all of them. I do NOT think that doctors should give this or any other service away. We are knowledge workers, no matter how or when we communicate the knowledge. If you’re like me and have no specific procedures to offer or perform, then your interactions with patients, exams, and discussion/education are your job and what you get paid for.
Enjoying your writing. Keep up the good work.
would love to have this for the idiotic school stuff. My son, 18, now has 2 unexcused absences because he got the stomach flu. A fever of 100.6, GI both ends and a migraine. I’m not taking my 18 year old son to the doctor for that! Knowing that in 24 to 72 hours he’ll be just fine.
So I’ve got to take my son in, where people could have REAL infections (or he could give someone else his stomach bug) because his immune system isn’t at it’s best, it’s fighting a stomach bug!
Because the school won’t believe ME ..his mother or my HUSBAND …his FATHER ..or HIM the ADULT student (Senior)
so now, with 1 week of school down, he’s got 2 unexcused absences with only 7 allowed.
And our doctor’s office … will NOT give a note if they’ve not seen the child.
Even for issues, like his infected toe (that took from September to April to solve) they’d seen him in the past 30 days, but they didnt’ see him ON the day he missed so therefore, no note. He almost failed his Junior year because of a dadgum infected toe!
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