Why I don\’t Accept eMail From Patients

Dr. Wes (a cardiology blogger who all should read) wrote a very compelling post about technology and the bondage it can create for doctors.:

The devaluation of doctors\’ time continues unabated.

As we move into our new era of health care delivery with millions more needing physician time (and other health care provider\’s time, for that matter) – we\’re seeing a powerful force emerge – a subtle marketing of limitless physician availability facilitated by the advance of the electronic medical record, social media, and smart phones.

Doctors, you see, must be always present, always available, always giving

This sounds like dire words, but the degree to which it has resonated around the web among doctors is telling.  He continues:

Increasingly the question becomes – if we choose future doctors on their willingness to sacrifice for others without expectation of appropriate boundaries and compensation – will we be drawing from the same pool of people as the ones who will make the best technically-skilled clinicians? What type of person will enter medicine if they know that their personal life will always take second place to patient care?

Dr. Brian V (long last name, but another one who you all should read) adds his voice to this:

It started with the pager and it’s evolved to real-time social media.

I’ve seen it too many times:  Physicians excited to please open the door to unlimited patient email only to see themselves shutting their families out at night as they answer questions – all for free.  And those physicians who suggest that emails should carry a fee are indicted for greed.

We have been on EMR for 14 years, yet we don\’t accept email from our patients.  We could do it, but we don\’t – and both of these doctors hit on the head the reason why we don\’t.  The goal of IT in our office can be summed up in one word: efficiency. The practice of medicine has become dominated with non-clinical tasks.

  • We have to gather information and organize it.
  • We have to serve as an \”information central\” for our patients, collecting from disparate sources to make informed choices.
  • We have to comply with the maze of government and insurance industry rules.
  • We have to give information to patients and to other medical providers.

So what actually happens in our office is less medicine and more information management.  IT allows us to do this in less time, leaving more time for our patients.

Accepting emails from patients at this point would mean more time spent doing unreimbursed tasks.  Actually, it would potentially decrease our revenue, handling problems outside of the office (for free) instead of being paid for our services.  Doing so would give us three options:

  1. Working extra hours to make up for lost revenue.
  2. Giving free care via email and just accepting less pay, seeing less patients total.
  3. Spending less time with each patient to make up for the decreased revenue.

I am busy enough that I don\’t want anyone to have to come in for things I could handle remotely.  Email communication with patients sounds ideal in many ways.  But unfortunately, the business case for this is so bad that we can\’t open ourselves up to patient emails.  One answer would be to have a minimal charge for an e-visit ($20?), which would be credited toward an office visit if the e-visit warranted that the person come in to be seen.  The amount needs to be enough to ward off frivolous questions, and would have to be applicable to ALL insurances (including Medicare and Medicaid).

Email also works well with the idea of the \”medical home,\” which reimburses doctors for overall care of populations.  (I give my opinion on the medical home in this post.)

Until this happens – until we are somehow paid for giving care outside of the office – this useful technology will remain unused.  Is it greedy to not want to give things away for free?  Is it greedy for me to not want to spend less time with my family, make less money, or spend less time with patients?  Is it greedy to think I am worth $20?

If so, you can call me greedy.

41 thoughts on “Why I don\’t Accept eMail From Patients”

  1. I personally LOVE email and do use it in contact with my PCP's office. But I 150% agree and believe that email can NOT replace face-to-face contact between patient and physician.

  2. No, it's not greedy. But the way the topic is discussed here implies that doctors are the only ones who endure expectations of limitless availability as a result of email access. You are, perhaps, one of the only remaining professions that is not expected to be available electronically and answer emails at all hours.

    Wes asks,
    “What type of person will enter medicine if they know that their personal life will always take second place to patient care?”
    Well, medicine has always been a profession that has expected its members to put patients ahead of all else. It has always been a profession that requires substantial time away from family. This has improved in recent years due to trends like the use of hospitalists, etc., but people who go to medical school know what they are getting themselves into. So, my answer to his question is that, like now, the type of person who will enter medicine is someone with their eyes wide open and who loves the profession so much that the dedication required does not dissuade them from choosing medicine anyway. Not really any different from now. This particular argument really isn't strong enough to win the reimbursement scheme the profession seeks.

