Sep

7

 In a survey of doctors on a website I follow, 80% of responding doctors answered no way would they allow their patients to email them.

This was the response I posted:

To the 80% of responding docs who say "No way": If you wonder why many patients develop major hostility to doctors' office procedures and to doctors themselves, and why the public is happy to stay silently on the sidelines while the government and insurance companies take over control of doctors' working lives, could it be that doctors (who for 100 years had control of their practices and refused to make them patient-friendly and efficient) have failed to enter into the 21st century? And regard it as perfectly acceptable to impose inefficiency, frustration and wasted time on patients by not letting them communicate with the doctor but requiring them to make an office appointment (probably 3 or 4 hours with travel to and fro, long office waits, etc) for every question or matter?

I see nothing wrong with a doc charging for email or telephone time. Those patients wishing to use email or telephone should be willing to pay the time charge, regardless of whether such charge is covered by insurance. But if our profession continues to lord it over patients by refusing to allow them what every other profession and all of modern life does, doctors will deserve what they get in the way of government and insurance oversight and regulation.
 

Charles Pennington writes: 

Chiming in, that is a pet peeve of mine. What other profession won't take email? Lawyers, dentists, accountants, etc. all communicate by email, of course. Doctors make it even worse by making you communicate with them only via a voice-mail maze that begins with "If you are a physician, press 1; otherwise, your call is very important to us so please remain on the line…"

Russ Herrold comments:

I'm with the doc's here.

When the tears are flowing, everyone says they are willing to pay, but without getting into the business of FIRST AND AT THE ONSET, having a Retainer Agreement, unilateral right to draw it down upon presentation of statement, Mandatory Arbitration clause, deposit for fees in the Trust Account, all one does is lay a background for a fee dispute complaint or malpractice counterclaim to a suit to collect those fees. It's not gonna happen as a general practice. The doc is caught between the rocks of patient desire for immediacy and convenience; the professional obligation 'not to miss' something that in hindsight seemed obvious; and the fact that insurer reimbursement for web and email oriented 'treatment' lag.

Having had poor service (breaches of patient confidentiality, outright prevarication by nursing staff, and failures of delivery of test results repeatedly and after specific instruction) in the care of a wound, all since May of this year, from the standpoint of the patient, I want there to be a formal paper trail (not email; not call center notes in some database, forgotten and closed; not some other ephemeral media) … a well drafted letter explaining the issue, a file CC, and a cc to the supervising agency (hospital system privacy officer, nursing board, 'authorized provider' certification entity), and an equally formal response (or in its absence, proper escalation on my part).

Unreasonable, I know, but progress is made on the backs of unreasonable people.

The same goes for lawyering. If a client cannot keep and will not pay for an office visit, or meeting at other venue of their choice, to permit the open-ended probing that proper representation requires, they won't be MY client very much longer, as I cannot properly represent them.

Alex Forshaw writes:

The fact stands that interacting with doctors is a pain in the ass from the second you enter the door. They do not face nearly enough competition. There is no bigger beneficiary of protectionism in the entire country. The lack of competition has meant they face no evolutionary pressure. I hate "socialized medicine" as much as anyone but US doctors are as much culprits in their own demise as the tort bar and all of doctors' other favorite bogeymen.

George Zachar adds: 

In my conversations with doctors, I've been told the potential legal and regulatory liabilities risked by patient email contact are vague and large, leading them to simply shun the practice.

Phil McDonnell writes: 

Regular email is not a secure medium. Privacy regs hamper a Doc's ability to use email. Most will call you on the phone and/or write a letter with results. That is why expensive software with encryption is required that often the smaller practices cannot afford.

Gordan Haave responds: 

Sure that's what they say. But it's BS. How is the fax or telephone somehow more secure than email?

If the issue is confidentiality, why is it that Lawyers will email you but not Doctors?

There is one other group that won't send emails: The IRS.

I am in the middle of a personal and business audit, and you can't email the IRS. It's very inefficient.

To me this is just further proof that Dr's collectively are not the saints they claim to be, but rather just a cartel that uses wildly inefficient systems to extract rent's from consumers.

Dan Grossman writes:

I am surprised that a few otherwise highly astute Speclisters so easily accept doctors' excuses for refusing to permit email. As a service to the medical profession and to our country (and in time for inclusion in the President's speech tonight as a new regulation under the Patient Protection and Affordable Care Act), I have drafted and present below a few simple groundrules that a doctor can require a patient to accept as a prerequisite for emailing him.

