I hope I don’t come across as a know-it-all; I’ve never worked in a medical practice. Reviewing my comments above, my sin may have been in construing reported results as reality, and you’re saying that’s incomplete. I hear you.

Jsmith, I’m certainly interested in getting the job done, too. Not sure I agree, necessarily, with your last sentence. (Not saying I disagree, just saying “not sure I agree.”)

Merry Christmas to all Christmas people out there. And as I say now and then to each of my clinicians, “Thank you for going into this profession and being really, really good at it.” They saved my life.

“Did you see the Kaiser comment above about the reality of how it’s worked out for them?” I have several friends working for Kaiser, and Email is a pain for them and time intensive. They were logging in from home, while making dinner and answering long winded and complex medical questions – just ripe for legal review. Kaiser did (does)not give them extra time for ALL this extra work which is why many have left the clinics and become hospitalists. It has extended their liability to more interactions. Kaiser is a great system, but we shall see how this plays out. Although it may seem like docs just don’t want to answer patients questions, I see it more an issue of how much time and energy there is in a day. Open the floodgates and people will drown – and some of them will be patients – not just docs.

Your multiple replies and interjections of must read studies demonstrates a higher level of time commitment you are expecting from already overstretched PCP’s. This is really best suited for VIP/ Concierge medicine. It is not something that I, or most of my colleagues, could do very much of for the the next 10 years of my career. The rest of my career would either be shorter or as a hospitalist full time and giving up clinic patients that I have care for many years. That is not good medicine.

“I love choice, variety, diversity – I love people being able to get what they want, and I love you being able to offer it.”

Thanks! I think what a lot of docs object to with the “new model of medicine” or whatever you want to call it, is that we’re being told (particularly within the PCMH model) that we HAVE to do this, this, and that: process is elevated to being far more important that results (i.e., better health for patients). E-mail may be great for some docs and patients, not for others. What counts is patient outcomes.

I don’t routinely e-mail my physician, though I did when I developed an unexpected complication after a procedure, most likely as a result of her poor technique.

What came through loud and clear via e-mail was what an ass my physician was. She made several incredibly rude and unprofessional statements. I dropped her shortly thereafter.

You might be surprised to hear this (or not!), but I’m tickled to hear that you have a practice of Kaiser refugees who are happy with your service! More power to you.

I love choice, variety, diversity – I love people being able to get what they want, and I love you being able to offer it.

Frank

If the issue is that efficient health paradigms cannot be implemented under current health economics, there is no one (besides, I guess, Kaiser, and parts of the DoD and the VA) who is innocent. I went to a conference in 2003 where the head of a large Boston physician organization said that they did not allow as members any doc with more than a small fraction of capitated patients — capitation being a mechanism under which a good system of efficient electronic communication could provide dramatic benefits to physicians. Capitation, as implemented in the 1990′s, is not the answer, but clearly fee-for-service plans dramatically limit the options for interaction paradigms and offer no one an incentive for early, conservative intervention or efficiency. It was the efforts to eliminate capitation, rather than improve it, that yielded a system that rewards utilization. We need to change the system to align financial rewards with positive outcomes. Kaiser has done this. When will the rest of us?

> I wonder if the dentists get e-mails from their patients?

Mine does. He’s a member of the Pankey Institute, a whole-patient-oriented (yet business oriented) organization.

I discovered this when I moved away from him a few years ago and asked how to find someone like him. He told me to look for Pankey-trained dentists.

I found, interestingly, that most Pankey dentists don’t accept insurance, because they don’t want insurance getting between them and dictating what can and can’t be done. A few do. (Mine does.)

See the ROI tab on their site, as well as history.

I know people like Kevin are smart – no question. (Couldn’t be docs otherwise, especially not while juggling a blog like this.) I also know that too few smart people are aware of the evidence that a lot of patients want email, and the evidence that as Kate says, when well managed it really doesn’t turn out to have the anticipated problems, as understandable as those concerns are.

Thanks for the response.

All I can say is that my small private practice is full of Kaiser refugees, and, as I don’t use e-mail to communicate with patients, it doesn’t seem to be an issue.