The health care industry created a tool for patient/consumers, but the time in my day did not double to address my “bucket”. Now, there is a parallel universe that occurs simultaneously of scheduled in-person visits and the remote/portal world. Sadly, my parallel universe self never shows up. Mychart work is a full time work. The medical assistants who filter these messages in our organization do not have the ability (I do not expect them to) to even triage and handle simple clinical matters. They get forwarded to me with “please advise”.
It used to be the EMR as the source of burnout. Now that we’ve gotten better with it, this comes along.
This is fascinating ... When I first read the headline, I thought it must be a joke. Surely we wouldn't charge patients to use a messaging platform! But as I thought about what that could do to clinicians' inboxes, I started to really get it. SOME kind of triage is critical - there is no way a clinician should be the first one to go through the inbox. Would it also help to have a (relatively small) character limit to force patients to be concise? Or would they simply spread their issue over a dozen messages which seems worse)?
It certainly is not straightforward, Greg. As you may have noticed, I didn’t even directly address the question in the post because I’m still conflicted. I think the issue is pretty complicated. With regard to the word count, yes, we humans are very clever and we find the workarounds!
Incredibly insightful article. From a patient perspective, MyChart messages have been a game changer for me to communicate with my physicians on an as-needed basis. With that said, I have decade+ long established relationships with my physicians where I understand what constitutes a message vs. an appointment. I keep my messages brief and informative without an expected response time. I would imagine this may not be true for the average patient, and I believe that’s where patient education and expectation management comes in. There’s a reason that on-call systems were established for physicians, and I believe those same standards should apply to MyChart messages. Technology has created a demand for 24/7 communication that I do not believe is healthy to ask of physicians or any professional. However, before charging for or eliminating this tool entirely, I would advocate for establishing boundaries for greater success.
Thanks Bridget. All great points. To give patients credit, I have noticed the phenomenon where patients 'learn' that long, complex issues are cumbersome by text. And alot of patients get it right after a bit. It's funny that you bring up on-call, because docs do a great job of creating tight boundaries around getting woken up! Governance is not an issue. But, of course, some families need to be reminded still.
So I think that the true abusers of these tools are rare. I also don't let it evolve -- I'm quick to convert to a tele or IRL if things can't be resolved with a simple answer.
Physicians: the only profession expected to do more work every year for less money. Its Extra obvious in these inflationary times. Medicare sequestration anyone?
I disagree that we did not see this coming. I saw it coming and complained that it is unreasonable to ask us to respond to myChart messages when we are already crazy busy. To no avail, of course. When I contact my lawyer for a question or my accountant, I get a bill fro the time it takes them generate and communicate the answer. Why should a healthcare professional be any different? Physicians also have only 24 hours in a day like any other person. BTW, this is only part of the unreasonable demands on Physician time that the EMR ushered into our lives. Burnout a serious issue. I firmly believe that many of the frivolous patient messages will disappear when we charge for answering the questions and get appropriately reimbursed for our time. Also, for urgent concerns we have ERs and Urgent Care Centers, and myChart is not the right place anyway, because the patient does not know when the message will be viewed.
100% agree with this as a general internist practicing for over a decade. The EMR on its own is a full time job actually competing with the fully booked appointments I have all day. I was just out with covid and worked two weeks daily at least four hours a day and could not clear my work list and notes. If is literally impossible. Despite my office covering me while I’m out. This is because no one actually replaces me when I’m out. The demand on us are way too high . The hospital organizations do not support physicians and actually encourage undermining our authority as “ providers”. It’s making me seriously think about switching to concierge. This job is not sustainable. There will not be physicians as PCPs in 10 years only APRNS and PAs. This is what will happen to change this. I am trying to hold on for as long as I can but at what cost? My mental health? Time with my kids? I certainly don’t make enough money to hire help or pay back my loans despite the work I do . No one thinking logically would enter primary care . We are literally professionals who care for patients above all else and now the system and patients have taken advantage of us to the point that we are breaking
This is so insightful. The Medical assistants triage but this is a double edged sword which makes me worry about patient safety issue. In my mind, nothing should be taken care of virtually without seeing a provider.
In box messages is largely why I left a busy PCP practice with a large panel after 25 years to become a hospitalist. My decision was solidified the day I realized I had missed a hemoglobin of 8 on an otherwise healthy patient. They had come to see me for a physical and I ordered routine labs. The next day I sent him a letter saying his labs were normal. Fortunately he came to see me a week later for an acute minor illness and I realized my error. I simply had more than I could safety do
I am reminded of a study referenced in a book by psychologist Daniel Kahneman. An Israeli day care facility wanted to discourage late pickups by the parents so they instituted a fee. The result was more rather than fewer late pickups since the parents now were relieved or the guilt of arriving late and instead saw it as a routine economic transaction.