    All of this said, there are two perspectives that need to be addressed here – not just the perspective of the physician. Patients have ideas about being able to communicate with their doctors by email, as well. Patients have to take unreimbursed time off to go to your office, wait in your waiting room, wait in the exam room, see you in the exam room, wait to check out, check out, and then travel back to work. Not only is that sometimes a full 1/2 day off, they then get to pay your bill and the bill for any labs or imaging ordered during their visit with you if they have a high-deductible health insurance plan (or no insurance at all). Needless to say, we will avoid this at all costs… and since you also are concerned about your finances and want $20 for responding to an email, I suspect that you can understand how we might wish to avoid such a scenario in order to maintain our own financial viability.

    Patients will continue to think that not offering email access is poor customer service. As more docs do it, those who don't look increasingly unaccommodating. This may or may not be of concern to healthcare providers who may or may not receive bonuses based in part on patient satisfaction targets. We, as patients, increasingly have alternative options available to us… like retail healthcare clinics. When taking 1/2 day off doesn't work for us, we are no longer trapped… no longer a captive audience. I say this simply to make the point that each side has choices to make and there are ramifications to these decisions. Patients are no longer just a cog in the Wheel of Medicine. We are active players and active consumers who decide where to put our money and where to take our business.

  3. I'm not sure where the issue is here. Granted, I'm only a medical student at the moment and haven't worked full time as a GP yet (although I plan to), but the argument here strikes me as a bit fantastical. I suspect that most people realize that a physician's time is valuable, and wouldn't label them as greedy for charging for their time and expertise. If you want to allow email from patients, as I intend to do, then great – charge for it, just like you would for any other professional use of your time. If patients don't want to pay, then they won't email you – problem solved.
    As for email eating up your time, there's an easy solution to that as well: separate professional and personal email accounts, as I've had for years while doing web development as a casual job. When you sit down to get some work done, then check your professional account – otherwise stay away from it. Don't check it on your mobile, and don't check it at home.
    An email to your physician isn't appropriate in an emergency anyway, and maybe make sure you post that as a disclaimer on the email form.
    For ways of doing that that can make your life much easier, follow the likes of Jay Parkinson and Myca Health. I plan to do much the same, and can't wait to bring together my life as a web developer and a physician into something awesome!

  4. As a patient, I would love to pay a fee to be able to handle some routine matters via email. Some insurance companies are already paying doctors for answering patients' emails (primarily HMOs, I guess — which fits in with your point about it really only being financially viable if doctors are getting paid to keep their patients healthy as a community). Twenty dollars is, to me, a bit steep. But I suspect that's because too many patients would abuse it for things more complicated than I would. The only doctor I have who has his email address on his business cards (he's at the local medical school), I've only emailed for things like reminding him that he promised to approve putting my blood test results in the part of the system that I can access.

    But here's the thing — don't you take phone calls from patients already? Yes, they are undoubtedly screened and referred, when possible, to an advice nurse/triage nurse. But I think all doctors spend some amount of unpaid time on the phone for and with their patients. Personally, I try *really* hard not to take advantage of that. And my PCP has occasionally told me that, really, it's ok to call and talk to her on the phone (sometimes for 30 minutes) to discuss test results or new symptoms in my ongoing mystery illness. But I'd rather make an appointment and know that she's getting paid to talk to me about complicated test results or a new direction my health seems to be going. I save bothering her on the phone for the times when I'm too sick to leave the house and want to know if she wants me to go to the ER. (Uh, it's probably not clear from the way I'm describing it, but honest, she's really not trying to tell me I don't need to take up an appt slot; she says she just feels badly when I come all the way in to see her when it's fairly routine. I figure she ends up spending too much unpaid time on me as it is, I'd like to see that she gets paid for as much of her time spent on me as possible so she doesn't decide that it's too much unrecognized work to have me, or patients with debilitating chronic illnesses like me, in her practice.)

    OTOH, I was blown away by a neurosurgeon who, when an MRI my PCP had ordered suggested I had a very small brain aneurysm, not only looked at the images, but ordered a CT angio to get a better look, read those images & radiology report, and told me it wasn't anything to worry about right now, all without an office visit to get paid for any of his time. I would have been happy to come in for the CT results so he could get paid; I was just relieved to know I didn't need brain surgery. 🙂

    Anyway, couldn't the email be triaged by MAs and therefore if the topic/request was too complicated or not routine, they could be emailed back saying they needed to make an appointment or something? I don't know … I'd like to see better access to doctors, but I also know that first-line doctors like internists, pediatricians, etc, aren't paid better, people are going to leave the field and/or not choose to go that direction in the first place. And that's not a good answer for any of us!

