One oft-heard complaint is how difficult it is for patients to talk to an actual physician.

The reasons are myriad, but the main factor is that doctors are not reimbursed for e-mail and telephone communication with patients.

A group in California is going to find out how badly patients would like to use e-mail as a communication tool. For an annual fee of $60, patients get the privilege of sending an e-mail to a doctor’s receptionist, who then forwards the message to the physician. The doctor’s reply follows the same onerous path through the receptionist.

It seems quite cumbersome for such a simple task.

That patients have to pay to ask a question through e-mail is, in itself, ridiculous. But that’s the scenario that the payment system has wrought. Now with Twitter gaining mainstream acceptance, I can envision an idealized scenario where a doctor can spend dedicated time on various social media platforms addressing patient concerns. I suspect that would significantly cut costs and increase patient satisfaction.

But, as long as physicians continue to only be paid via face-to-face visits, there is not much incentive to take that next step forward, and embrace e-mail and social media as a way to talk to patients.