I think that physicians should be able to bill the insurance for this communication if it is significant and important enough. It’s funny that you wrote this because there have been several times in recent months, for various reasons, that I have had this very thought as I type my message. I wish the doctor could bill for this communication bc it would be the same communication only much more clear and uninterrupted written than it would during a tele or in-person visit. It does solve the problem that many patients have, in my experience, and a significant important problem, which is that they tend to forget the important questions that they meant to ask the doctor. It happens so often that we advise patients to write down their questions and concerns prior to the visit with the doctor. Something happens during the face to face interaction, perhaps nervousness, unintended intimidation or distraction due to the focus and communication of the doctor which can lead the conversation down a different path. Doctors tend to interrupt patients, in efforts to hone in on the right questions in a timely fashion, but this interruption can cause patients to loose sight of their own questions and they just get intimidated and nervous.
Messaging also gives the doctor a chance to think about a response or a solution rather than just responding in person which sometimes results in a knee jerk response which is then followed by a double down on that knee jerk response. Right? Can we admit that we need to think about things first sometimes? Lawyers do it all the time. They say things like, “I need to do some research”
I feel bad that the doctor cannot bill for the communication so I made a tele appointment and then kept it short… tried to anyway.. not sure if that worked.
Great article. My clinic is thinking of turning off patient incoming email entirely as it's simply proving overwhelming for the providers.
Wondering if there are supposed to be links in this paragraph? : "A new relationship with expectations. Once we agree on how a tool will be used, patients need guidance. Patients need to know which tool to use to reach their health provider with and when. For example, these scenarios are great examples of how to use MyChart. And these scenarios will need an office or virtual visit with the doctor. Helping patients understand how to manage a system’s communication wardrobe will go a long way in improving the satisfaction of their encounters."
The challenge with email is getting things into the EHR, especially when there's a short thread. For sure there needs to be governance around how these channels are used and for what. Thanks for chiming in... Oh, and my links are in navy blue, which is hard to contrast from black. Let me work on changing that. If you are able to view in dark background their obvious....
The health care industry created a tool for patient/consumers, but the time in my day did not double to address my “bucket”. Now, there is a parallel universe that occurs simultaneously of scheduled in-person visits and the remote/portal world. Sadly, my parallel universe self never shows up. Mychart work is a full time work. The medical assistants who filter these messages in our organization do not have the ability (I do not expect them to) to even triage and handle simple clinical matters. They get forwarded to me with “please advise”.
It used to be the EMR as the source of burnout. Now that we’ve gotten better with it, this comes along.
This is fascinating ... When I first read the headline, I thought it must be a joke. Surely we wouldn't charge patients to use a messaging platform! But as I thought about what that could do to clinicians' inboxes, I started to really get it. SOME kind of triage is critical - there is no way a clinician should be the first one to go through the inbox. Would it also help to have a (relatively small) character limit to force patients to be concise? Or would they simply spread their issue over a dozen messages which seems worse)?
It certainly is not straightforward, Greg. As you may have noticed, I didn’t even directly address the question in the post because I’m still conflicted. I think the issue is pretty complicated. With regard to the word count, yes, we humans are very clever and we find the workarounds!
Incredibly insightful article. From a patient perspective, MyChart messages have been a game changer for me to communicate with my physicians on an as-needed basis. With that said, I have decade+ long established relationships with my physicians where I understand what constitutes a message vs. an appointment. I keep my messages brief and informative without an expected response time. I would imagine this may not be true for the average patient, and I believe that’s where patient education and expectation management comes in. There’s a reason that on-call systems were established for physicians, and I believe those same standards should apply to MyChart messages. Technology has created a demand for 24/7 communication that I do not believe is healthy to ask of physicians or any professional. However, before charging for or eliminating this tool entirely, I would advocate for establishing boundaries for greater success.
Thanks Bridget. All great points. To give patients credit, I have noticed the phenomenon where patients 'learn' that long, complex issues are cumbersome by text. And alot of patients get it right after a bit. It's funny that you bring up on-call, because docs do a great job of creating tight boundaries around getting woken up! Governance is not an issue. But, of course, some families need to be reminded still.
The problem is that the subset of patients most likely to abuse this are also the least amenable to education about it in my experience
So I think that the true abusers of these tools are rare. I also don't let it evolve -- I'm quick to convert to a tele or IRL if things can't be resolved with a simple answer.
In my patients too but I have a 3 decade relationship with most
Physicians: the only profession expected to do more work every year for less money. Its Extra obvious in these inflationary times. Medicare sequestration anyone?
communication between patients and their caregivers makes good sense and ensures that the patient does not get harmed.