  5. Something I have heard of, and not seen criticized, is the idea of an e-mail collective, the idea being that a group of doctors answer a pool of questions to a subscription service. You would be reimbursed for being a member of the pool or per response or something (I'm sure working out the cost model wouldn't be hard), and patients could get a level of care sufficient to deal with small, routine matters without getting transportation to their doctor/stressing the ER system. Thoughts?

  6. I don't know if its greedy because I don't know how much you earn! So its impossible for me to say.

    This service isn't available in Germany although I personally would be grateful for it,I hate having to go to the Doctors and wait for an hour to only have to be sitting in his office for two minutes to get a prescription that could have been ask for through an email…of course that opens a door to abuse of the system but I suppose there could be limits to what prescriptions could be written without a visit to the Doctor or a record of regular medications if it be only a matter of a refill perscription. although in America I suppose many of the drugs are available anyway over the counter,where they are not here.
    There are dangers too that a if a Doctor doesn't get to see the patient potentially dangerous situations for a patient might not be caught.
    I don't think anyone should have to work for nothing I think $20 is alot of money for those who don't have it,it could be useful for those who aren't sufficiently insured to still have some kind of access to a Doctor.
    There are pluses and minuses.
    But NO don't think you should work for free unless its in the interests of charity or you earn huge amounts of dosh anyway!!

  7. I recently began hiatus from my practice as a pharmacist in a retail setting. It has always been perplexing to me that although the world is awash with information about how to protect, improve or regain our health, many of as patients neglect our responsibilities to take care of our own bodies. Yet, we will spend untold hours seeking “damage control” for preventable disease states. We expect health care providers to provide the answers, restore us to health, and be gracious all the while.

    In a perfect world I suppose, pharmacists, doctors and nurses would be able to practice promoting health, versus fighting disease. Third party providers would sponsor client health in the form of reimbursement to fitness trainers, diet planners and reduced premiums for those with proof of participation in healthy activities. Patients could spend the time they are currently investing waiting to be seen or waiting for a prescription doing other things; running,biking, taking a hike or (no disrespect intended) even finding a lake and jumping in!

  8. I think e-mail can save a doctor time in some instances. We have been sent on a wild goose chase based on a misreported phone message. How efficient is to have an admin take a message, pass it to a nurse, who passes it to a dr., who gives the answer back to the nurse, etc.? I can compose a coherent question and include all manner of contact info in an e-mail sent to a physician's office. My own words can be read by the person who will answer the question. Maybe it will be need to be seen by the doctor, or maybe the nurse can take care of it. I think all offices should accept e-mails.

    Best of all – no phone tag!!!!! I have spent entire days afraid to pee, after being told a specialist would “call back” (and never being called). It might just be business as usual for the doctor, but it is very different from the patient side.

    My child's pediatrician has given me an e-mail address to communicate with him, and is a mutual convenience for us. I still use the practice's nurseline for questions that need timely answers, but will e-mail the pediatrician occasionally with updates. My child has a chronic condition and sometimes a lot happens with specialists in between pediatrician visits (and he doesn't always receive their notes). I can take as long as I need to write out an e-mail, and he can read it quickly prior to a visit and be up to speed. That gets us in and out without getting him behind.

  9. The biggest problem with email is its ease of use. It takes a lot to call a doctor and wait to get an answer, but an email takes less than a minute (or more, depending on the patient). Plus, the patient knows they are going to talk to a nurse first when they call, but email give the potential for talking with the doctor.

    As far as retainers are concerned, this would be against our contracts with insurance companies as well as illegal to use with Medicare and Medicaid patients. It's a great idea, and one I'd love to do, but I can't do that unless I went to a concierge style of practice.

    The sad thing is that I see a huge upside to email communication. I would love to use it. We do email our patients their lab results and we send reminders of visits this way as well. It's a much more convenient form of communication, but it's also a Pandora's Box that invites overuse. I don't think most patients would abuse it, but it's not most patients I am worried about. A small segment would use it so much that it would become a logistical nightmare. Plus the fact that everything that's written in an email is permanently recorded in a way that phone calls are not.

    I see us going to email at some time, but the payment system has to change first.

  10. I agree 100%. The upside for patients is huge, and the upside for us is large as well. BUT the downside for us is even bigger – until we get paid for it.

