Does your doctor respond to requests via secure messaging?

We have a “concierge “ doctor that we pay a small monthly fee for access to (they bill and take Medicare and insurance for all visits). They have an App with a chat feature which we use extensively for questions, meds and to make appointments. They respond immediately!

We are just ending a 2 week cruise trip that we got meds to take with us (z-pack, motion sickness, nausea, etc) all without seeing the doctor.

Our daughter in town with our 2 young grandkids (both under 7) uses them as well and has no issue ever getting scripts or sick appointments with the kids.

It is the best expense we incur in retirement!
 
My PCP and specialists are good with My Chart, but I use it mostly for Rx refill requests.

My cardiologist gave me his cell number in addition to email. I’ll use the cell to text PDFs of my heart rhythm that I take at home, also asking questions about what to do. He is a gem of a doctor for providing such availability, and often calls me back—even after office hours. Got a call back a couple of weeks ago when he was 5,000 miles away. Of course, I am careful to use this access sparingly.
 
Ours is pretty good at responding. DW put in a request for consultation yesterday and the first available time was in March. They called her 5 minutes later and advised her to come early as they were able to get her in earlier. Been with him for a few years and like his service.

Just had an annual with him yesterday and he's consistently thorough imo. An online app for bloodwork is a nice thing too.
 
Yes, mostly. I usually do not ask questions that I think are better left to a visit. They should be compensated for their knowledge and doing text does not pay them anything.
 
Several years ago I quit our local health system, the one owning the hospital I worked in for 20 years, because of an unresponsive doctor. She ordered a HepC test without telling me along with the usual lipid and hemoglobin A1C. I was billed for it as insurance didn't cover it. I had previously had a HepC test when I had a HepB panel done with my employment physicial and was negative for HepC as expected. I called and they reversed the charges. But a doc ordering a test (on another doc) without telling the patient is a breach of trust.

So I have a concierge doc for which we pay monthly and with whom I am very satisfied. Most of our communication is by their portal. I'm weaning off my BP meds now that I am normal weight, and I have a Welch Allyn BP cuff with a phone app. I can share the results with my doc via the portal. No need for a visit.

If you want those labs done, look up Quest and LabCorp. Both offer them without a doctor's order.
 
I try not to abuse the messaging service, maybe 3-4 times a year at most, usually far less. I just had an office visit 2-3 weeks ago, so I'm far from overdue for a checkup. Maybe I'm wrong, but I don't think I'm asking for anything major over messaging.

"Could I get a referral to a cardiologist" - Make an appointment

"Could I try a lower dose of my BP med" - Make an appointment

"Could I get blood tests for vitamin D, B12, Magnesium" - Make an appointment

The only time I haven't got the "make an appointment" response is when I'm giving THEM some kind of information (a BP reading or something).
 
mountainsoft said:
I like my doctor, she's friendly and personable, but sometimes it feels like I'm visiting just so she can collect a visit fee.
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Bingo! She will collect hundreds of dollars from your insurance company for an in-person visit, and probably much less (or nothing) for messaging with you through the portal.
 
mountainsoft said:
"Could I get a referral to a cardiologist" - Make an appointment
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This is outrageous. I would ask to speak to the doctor directly and complain about this one.

mountainsoft said:
"Could I try a lower dose of my BP med" - Make an appointment

"Could I get blood tests for vitamin D, B12, Magnesium" - Make an appointment
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These are a little more in the gray area, IMHO. My approach would be to bring these up to my doctor during an in-person visit (like my annual physical check-up).
 
mountainsoft said:
Could I get a referral to a cardiologist" - Make an appointment
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This could be an insurance requirement. There are some conditions insurers want the PCP to address before referring to a specialist. And an exam may reveal that the condition isn’t even heart related.
 
Mychart. Yes she responds or someone from her office calls. I don't always have to make an appointment. I don't often message her, though, since I know she's answering at night after getting the kids in bed.
 