I disagree that we did not see this coming. I saw it coming and complained that it is unreasonable to ask us to respond to myChart messages when we are already crazy busy. To no avail, of course. When I contact my lawyer for a question or my accountant, I get a bill fro the time it takes them generate and communicate the answer. Why should a healthcare professional be any different? Physicians also have only 24 hours in a day like any other person. BTW, this is only part of the unreasonable demands on Physician time that the EMR ushered into our lives. Burnout a serious issue. I firmly believe that many of the frivolous patient messages will disappear when we charge for answering the questions and get appropriately reimbursed for our time. Also, for urgent concerns we have ERs and Urgent Care Centers, and myChart is not the right place anyway, because the patient does not know when the message will be viewed.
100% agree with this as a general internist practicing for over a decade. The EMR on its own is a full time job actually competing with the fully booked appointments I have all day. I was just out with covid and worked two weeks daily at least four hours a day and could not clear my work list and notes. If is literally impossible. Despite my office covering me while I’m out. This is because no one actually replaces me when I’m out. The demand on us are way too high . The hospital organizations do not support physicians and actually encourage undermining our authority as “ providers”. It’s making me seriously think about switching to concierge. This job is not sustainable. There will not be physicians as PCPs in 10 years only APRNS and PAs. This is what will happen to change this. I am trying to hold on for as long as I can but at what cost? My mental health? Time with my kids? I certainly don’t make enough money to hire help or pay back my loans despite the work I do . No one thinking logically would enter primary care . We are literally professionals who care for patients above all else and now the system and patients have taken advantage of us to the point that we are breaking
This is so insightful. The Medical assistants triage but this is a double edged sword which makes me worry about patient safety issue. In my mind, nothing should be taken care of virtually without seeing a provider.
"But we never saw this coming when we turned on the feature."
Are you kidding. Stevie Wonder could have seen this coming
In box messages is largely why I left a busy PCP practice with a large panel after 25 years to become a hospitalist. My decision was solidified the day I realized I had missed a hemoglobin of 8 on an otherwise healthy patient. They had come to see me for a physical and I ordered routine labs. The next day I sent him a letter saying his labs were normal. Fortunately he came to see me a week later for an acute minor illness and I realized my error. I simply had more than I could safety do
I am reminded of a study referenced in a book by psychologist Daniel Kahneman. An Israeli day care facility wanted to discourage late pickups by the parents so they instituted a fee. The result was more rather than fewer late pickups since the parents now were relieved or the guilt of arriving late and instead saw it as a routine economic transaction.
Whoa. Kinda like a buyout.
I think that physicians should be able to bill the insurance for this communication if it is significant and important enough. It’s funny that you wrote this because there have been several times in recent months, for various reasons, that I have had this very thought as I type my message. I wish the doctor could bill for this communication bc it would be the same communication only much more clear and uninterrupted written than it would during a tele or in-person visit. It does solve the problem that many patients have, in my experience, and a significant important problem, which is that they tend to forget the important questions that they meant to ask the doctor. It happens so often that we advise patients to write down their questions and concerns prior to the visit with the doctor. Something happens during the face to face interaction, perhaps nervousness, unintended intimidation or distraction due to the focus and communication of the doctor which can lead the conversation down a different path. Doctors tend to interrupt patients, in efforts to hone in on the right questions in a timely fashion, but this interruption can cause patients to loose sight of their own questions and they just get intimidated and nervous.
Messaging also gives the doctor a chance to think about a response or a solution rather than just responding in person which sometimes results in a knee jerk response which is then followed by a double down on that knee jerk response. Right? Can we admit that we need to think about things first sometimes? Lawyers do it all the time. They say things like, “I need to do some research”
I feel bad that the doctor cannot bill for the communication so I made a tele appointment and then kept it short… tried to anyway.. not sure if that worked.
As we have moved to a relationship that is increasingly dominated by the consumer model it feels like we have become unanchored as healers.
Is there any turning back?
Great article. My clinic is thinking of turning off patient incoming email entirely as it's simply proving overwhelming for the providers.
Wondering if there are supposed to be links in this paragraph? : "A new relationship with expectations. Once we agree on how a tool will be used, patients need guidance. Patients need to know which tool to use to reach their health provider with and when. For example, these scenarios are great examples of how to use MyChart. And these scenarios will need an office or virtual visit with the doctor. Helping patients understand how to manage a system’s communication wardrobe will go a long way in improving the satisfaction of their encounters."
The challenge with email is getting things into the EHR, especially when there's a short thread. For sure there needs to be governance around how these channels are used and for what. Thanks for chiming in... Oh, and my links are in navy blue, which is hard to contrast from black. Let me work on changing that. If you are able to view in dark background their obvious....