  11. Thank you for clarifying this. Its so simple I should have known the answer myself, but it didn't click! You were the one who taught me the importance of boundaries & I'm very glad to see how fiercely you protect your own! Stick by it-& NO-You are NOT greedy. It is probably one of the reasons you are still happily married!

  12. My PCP's physician's group requires that they use a web-based email system. When I write to him, it limits the words to such a small number that it's impossible to communicate effectively. I quickly learned a workaround — I just send a second message. I asked him if other patients do the same and he told me they did. He's indicated that he likes communicating this way with patients because it saves unnecessary office visits and, yes, phone tag. He's very good about saying “you need to come see me” (like when I tried to describe a rash to him via email). BUT, I've noticed that I may get a reply from him at any time — in the evening, on the weekend — and so clearly he's working from home and (I assume) not being compensated (oh, and he's married with two children). And so, I think you are not being selfish, greedy, or otherwise “bad” as a doctor to Just Say No. What disturbs me is that my doctor has no choice — he's required to do this, like it or not. The fact that he likes it doesn't make the policy okay.

  13. Well said. Again. Until the system catches up with the technology, the value proposition just doesn't add up.

  14. Like you, I'm a patient and healthcare consumer. Unlike you, I don't consider it poor customer service that my doctors are not at my beck and call 24/7 and that they don't share e-mail addresses. I had four wonderful doctors see me through five surgeries for early stage breast cancer and not once did I feel like my care was lacking due to the absence of e-mail.

    I agree that “availability creep” is endemic to everyone, not just doctors, and I have to grit my teeth every time I enter my out of office vacation message to say I will not check voice mail or e-mail. I really think we're forgetting how to unplug in general and that leads to burnout. But I think it's probably worse for doctors because what they do is so personal and can be so intense. And let's face it, patients can be needy.

    And with regard to whether they should charge for e-mail? The same people who think a doctor should be available at any time via e-mail are the same ones who think they should get a free diagnosis at a cocktail party. I come from the PR/ad agency world and we don't hand out free advice either, nor do we make ourselves available on a 24 hour schedule (with crisis communications being the exception–and doctors know about crisis availability only too well). And doctors went through a heck of a lot more training/invested a lot more time than we ever dreamed of doing. So yes, their time is worth something.

  15. One of the biggest problems in our society is that everyone thinks they are entitled to anything they need for free.
    Life doesn't work like that.

  16. OMG! Thanks to all of you docs who brought me into awareness about e-mailing my doc. I'm a retired R.N.P., and thought I was “helping” him keep track of me with my every month or so e-mail. Ouch! It is embarassing to learn the facts from those of you on the receiving end of these e-mails. Never again shall I update him. Well, not with an e-mail. Or a phone call. If I need care I will go see him. Right? Of course right!

  17. Most insurance contracts and Medicare prohibit separately charging for services that are already considered “paid for”. Patient communications (phone and email) are in this class. Unless you choose to opt out of Medicare, it would be illegal for you to choose to charge your patients for email.
    The reason for this whole page of frustated posters is that you can't simply charge for email; if the answer was that obvious, there would be no debate.

  18. What I've done sometimes when leaving a detailed message with a nurse to report to a doctor is just rife with ways it's going to get lost in translation is I fax a letter to my doctor so that I know he will get all the details in exactly the way I stated them. Plus, I know it will make it into my records, which for some of the specialists I see every six months is a good thing because I just can't remember all the details sometimes, even of stuff that's fairly important for me to report.

    The times I've taken that tact with my rheumatologist, who schedules me every six months but asks me to “report in” to his nurse more frequently, I've made it clear whether it's something I need a response about (and then I'm generally fine with getting it via the nurse, who I know is simply reading the note he gave her about me), or if it's something that I just want him to know about and put in my records but he can call if he thinks it's worthy of a call.

    Like you, Suzanne, I hate the phone tag! I guess I don't know from an MD's point of view if what I'm doing with my rheumy is better or worse than email. I figure it's better from my POV about being able to communicate when it's convenient for me and yet know I'm getting all the details to the right person. I *think* it's easier on my doctor than getting a call from me and having to call me back, or having me take up his assistant's time with multiple rounds of calls because the message I left or his answer doesn't get communicated properly. Dr. Rob? What do you think?

  19. Updates are fine – although the problem is one of HIPAA compliance, with most docs email systems not being secure from a privacy standpoint. Ask your doctor, and if he/she is OK with your email, then go ahead. I am not saying that docs as a whole don't do it, just that we don't and won't until we can control it in such a way that it won't take over our lives. Status updates are very different than questions awaiting a response.

