email – responding to excellent critiques

1. Fear of being sued – I do understand that many physicians worry about being sued constantly.  Email should not increase this fear.  You can use email to ask a patient how he or she is doing, to receive a request for medications, to report laboratory tests or to arrange a visit.  If a patient asks a question that you cannot answer without seeing the patient, your response is simple – tell the patient that you will need to see them.  If they ask for antibiotics, handle the request exactly like you would handle a telephone request.

2. HIPAA guidelines – if the patient emails you, then he or she is (in essence) waiving their HIPAA protection.  You can circumvent this concern with secure dedicated email web sites (as described in the NY Times article.)

3. We need to be paid to do email.  If you read my post, I agree entirely.  If I was still doing outpatient practice I would include email, while awaiting and advocating for payment schemes.  Email takes less time than phone calls, and is more clearly documented.  The monetary problem does need fixing, and I can understand why physicians make this decision.  I would strongly favor an email fee (if you want email communication, pay $X per month (perhaps $20 per month – but it would need a careful analysis.)

4. Anon wrote:

Doctors need to stop taking such a passive attitude towards how they get paid and instead decide how they need to charge in order to provide the service that their patients want–and then swim upstream and do it. In the final analysis they are independent businessmen and woman and have the final say so about the terms of their service–as long as they act like other businessmen and take a little risk.

Unfortunately, most physicians cannot fight the insurance industry (including Medicare.)  Your comment explains why I find retainer medicine or cash only practices a very good idea.  We do need a payment revolution, and this email situation highlights the problem.

Thanks greatly for all the comments.  I love when one of my rants creates such passion.  This issue is not simple and our discussion does an excellent job of framing the issues.