Monday, August 09, 2010

More on Doctors and Electronic Communication

Some thoughtful responses to my prior post on the devaluation of doctors' time were published this weekend as doctors set boundaries in their new role as uncompensated information technology managers:
Bryan Vartabedian, MD gives his take on this issue, noting what happens if doctors request payment for their responding to e-mails:
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.
Dr. Rob over at Musings of a Distractible Mind and 14-year veteran of the electronic medical record counters with his group's approach: they simply don't take e-mails.
I'm not sure I agree with NO e-mail interaction with patients, since some simple requests or clarifications using the medium might actually reduce time for all involved. (It would be great e-mails were limited to a short length like Twitter, maybe 140-characters. Heh.) But Dr. Rob's approach is an appropriate effort to set limits on doctor's uncompensated time and until a model is created to compensate doctors for their work, few will tend to adopt it into their daily routines.

Having said that, many patient inquiries to their doctors are for test results. I believe patients will continue to demand greater access to their test results whether doctors like it or not, espcially as they are responsible for paying more of their health care dime. We should look at this as a good thing. But our current model of the electronic medical record sending every single result to our inbasket, even though it contains previously read or acted-upon results is creating a "Boy-Who-Cried-Wolf" scenario for doctors suffering from information overload. The electronic medical record must to a better job of filtering the myriad of tests that end up in our inbasket each day (I'm thinking of EKG final results that I have already read or recurrent INR test results within a therapeutic range, for instance).

I suspect the day will come where we will move to releasing test results to patients before physician review out of necessity to avoid reporting delays. If that day happens, patients should understand that not all abnormal test results may require an action, but their doctor is the only one who should interpret the importance of any abnormal result based on their entire medical history.



Anonymous said...

My husband also takes no email from patients. Unlike his staff, he does not have an email address tied to the practice domain name (web address), so patient's can't even try to figure it out.

Where appropriate, his nurses communicate with patients and in the event his input is needed, he will call the patient to maintain the 'no electronic' communication policy for himself and patients. That rarely happens though since his nurses manage the few patients that need some email communication....otherwise, calls go through the front office staff - fielded to the nurses or my husband for follow-up.

The front office and clinical staff are who needs to PROTECT a doctor's time and my husband appreciates how much his staff keeps his time valuable.

Docbeccy said...

Hey Wes! How's my favorite intern- as in you- intern / me- med student? I got linked to your inciteful comment via the Health Care Blog that I subscribed to recently. I'm almost done w/ my healthcare MBA and like most am more than a little alarmed about the coming mandates. We were somewhat lulled by limitless resources and lack of competition while in the military, hmmmm? Hope all is well with you and your lovely family. Peter says he's seen you on occasion @ Cardio meetings. One of these days he'll get out of the boat club - but no idea when. Ann Secord