Streams

Why Can't We Email Our Doctors?

Thursday, July 10, 2014

Dr. Joseph Kvedar, dermatologist and founder and director of the Center for Connected Health at Partners Healthcare, talks about the push for doctors to be more accessible to patients via email, Skype, or text -- and why he's an advocate for openness. Plus: he'll take calls from doctors and patients on their approaches to communication. 

Guests:

Dr. Joseph Kvedar

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Comments [16]

I am a senior seen at a Weill-run clinic.

I make appts, read my labs, am alerted by my MD to relevant changes by email.

Further after seeing my MD in the clinic I am provided with a visit summary verifying my vitals signs, relevant findings, etc. Within the week following I am alerted to any negative lab results.

I'm satisfied with all the services my clinic provides.

Jul. 10 2014 01:32 PM
kate hoekstra from Putnam Valley

AT the very end of the interview, Dr. K acknowledged that while he spends an hour each day on emails, these are screened beforehand for him by staff. This is not possible in the typical physician's office. He could have been more candid about noting that this is a very real obstacle for most docs, rather than leaving an expectation that docs were choosing to ignore patient requests. He also skirted the issue of non-reimbursement by insurance companies for doctors who email patients. While some insurers may reimburse doctors for communications via the electronic record system--and he wasn't specific about how many actually do--the reality is that communicating with a patient via this system is very cumbersome, allows of no corrections, so that a physician could be held to anything he has written, regardless of whether it was a typo, or something he subsequently corrected. So, far less truly feasible or available than Dr. K has indicated. Also, remember that Dr. K is a dermatologist. Not as likely that he would be contacted by patients for true emergencies or after hours. As he himself said, "Follow the money" if you want to see meaningful change in medical care. This fact of life, ie. you get what you pay for, is why patients who and are able--and willing-- to afford it, are choosing concierge doctors.

Jul. 10 2014 12:43 PM
Kate Hoekstra from Putnam Valley

Answering Amy's question about the extra charge for concierge physician. The costs can range from $100 to $200 per month, usually with discounts for families. Some patients are able to use their Health Savings Accounts for these retainers. Some practices permit monthly or semi annual contracts. The types of concierge practices are very varied. Anyone who is willing to trade in another non-essential item for this kind of care can get it. Several concierge docs in Manhattan; at least two in Connecticut.

Jul. 10 2014 12:18 PM
Kate Hoekstra from Putnam Valley

A nice comment from AE in Brooklyn. It sounds as though the communications are coming via a hospital, rather than an independent doctor's office, and that they are limited to lab results which lend themselves to such communication. Expecting a physician to diagnose or prescribe via email, however encrypted, is unrealistic, however, given the current malpractice atmosphere. Also,unlike independent practices, hospitals have more levels of staff which make it more financially feasible to provide digital communications.

Jul. 10 2014 12:00 PM
C.E. Connelly from Manhattan

Wow, an HOUR for e-mail. I should have been a doctor. This guest is a professor AND a doctor and he spends AN HOUR on e-mail. I spend 8 hours and another 8 on phones.

Jul. 10 2014 11:59 AM
Amy from Manhattan

How much is the (additional) charge for concierge medical service?

Jul. 10 2014 11:56 AM
A Listener in NYC from NYC

I have used email with a psychotherapist very well. When I started I realized from prior experience that I would simply forget important things between sessions. Above that, I "present well". Email helped me keep honest and also put down my thoughts more as they were happening. It was also better than having to be on the phone. My therapist could react as needed; I knew he would get back to me, which was usually enough for what I needed. It was very, very helpful.

All that said, make sure you have your account secured!

Jul. 10 2014 11:49 AM
Truth & Beauty from Brooklyn

I have called my doctor on occasion, usually to ask a question; however, what doctors do requires them to use ALL their senses, because patients don't always know what to look for or what may be relevant, or the doctor may be examining the patient for a complaint the patient has and then discover a completely different problem based on sight or smell. Doctors can't do a proper examination or collect lab specimens or biopsies on line.

So doctor-patient electronic communication has to be used judiciously and based on common sense. It's great for confirming appointments or following up on a patient after medication has begun or been completed, but certainly not for examinations.

Jul. 10 2014 11:49 AM
Amy from Manhattan

What, a patient portal can't be hacked? How secure are they (& how long will that last?)?

Jul. 10 2014 11:48 AM
SC from Brooklyn

I like having email access to my doctor, who I email a handful times every year. My doctor responds very quickly to my emails, she tells me whether I should come in, gives me quick tips with the kids, gives updates on prescriptions/tests, etc. The emails tend to be short one line missives, sometimes to try this or that, in reply to my emails. I makes me feel well cared for.

Jul. 10 2014 11:48 AM
peter from Queens

Oh my god it is SO frustrating to not be able to email!! our kid's neurologist won't email, but our OB does. We have a much closer relationship with the OB because of that. All to often a simple email is all that we'd need to answer a question rather than have to call the after-hours answering service or - even worse - make an appointment (which in itself can take close to 30 minutes sometimes).

Jul. 10 2014 11:43 AM
Susan from Yorktown Heights

My doctor has yet to discover the telephone.

Jul. 10 2014 11:42 AM
J from Brooklyn

Like AM, my records have moved online via the MyChart system.

I'm able to make basic requests like prescription refills automatically and check the status of my vaccinations, as well as schedule appointments.

It's a supplement, not a replacement for IRL interactions.

Jul. 10 2014 11:40 AM
AM from Brooklyn

I have been undergoing treatment for the past 3 years, and have seen firsthand how doctor/patient communication has changed during that time:
- Three years ago, I had to wait 3-4 weeks for my doc to call me to discuss test results
- But now that my hospital securely posts my medical records online, I am able to read the results report within 2 days, email my doc with my questions on the results, and get a quick response from him within a day.

The transparency and dialogue has taken a lot of the anxiety out of my situation, and I feel like I have more control when I can see my results and get my questions quickly (and conveniently) addressed.

Jul. 10 2014 11:30 AM
kate hoekstra from Putnam Valley

See earlier interview on BL show in which the growth of concierge medicine was discussed as one of the responses to complaints by both doctors and patients like you about their dissatisfaction with the limitations of overburdened medical practices. An annual retainer fee to a concierge physician guarantees you immediate and personal contact with your own personal physician 24/7, and same day appointments, coordination with your pharmacist and specialists by the concierge doc's office, home visits, hospital coordination and insurance advocacy. Several concierge docs in Manhattan; a couple in Connecticut.

Jul. 10 2014 10:53 AM
David from Manhattan

How long is an acceptable wait time for a doctor's office to return a phone call from a patient. When I called my pharmacy to order medication, I was told that it required a recertification (not a renewal) that it was still medically necessary for my treatment. I called the doctor's office during normal business hours and left a detailed message with my phone number. After 24 hours, my call had not been returned and I could not re-order the medication. I did not need to speak to the
doctor - anyone in the office would have been acceptable. Please comment. Thanks.

Jul. 10 2014 10:26 AM

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