"A Patient wishing to email Doctor must indicate his acceptance of the following:

1. Complex or detailed matters require an office visit. This email is for minor procedural, scheduling and prescription renewal matters.

2. Doctor will attempt to look at reasonable numbers of emails as time permits but because of his busy schedule cannot commit to read or deal with every email. Any information Patient wishes to convey with certainty must be conveyed by other means.

3. Emails are not secure and should not include sensitive personal information. They will not necessarily be presevered or included in Patient's medical file or record.

4. Patient agrees to pay $20.00 for each ten minutes or part thereof Doctor spends reading or dealing with emails from Patient, regardless of whether the amount is reimbursable to Patient by his insurer. Medicare and Medicaid Patients unfortunately are not eligible to use this email since such programs do not permit email charges. (Doctor regrets this and asks that you please take up such inefficiency with the Government rather than with him.)"

With regard to 3, doctors or their office assistants can instead spend 15 minutes setting up free encryption, as others on the List have already pointed out.

Cheers,

Dan

 


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4 Comments so far

  1. steve on September 7, 2011 11:33 am

    “They do not face nearly enough competition. There is no bigger beneficiary of protectionism in the entire country. The lack of competition has meant they face no evolutionary pressure.”

    Spot on! This is why interest in alternative medicine, nutrition, supplements and self medication will continue to thrive.

  2. TR on September 7, 2011 1:16 pm

    As a physician I can say that the issue is more complicated than a lack of competition or a lingering Luddite mentality in the medical profession. There is plenty of competition in healthcare, particularly in regards to primary care. Chiropractors, naturopaths, homeopaths, traditional medicine practitioners etc. are in abundance throughout the US. The CDC reports that nearly 40% of all adults utilize some form of complementary or alternative medicine, spending $33.9 billion on such treatments in 2007.
    Two major factors reducing use of email in healthcare are inconsistent reimbursement and legal liability. While it is true that lawyers, architects, accountants etc. all commonly rely on email, they also charge the client directly for their time spent on email. Third party reimbursement in healthcare requires private practitioners to bill the health insurer for the email interaction. Insurers have been extremely resistant to reimburse, as their policies typically require a face to face doctor-patient interaction to justify payment for service.
    Physicians practising outside of the third party payment system are much more open to email. For example Kaiser Permanente, an HMO, implemented a secure email system for it’s docs several years ago. They report that in 2010 their system handled 5.8 million emails to their physicians in Northern California alone.
    Legal liability associated with email is a significant problem for physicians. The Health Insurance Portability and Accountability Act (HIPAA) mandates that providers ensure the absolute privacy of patient related information. The act imposes civil and criminal penalties for disclosure of confidential information, even is the disclosure is accidental. As a result, only email systems that are secure on both the provider and the patient side can be used to transmit healthcare information. GMail etc. is not acceptable. While the largest systems such as Kaiser can afford the cost of implementing such systems, even large hospital systems have difficulty developing such email systems, and any lapse in security can result in enormous civil fines and even possible criminal charges for the hospital.
    As with most things, there is more to this issue than meets the eye. Regulatory reform would certainly help, but this is one of the many imbalances of the US healthcare system that Obamacare didn’t touch.

  3. Jerome Bigge on September 8, 2011 1:28 am

    A major part of the problem is created by the monopoly doctors hold over medicine thanks to prescription laws passed in 1938. Prior to that time, sick people often went instead to the local drug store and spoke with the druggist. Who drawing on his own experience, often could do as good a job of prescribing as any doctor. However this practice was strongly objected to by the doctors, who working through the AMA, got the Roosevelt administration to pass laws that required everyone to obtain a prescription from a doctor in order to purchase the exact same medicine that they had been getting before from the same druggistg without having to pay the doctor’s office fee. The economic term for this is “rent seeking”, and this is what prescription laws do. Interestingly enough, you now need a prescription to purchase heart worm pills for your dog or cat. Because the “vets” managed to get prescription laws passed for their own economic benefit. Again, a prime example of “rent seeking” by the licensed professional class. And in the case of dogs and cats, I hardly think such laws can be “justified” as protection of the consumer. The correct answer is that these laws exist to increase the incomes of a politically powerful group at the expense of everyone else!

  4. BG on September 10, 2011 10:37 am

    Why the over obsession with privacy in medical records more so then legal records? The ill effects of someone’s medical records falling into the view of a 3rd party are probably significantly less then business records falling into the view of a 3rd party.

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