Friday, October 5, 2007

Doctors and Email

I tried to phone a patient last night with the results of her bone density test. She wasn't home and the thought of playing phone tag for the next few days was not appealing. I asked her husband for her email address and emailed her the results with my recommendations. Mission accomplished!

Everyone emails. My son chats online with all of his friends together every night. You can order shoes online (Zappos is great), do banking online, make reservations online, even hire gardeners online...but you can't communicate with your physician online. There is a web revolution and medicine is still in the last century.

A 2002 Harris poll found 70% of patients wanted online access to their doctors and 40% would pay for it. Although it is now 2007, not much has changed. Medicine is astonishingly behind the rest of the world. From the physician view, here's why:

Doctors want to reduce their cost of business and their staff time. They see email as a new service that will not be reimbursed. They worry about opening a floodgate of trivial emails with the expectation of a physician response. They worry that serious health issues will be presented in email that should be seen in person. They know they are already performing hours of unreimbursed work a day and don't want to voluntarily make it worse. For physicians time is money and this is just more time without money. They worry about security issues and lawsuits.

The physicians that are practicing "concierge medicine" (also known as retainer practices) have it figured out by charging a joining fee that covers email and phone calls. The rest of us just adopt email one by one. For me it is a time saver. Nothing is worse than ending my day with a stack of charts, labs and phone messages that need to be returned. Last night I did that for 2 hours and my mood was bad. Email saves me time and is quicker than the phone call. Both are unreimbursed but email is a patient pleaser and a bad mood never comes through electronically.


JD said...

I have asked my doctor if he used email and he said no. End of story. I do understand the fear of getting too many emails that take up too much time. I would be willing to pay for an email or phone consultation but doctors don't seem to want to do that either.

K said...

I know I would often like a nice, simple way to get in touch with a doctor, if only to just ask a simple question like "Is it ok that I am having this reaction?" that doesn't really merit going in for an appointment but that a nurse practitioner/whoever is answering the phone is often reluctant to answer. This is especially true of, say, the doctors on campus, who are a good 45 minutes to an hour and a half away from me.

Of course, on the other hand, I completely understand that a doctor could spend all day just responding to emails people send, and that it'd be hard to tell from text whether something was serious or silly, and that real problems can arise from such diagnoses.

I just wish there was a middle ground. Right now, because of high costs and capricious demands from consumers, it's hard for doctors and patients to come to an understanding - you want this, and this is what we can provide in return, and we're all happy. I know I'm not articulating this well but oh MAN it's obvious the system's broken but we haven't been doing things this way long enough to really know what the best (or even workable) way would be.

Rich said...

The hopsital I go to has what is called "The patient site" which gives a patient all their results right on line. All you have to do is register and it's very secure.

This is great because whenever I have a test there is no need to wait and wonder I can go on a find out. The only drawback would be some of the medical lingo might not be understood fully by some folks.

LovelyL said...

Thank you for taking a leadershi position on yet another issue.

Of course, email is effective and efficient. Just delete if you don't like the message, meanwhile you have saved everyone time and money by using email.

It makes me furious to wait for physician return calls, which are most likely missed.

Keep up the good messaging.

Jonathan said...

I think you’ve staked out a solid middle ground where both your use and your patients’ use of email is efficient and hence of mutual benefit.

Norman said...

A couple reasons for physicians not using emails is that routine emails are not encripted and therefore violate HIPAA regulations, and because there is no easy way of charging for them. But there is a free on line service,, that does both. Makes the whole thing much easier.

tina said...

