Sometimes. Carriers are wise to testing; they limit payment if more than a certain number are ordered within a set period and also if the ICD code does not appear to justify the test ordered (in their estimation, which is suspect.)

So many of the tests I order have nothing to do with whether I talk or not, and I don’t earn a penny extra for ordering them; they are done by outside laboratories and radiology centers. If anything, they are makework for me as I have to order screening labs for imaging and then have my staff do the pre-approval process which costs me time and money. Then of course, I have to follow up on them which involves phone calls or letters to the patient which is still more uncompensated time and money. I wish I could order less testing.

Procedures? I do them, but again, unless it is something cosmetic, the time for money in the procedure along with the inclusive period–as long as 90 days–makes the doing of procedures in my specialty of debatable value. Of course, it is more valuable than doing nothing, but it isn’t necessarily more valuable than seeing more appointments in the office in the same amount of time spent in surgery and during followup visits..

But procedures make even more money. Why talk when labs and tests are more profitable.

The current system requires a receptionist to answer the phone and interpret my question, then reduce it to written form. This takes time, paper, and ink. It takes even more time for the nurse to decipher the gist of my question and call back. Sometimes the conversation needs to be documented, which requires even more time.

Email would require less/no time on the part of the receptionist, and take less time for the nurse than phone calls currently take. Email could require patients to be concise in their inquiries instead of rambling on about the weather, pets, etc. If a phone inquiry would result in “you need to come in” then email could just as easily say that in less time than a phone call. If documentation is required, it’s simple to retain the email.

Phone calls aren’t as secure as some are making this sound. Numbers get misdialed. Answering machines permit anyone to overhear what is said. Most homes have multiple lines; anyone can pick up an extension and evesdrop. This is true in many workplaces, too. Privacy gets compromised over the phone. Privacy can be protected over the internet.

I suspect that physicians would be surprised at the number of patients willing to pay cash for the convenience of email with their doctor’s office.

At least the face-to-face communications start with the understanding that there is a service being paid for; with letters, phone calls and e-mail, that same time spent carries no such expectation. Big difference.

As you doctors reject electronic communication, you will eventually have a whole generation of patients you won’t be able to communicate with.

Then you chip away at it by the message until you’re out of credit and it’s time to refill.

With “free” phone calls you have to air your personal matter to some nurse or receptionist who, for all you know, blabs it to everyone around or gets your issue wrong. Then you’re stuck waiting for a phone call that may or may not arrive depending on when you called and whether the doc is too busy or can reach you. Of course, if he/she reaches you it’s almost always when everyone is there to listen in or the kids are screaming and it’s not the best time to talk.

With a paid-for email you put your concern down and don’t press “send” until you thing you’ve got it laid out as clearly as you can. For your fee you should get some kind of turnaround – maybe 8-24 hours response. The message comes to you. You can go to the bathroom without worrying you’ll miss “the” call.