Doctors and e-mail

There are plenty of reasons why this isn’t happening:

Doctors have their reasons for not hitting the reply button more often. Some worry it will increase their workload, and most physicians don’t get reimbursed for it by insurance companies. Others fear hackers could compromise patient privacy “” even though doctors who do e-mail generally do it through password-protected Web sites.

There are also concerns that patients will send urgent messages that don’t get answered promptly. And any snafu raises the specter of legal liability.

Robert Centor comments:

If you email your lawyer, you may well receive a bill for the time necessary to handle that email. You will also receive a very long paragraph designed to protect that correspondence from liability.

As I write repeatedly, physicians are not paid for their time, they are paid by the widget. The patient visit is our version of the widget. Anything that we do to prepare for that visit, communicate between visits, review the tests induced by that visit or discuss you problem with another physician is gratis. We cannot bill for the proper use of time to improve the patient experience.

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  • Anonymous

    As a family practitioner, I am ok with the concept of email communication with patients under the following conditions:
    1. I want patients to be patient awaiting a response
    2. I want patients to not argue if my response is “you need to come in.”
    3. I want to be fairly reimbursed at the same rate as if I had the patient come in.
    4. I want the “set up” to be subsidized by the insurance companies
    5. I want to be immune from any alleged confidentiality violations.

    Is that too much to ask? If the answer is yes, then that explains quite clearly why more doctors have not embraced email.

  • Anonymous

    Yes, it is too much to ask. You can ask but . . .

    1. Some aren’t going to be patient

    2. Some are going to argue no matter what you say.

    3. Your desire to be reimbursed fairly will not make it happen. You would have to demand it, bill for it, collect agressively, and swim upstream against expectations.

    4. The insurance companies don’t own your practice and aren’t responsible for your capital expenditures. Their only obligation is to their enrollees to cover your fees and it is your fees that are to fund your capitial upgrades.

    5. You can get the patient to sign a waiver of confidentiality liability but you will have no gurantee that you would no be sued anyway and that it would then protect you.

    One of the burdens of medicine in general and primary care specifically is that you have conditioned people to expect you to give give give all kinds of services and time while taking whatever insurance pays acting as a sort of insurance company service center rather than an independent professional. They are unfair expectations but you have been the primary culprit in creating them.

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