  20. Very nice thing for you to say. I think docs feel obligated to do things (or if they are junior, they are forced). We are just very obstinate about running our business well, feeling that a well-run business means we can do more things for our patients. We already do email lab results and such. We are trying to make more and more available online, but won't do it at the cost of quality of life or quality of care.

  21. The reason to do this post is to (hopefully) get the politicians aware that to go into the electronic age, there must be some consideration of this. The cost savings would be large if things could be handled over email. I would like it and my patients would like it. Employers would like people getting to stay at work as well. It really is a win-win-win proposition, but policy stands in the way. But that doesn't mean policy can't be changed. It will never be changed if we don't raise our voices (which is what I am doing right now).

  22. “The biggest problem with email is its ease of use. It takes a lot to call a doctor and wait to get an answer, but an email takes less than a minute (or more, depending on the patient).”

    You seem to be making the case for e-mail here! I mean, how long does it take you to call a patient, when you have to?

    I have never once, never not ever, demanded to speak directly to a physician, but there have been many times throughout our…ordeal…that I have needed an answer from a medical professional. If the office makes the decision that the answer must come directly from the dr., that is not my fault, and I still need the answer.

    More than once, when the question was asked or the concern was raised during office hours, I won't receive the answer until the physician calls me outside office hours. Nights, weekends, holidays. Sunday afternoon. Wednesday evening at 9 freaking 45. “You are still working at 9:45????” “Yes.”

    These guys aren't getting paid for this time any differently than they would be sending an e-mail. Plus, the phone ringing wakes up the kids at that hour! I like to be prepared and efficient if I do have to speak with a doctor, but they seem to be the ones who make that more difficult when you have no idea when to expect the call.

  23. SickMomma and Suzanne: If your doc allows email of this sort, that's great. I think the majority of my patients would understand and respect the limits. Giving me information like this is really useful for me. But there are a significant number of patients would see this as a means of getting free care – perhaps 10%? – I want there to be better communication, but am worried about giving a very easy means of communication to those who would not use it properly. Besides, if we were paid to do email, then I wouldn't try to limit communication. Why force people to come in to get paid? I don't like that any more than patients do. I just see it as a slippery slope to start offering free access.

  24. It IS a good case for email – it is REALLY easy and quick. The problem is that the system discourages us financially from becoming more efficient and doing things in a way that will be better for our patients. I am not against email communication (how could a blogging doctor be against electronic communication?), I am just against forcing docs to foot the bill for change. If the payors gave incentives to change, it would happen very quickly . It would be like ATM machines; nobody had to convince people to use them, they just worked better. The payors can easily change the system through what they choose to pay for.

  25. I did know it would sound whiney to those who were listening that way. It’s hard to explain that a person who REALLY wants to do e-visits with his patients doesn’t do it. I want to e-communicate with them. It bugs me that people have to call. It bugs me that they have to come in for things they could do from home. The problem is not in the technology or the desire, the problem is in the reimbursement model that penalizes us for seeking a better solution. THAT is the point of this post. We are rewarding doctors who force patients to come in. We are rewarding doctors who do little “off line” communication with patients. I actually do a good amount of free care, answering questions in the exam room and over the phone that I could be charging for. I have plenty of business, so I can afford to do some free care. But I am not about to shoot myself in the foot by practicing medicine via email and not getting paid. Lawyers and accountants can charge you, but docs can’t? Patients would embrace it, and payors would save money. Why not give incentive to something that will improve satisfaction and reduce cost? Why rely on docs to give up income or family time?

  26. Have you done a cost/benefit analysis (from the PCP's standpoint) of email versus telephone communication? You don't have someone answer your phone away from office hours (unless you pay for an answering service), so your patients don't expect to talk to you after hours. My PCP, working in a group practice, accepts telephone calls, but they all go to voice mail. This means that his nurse sits down at 4:30 and listens to all of the accumulated messages deals with them. An example of how this works for the patient is the time, about a year ago, when I shot a nail into my hand at about noon the day before having to fly to the coast on business. I called my Dr's office to find out if I needed to come in for a Tetanus booster. The nurse dutifully called back at 5:00 to state that, yes I did need a booster but they were, of course, just leaving the office. I went on the trip and we waited to see if I really needed that booster or not. Email, check a couple of times a day could have made the issue moot and made the doctor the revenue for an office visit and an immunization.

