Three Wishes

So I was walking down the hallway in my office, mildly distracted, when I kicked something.  It was a USB \”thumb drive.\”  I picked it up and inspected it, trying to figure out who had dropped it.  The side of the drive had a picture that I couldn\’t make out, as it was all smudged with something.  I pulled out a tissue and rubbed it, thinking it may be a clue as to whose drive it was.
There was a sudden rushing sound and a strong wind.  Out of the thumb drive emerged a large blue figure wearing a turban.

\”Are you a genie?\”  I asked

\”No, I am David Blumenthal, the health IT \’czar.\’\” he responded.

I hung my head down, \”I guess this is about the fact that I write the word healthcare instead of health care. I was wondering how long it would be before the feds came down on me for that.

\”No, that\’s not my realm.  That would be the job of the Department of Language Security, and they\’ll be appearing in some creative way next week to get on your case about the whole healthcare thing.  It has Matthew Holt and Maggie Mahar in a big tiff.\”

\”So why are you here?\” I asked, \”And why are you doing that whole genie gig?\”

\”Ah, well president Obama saw that you weren\’t using email to communicate with your patients, and he sent me to find out if there was any…ah…persuasion we could do to get you using it.\”

\”I do use email to communicate with my patients!\” I said. \”I just don\’t do any e-visits, substituting an email dialog for an office visit.  Are you able to fix this problem?\”

He got a small smile on his face.  \”That is why Obama sent me in this genie get-up.  He said that I could grant you three wishes on the area of electronic communication with patients.  That\’s what I am here to grant.\”

\”And where did you get the ability to transform like this?\”

\”Saddam Hussein had a bunch of lamps stored away in his bunkers.  It turns out that instead of weapons of mass destruction, he was hoarding weapons of wish production (known as WWP\’s, to us government types).\”

\”Who\’d have thought….anyway, I have three wishes to get to, right?\”

\”Right.  But don\’t wish for more wishes, and definitely nothing to do with llamas.\”

\”Got it.  Well, you know that I am a big computer geek and an early adopter of technology?\”  I asked.

\”Your geekiness is known nationally.\”

\”Great.  Well, the idea of e-communication is not only something I am not against, it is something that I would love to adopt.  The problem is in the payment system, not in the reality of doing it.  I think I could do it without much problem; I just don\’t want to start giving things I have made my living on away for free.\”

He looked bored and annoyed.  \”I know, I know.  I am as impatient as you about that.  The problem is that our lovely congress is in charge of fixing the payment system.  That\’s like asking a toddler to fix a broken vase.  Still, I am a genie now, so maybe we could work something out.  So what are your wishes?\”

\”My first wish is that e-communication would replace phone communication whenever possible.  Patients don\’t like to listen to our Muzak or figure out our voice-mail system, and would much rather send an email than leave a message.\”

\”I know.  You can only listen to Kenny G for so long.\”

\”It does bring in business for acute nausea, though.\”

\”I hadn\’t thought of that.  So why don\’t you just put a communication link on your website so they can request refills, appointments, and ask questions?\” he asked.

\”We already do the first two, and the patients are pretty happy with the convenience.  But the last one is the real problem.  If we get into an email conversation with the patient, it is recorded for all posterity.  We are legally liable for anything we write to them and for anything we receive.  With that kind of liability, plus the risk of losing income, we just can\’t afford to do it.\”

He thought for a moment and said, \”So you want me to reform the legal system to reduce your liability?\”

\”That would be a big start.  We\’re humans, and prone to mistakes.  We can\’t be looking over our shoulders for the 1-800-SUE-DOCS\” lawyers looking to get their windfall.  We need some protection in the day-to-day management of patients.  The use of electronic communication greatly increases documentation, and increased documentation greatly increases potential liability.\”

\”OK, I\’ll get to work on that one.  What\’s your next wish?\”

\”My second wish is that e-visits would replace frivolous office visits. I don\’t like to see people for every little cough they have, but many employers require personal office visits for doctor\’s excuses.  The schools are even worse at this, ever since the crazy No Child Left Behind legislation was passed.\”

\”I had an itch on my left behind once.\”

\”Too much info.\”


\”Anyway, we need to be able to get paid for simple visits that could be handled via email.  We need to be able to get paid for the management of their care as well as the risk we take giving care.  The same holds true for people with chronic disease.  If we could check on people regularly via email, or even by phone, to make sure they were doing OK, then maybe they\’d have to come in less and get sick less.\”

\”The latter sounds like the patient-centered medical home.  People are working on that one.\”

\”Correction: congress is working on that one.\”

\”I stand corrected.  So what you want is some sort of payment system that allows dumb visits to be handled electronically.  I think that\’s in my power as a genie. I\’ll have to ask my boss first.  So what\’s your last wish?\”

I stood there for a few minutes, scratching my beard and thinking.  \”You know, if the legal side of things got reformed as well as some sort of payment for e-visits, other things would fall into place.  Patients could handle more without coming to the office, so there would be more availability of docs.  Plus, they wouldn\’t resist coming in as much if they knew we were willing to handle things online.  I can\’t really think of a third wish.  Can I have a rain-check?\”

\”That\’s another thing I\’ll ask my boss.  Just don\’t take too long, and remember the llama stipulation.\”

\”That\’s a shame, you know.  Having llamas replace those folks in the senate may get things working better than with the folks we have in there now.\”

\”Llamas in congress?\” he asked, eyes widening. \”Hmmm…I hadn\’t thought of that.  I am sure that the prez wouldn\’t mind that one.  I\’ll get back to you on that one.\”

\”That\’s alright.  I\’m when I hear the passage of pro-poncho legislation I\’ll know you\’ve done your magic.  Thanks!\”

\”No problem.  Now, can you click the little switch on the side of that drive so I can go back in?\”

9 thoughts on “Three Wishes”

  1. I have to tell you how much I love this. Especially since we have been getting bombarded with emails from Strong about how they are now integrating email communication into all of the in house out patient clinics. I can only hope that since our patient population here is made up of the chronically mentally ill that they won’t be implementing it here anytime soon.

  2. Nice! I would like to pay for e-visits as opposed to going in. Would e-visits cost less?

  3. I’m just a lowly medical student (or I will be in a few weeks), so I’ve been confused about this issue. What’s wrong with this: out-of-pocket payment implemented through PayPal for every e-mail, say $15 per e-mail with a limit to three concerns (proof of payment attached). Plus every communication from the doctor is followed by a liability statement that amounts to: you cannot use anything I say in this e-mail in a lawsuit. I know this is a very simplistic way of describing the fix and the devil is in the details, but would the general idea work at all?

  4. Asya,Of course it is that easy. What’s wrong with your proposal is only that is currently “not allowed” by Medicare or Private Insurance. Something you will learn all too soon is that not only do those two entities tell us how much we can get paid for what we actually do, they also tell us we CAN’T get paid for other things we do…for instance, we have been calling patients with lab tests or to check on them or to discuss a “few” questions they may have after the office visit since before you were born. We just don’t get paid for that time, even if it takes 30 minutes (or more) on the phone. Try telling a lawyer or accountant that they can’t bill for time spent, see how far that goes…

  5. The daily grind of phoning patients is one of our most frustrating and unpaid efforts. Most of the time, the patient is not available when we call. They call back, but I can’t drop the colonoscope to answer. Lots of time spent to communicate some small fragment of medical info. And let’s be honest, some patients are hoping to have an ‘office visit on the phone’, which isn’t fair to either of us. Is e-mail the panacea, or simply a more efficient pro bono service?

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