I have been everywhere and seen a lot of doctor's and no one can seem to help they just say it's all in my head as i continue to get worse and worse. Sometimes things are so bad i feel like i am going to pass out,my b/p goes higher and heart beats so fast i think i am going to die. The pains are so severe they knock me down and now my legs are starting too they feel like they are bruised or sunburn but they are not and my heart beats in my throat not my chest.
This all started when i was 33 years old and found out i was pregnant for my last child but i am now 42 and it is worse not better they say anxiety/panic attacks but the meds did nothing except make me gain 70 pounds or more. I am lost and at my ends wits no one can help me.
My symptoms included: low energy, poor stamina, sore throat, unexplained menstrual irregularity, upset stomach, abdominal pain, chest pain, rib soreness, shortness of breath, cough, heart palpitations, pulse skips, heart murmur, joint pain, joint swelling, stiffness of the joints all over my body, muscle pain and cramping, twitching of the face or other muscles, neck pinches and cracks, neck stiffness, neck pain, tingling, numbness, burning or stabbing sensations, shooting pains, skin hypersensitivity, facial paralysis, (Bell's palsy), double, blurry, increased floaters, light sensitivity, buzzing, ringing, ear pain, sound sensitivity, increased motion sickness, vertigo, major facial flushing and bizarre skin rashes, poor balance, lightheadedness, wooziness, panic attacks, anxiety, tremors, confusion, difficulty in thinking, difficulty with concentration, forgetfulness, poor short term memory, poor attention, disorientation, getting lost, going to wrong places, difficulty with speech or writing, mood swings, irritability, depression, disturbed sleep, too much sleep, too little sleep, the overwhelming need to sleep for 4 hours every afternoon, and a complete intolerance to alcohol.sore on scalp,dry mouth and lips,burning to head,pins and needles in hands and feet,pain(like charlie horses) in the legs,pain,bottom of my feet pain,IBS,gas,heartburn,no libio,sex hurts,stiffness and cramps in fingers and toes,hot flashes,chills and cold, constant urge to pee,bones crack easily,disrealization,disoriention,lightheadness,dizziness,muscle twitching,feeling like a cat is purring inside my body,pain if i push on my skin bones or anything on my body,sometimes a weird taste in mouth,rib pain,eyes pain,back pain,feelings of doom and death,quickly angered,heaviness in stomach,weight gain,no motivation,afraid to leave the house, 8 years of hell,tired alot or never goes in spans,MEAN MEAN BITCH ALOT,littlest things set me off,ear/jaw pain,type the same words over and over yet type them mixed up?,hair never grows (same length since i was 10) pale skin,NO ONE WANTING TO HELP ME!!!!!!!!!! days where i can do everything and then some days where i can move and i am dying,groin pain,itchy skin,if i open my mouth i can hear my heartbeat,headaches,depression,bi-polar,crying all the time,

pain in legs,pitting,weight gain,blurry vision,stomach pain,nausea,fatigue,heartburn,stomach pain,twitching,muscle aches,

1/29/09-vomiting,diarrhea,stomach pain,heartburn,weight gain,numbness,shakes,leg cramps,high eosinophils,disoriention,bloating,sick!
please if you can have a heart and try to help me i am so close to just ending it that pain is soooo bad.................god bless..tina

Anonymous said...

One part propaganda five parts rubbish. These defenses are utterly disingenuous. The reason doctors don’t want email is that the don’t want clear statements of fact that can not later be denied. In cases of malpractice it’s much more convenient for a doctor to deny a patient said this or that. It’s much easier to obfuscate facts by sticking to a cryptic patient’s chart. ALL lawyers know perfectly well why doctors don’t want email and it has NOTHING to do with the patient’s best interest but the best legal interests of the doctor as a CYA measure. When doctors adopt such a policy they put THEIR interests above the patients best interests and ergo breach their fiduciary duty to their patients.

viagra online said...

I think we need the email. It's an obligatory application, specially if we're doctors. by the way, I am new in this blog and I think we can share a lot of topics together because I've got a similar website which its topics are the same.23jj

Anonymous said...

I'm 25years old and in Cameroon . I've a problem and I would be really glad if you help me out. I'd unprotected sex a few months ago and since then I've not been feeling too well. My balls itch almost all the time, sometimes I get weak, I have waist pain, most of the time some kind of rash like pimples appear around my penis and balls, my urine is often red and when I'm having sex, I discharge after a Minuit or two, the outer layer of my testicles is also weak. I just wish to find out from you what kind of venereal disease it may be and the possible antibiotic drugs which could be used to treat this disease. Please help me and I will be waiting for your reply. I know I have to see a doctor-I just want to know I'm suffering from first.Thanks. Keith

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