    If, like my thoracic surgeon, you have email and check it each morning at the start of the day in the middle of each day, no more freebies than would be dispensed by phone would be given out, but communication would be vastly improved.

  27. My neurologist tried that for a while. He opted out of the service because it was “too expensive, you and one other patient of mine were the only people who ever emailed me. It wasn’t worth the subscription cost just for two people.”
    My former GP used to personally answer all the emails I used to send to his office–until I changed mail clients. My current mail client won’t allow me to “set priority”, so I can’t mark anything as Urgent, Personal, etc. It became clear after I switched clients and lost the ability to prioritize my communications with him, he let his poorly trained office staff answer my emails instead. *They* were rude and condescending to me, and complained to my GP that I treated them the same way (not true, btw). My GP had known me since I was 12, knew my history, knew I can’t drive, and was more than happy to resolve minor issues via email. When his office staff tried to insist that I come in for matters he’d been formerly willing to address via email, and when I told them politely but firmly that unless I heard that from *him* and not *them* I wasn’t coming in, that’s when they complained to him that I was “rude”.

    In short, if my paying $20 means that my actual doctor will continue to address my minor concerns with much less office time wasted on either side of the table, I’m all for it….as long as the doctor doesn’t think it’s “rude” of me to “waste” his “personal” time.

  28. I had 1 doctor which I emails. She soon took the privilege away from me. Not because I abused it in frequency, but I found myself emailing her and every single time she'd say “you need to come in for an evaluation”
    She felt that my introversion was taking advantage of not leaving the house to get the help I needed.
    She was right. I get so tired of going to doctors, it seems the easy way out is to do the emails. But for people with severe illnesses, we can use it as a replacement. It should not be.

    I do email my therapist, but even then, I find myself emailing her things I'd not had the courage to say in session.
    (and even then, it's infrequent)

    For some docs & patients, it may be appropriate, but I can see far more problems with it than helpfulness.

  29. Email has pros and cons just like most things in life. We do weekly labs with our dtr and I already have the results from medical records by the time I call the next day. I leave a message for the nurse. She calls back and say “Are you calling about the labs….I’ll let him know.” Then I wait for her to call back and say what I already know about med changes because we do this every week and it isn’t exactly tricky. Email would be easier for me and it seems faster for the office as well – there would be no revenue loss since they aren’t getting paid for each lab visit. But I can certainly see room for abuse. My dr has email for reasonable things and it seems to work well. Prescription refills, lab orders, and “please let me know about test results” type issues can be addressed quickly and easily. Regardless, at the end of the day the office has to pay bills and salaries. Nobody works for free and the money has to come from somewhere. That isn’t greedy.

  30. I like being able to email patients but like Dr. Rob I already work >80 hours a week.
    I don’t accept patient e-mail because I have no “system” . Many of my patients who work for the same PHO behemoth that was foolish enough to employ me or who know me from church, kids school, even from the nursery where we get coupons e-mailed, or whatever have either my personal or professional account . I get e-mails like
    “I have become very short of breath at night or with exertion over the last two weeks ” to a home e-mail that I won;t be checking -for God’s sake its my HOME-because I am working at hospital that week
    or 4 or 5 e-mails about what I have said is an unimportant lab abnormality (back to that 10% of patients )

    So it needs to be manged , monitored if I am not there and there needs to be some method for dealing with the truly alarming messages. I took voice mail OFF my office number. 90% was junk, but some got there that should not have waited (in a PHO or HMO you don;t hire , fire or have any input into your office staff) . Theyare forced to speak to a person , I do have an answering service 24/7 and there is a doc available , with nurse screening until 8 pm . For those of you who are patients,80% of the calls are for med renewals for patients who have not been seen in > 1 year or for narcotics, which we have a policy not to give over the phone. If it is MY patient I will renew until an appointment can be set up, but often this is the 2nd or third time they have renewed BP pills without a BP check

    As for greed–I work every 6 weeks in the free clinic and give all my patients who are trying to renew because they have lost insurance that option , but very few of them actually use that resource.

    I am amused that some posters think we are competing for patients in primary care. We are not like a cable TV providers trying to give the best deal so we get more subscribers . Its more like we are the Bonneville Power administration trying to fairly manage the requests for our product (time and expertise)

  31. “We have to gather information and organize it.
    We have to serve as an “information central” for our patients, collecting from disparate sources to make informed choices.
    We have to comply with the maze of government and insurance industry rules.
    We have to give information to patients and to other medical providers.”

    Aww, poor doctor.
    I guess you don't realize how whiney this sounds.
    These are tasks that all of us do all the time in our jobs. Some of it (e.g. “gather information and organize it”
    can actually be interesting).
    Arguably medicine spoiled its practitioners before, in treating them like an elite who didn't have to do too many things that they didn't like. Perhaps there is less of that now, and the real problem is that you don't like being
    “ordinary.”

    I respect your decision to take or not take emails, as you like. But your reasoning is immature. And you are not representative of other doctors, many of whom have adjusted well to the 21st century. No, I don't mean the technical
    part of it. I mean the part where doctors are ordinary people like everyone else. That can have its pluses, too.

  32. My GP has a “patient portal” for accessing health history, scheduling and reminders for appointments, and non-critical health questions. I admit to wishing that my specialists had this option available- there are times when a general question that does not need an immediate response (the e-mail system warns that there is a three day response window, and to call 911 for emergencies) can be taken care of without playing phone-tag, which can be frustrating and time-consuming for everyone involved.
    Of course, the purpose and limits of the system are made clear up front (as a teacher who responds to student e-mail questions, I use a similar guideline), and the convenience of being able to access my labs, diagnoses and prescriptions from any browser is enormous.

  33. This is going to sound horrible, but I think anyone stupid enough to e-mail something like “I have become very short of breath at night or with exertion over the last two weeks” almost deserves a bad outcome. That is a perfect example of why e-mail is less than ideal for medical question. Those should be in the context of a person to person encounter.
    But I have often wished I could just shoot my neurologist a quick e-mail if I have a non-urgent question, so that I don’t interrupt him with a phone call and he can answer it at his convenience. Or I have thought it would be so convenient to e-mail for an appointment, or to change an appointment, especially if I think of it outside of office hours.

    Of course, I guess some patients don’t know the difference between a non-urgent issue and an urgent one and other patients could take advantage, so I can see where it is better to have a blanket “no” policy.

  34. Very true, but if only 10% of patients abuse the email privilege, why should the other 90% be penalized for their ignorance? I understand doctors not wanting to be bothered with “I liked the tie you were wearing today, Dr. Rob!”, but it irritates me when I’m not allowed to ask non-urgent *medical* questions via email because a patient thinks Dr. Rob is his best friend and so constantly pesters him with definitely non-urgent *social* questions/comments!

  35. I agree with you, but you can probably apply that formula that 10% of the patients take up 90% of the doctor’s (and his staff’s) time. So the line has to be drawn because of them.

  36. I’m sorry, but I couldn’t disagree with you more on your stance that drs should be available 24/7 just because they chose to be drs. I too have had alot of exposure to the medical world due to a son with alot of medical needs & I have seen the high divorce rate among doctors who are “married to their jobs” & choose to shut out their wives & children in favor of being available to their patients. Both of my son’s PCP’s were men who chose to believe like Dr Rob, that there need to be boundaries so they could take time away to refresh themselves with their families & thus maintain their top notch doctoring skills, and yes-many times my son’s critical needs happened at times when his doctors were not available–but we got the care we needed from the oncall dr or the hospital & his doctor took over when he came back on duty. My son never suffered in his care because of this & we never felt slighted that Dr ___ did not personally answer our need. I say this with no malice toward you & I am truly glad you have found an alternative that works for you but I will stay with my PCP who knows me inside & out & who can often pick up on things I don’t even mention because of that knowing.

  37. My PCP practice uses an encrypted email system and my doc’s assistant communicates with me, not the doc herself. I assume if I have a question, someone forwards that to the doc and she gives her reply, which is then emailed to me by her staff. There are boundaries when we use this service…. they tell us not to use it for emergencies and to expect a 24 hour delay in response. I don;t see how this is any different than placing a call and the doc or their staff getting back to you by phone. It also eliminates phone tag, as others have said.
    And to address the 24/7 availability issues, I suppose an office could set up an autoresponder when someone tries to email after hours that immediately sends a message to wait ’til morning or call the person on-call.

    I don’t see this an as all or nothing dilemma. Email is a communication tool, just like the phone. When systems and expectations are set up thoughtfully, it doesn’t have to take over your life or be uncompensated.

  38. I don’t think of you as greedy because I know you, I like you, and, so far as its possible in this media, I trust you. But if I didn’t know or like you? Then, yeah, I’d think Greed!

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