I am actually having the opposite problem with my dermatologist. I want an appointment for the doctor to look at a new spot on my skin--first available appointment on my chart is 6 months out. So I contacted the doctor by my chart and asked for an earlier appointment with my doctor or some other dermatologist (large practice) so the doc could look at the spot. Instead of giving me an appointment I was asked to make a bunch of pictures of the spot and send them via my chart which I have done. I still want an appointment.
 
My PCP and all specialists I've contacted through their health portal have been very responsive, except for one specialist. I've dropped him, because he seemed like a lazy and not very competent doctor. Not responding to my messages was one indication of that.
 
mountainsoft said:
I have tried messaging my doctor a few times over the last couple years, for things that seem minor to me. Unfortunately, every time I have asked a question by secure messaging, I'm told to make an appointment to discuss. What's the point of having messaging if I just have to make an appointment? That's one more thing to have to fit into my schedule, delays care for days or weeks, and can easily waste an hour or two of my day for what should be a simple request. It always stresses me out as I feel like I have to go to the appointment armed with "evidence" as to why I feel a request is necessary.

Recently I asked about reducing my BP medicine dosage as it was making me too dizzy, heart rate was getting too low, and my diastolic was getting too low. I had to make an in-person visit, repeating the same things I messaged about online. She didn't do an exam or run any tests, but approved the dose reduction. This could easily have been handled without the hassle and delay of an in-person visit.

A few days ago I asked to get blood tests to check my Vitamin D, B12, and Magnesium levels. Again, I got the response to make an appointment to determine if it was "medically necessary". It's my body, I just want to know, but I'm not making an in-personal appointment for that. So I'll just go without the tests.

I like my doctor, she's friendly and personable, but sometimes it feels like I'm visiting just so she can collect a visit fee. Other than asking questions during an appointment, I can't recall ever being examined in any way (other than the nurse taking vitals). She's in a small clinic, which unfortunately means we have to go to a different location to get any lab work or imaging done. That kind of defeats the convenience of her location.

In fairness, she may never even see my messages, as it's always one of the RN's that responds with the "make an appointment" response.

I've been thinking about switching doctors, but I don't know if the "make an appointment" response is just her, or if all doctors in the Vancouver Clinic organization would be the same. I got really spoiled by the previous doc I had at Kaiser. I messaged him all the time with questions, requests to change dosage, try new meds, etc. He always responded personally and was happy to handle things over messaging that didn't require an in-person office visit. It saved both of us time, and I didn't have to wait days or weeks to get an appointment. Unfortunately, I had to switch docs when our insurance changed after retiring.

Anyway, long story short, are you able to handle simple things with your doc via messaging, or are in-person visits the norm these days?
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Family practice physician here. I'll warn you that my reply here may be harsh, but it is reality.

Patient messages are literally the largest source of stress in my busy life, and I would imagine 9 out of 10 PCPs would express similar frustrations with patient messages. It is universally hated. Why? Because it is nearly always a losing proposition for us.

What you think is a simple request is not a simple reply. A simple request to reduce a medication requires me to pull your chart up, go over your meds, and usually look at the last visit. Then, I need to know I have numbers I can trust. In other words, that your blood pressure and pulse were checked in my office with calibrated equipment, and I will always recheck myself. I also need to ask you questions to determine if the problem you believe is caused by your medication is actually caused by that, and not a myriad of other causes. This requires an in-person visit, both for the best care and for liability reasons. Imagine if your BP cuff is inaccurate, or you're using it incorrectly, and your BP is high, and that's why you're feeling dizzy. I reduce your medication, and then you have a stroke when your BP spikes. Bad outcome for you, and liability for me.

When you request labs 'just because' we then have to go in and order the tests and then tie them to a diagnosis. If we don't have a diagnosis (or symptom) to tie them to, we can't order them. If we tie them to an existing diagnosis and then the lab test isn't covered, we have papers to fill out, and often angry patients that have large bills.

By the way, these messages are answered in between patient visits, early in the morning before seeing my first patients, or staying late after work. We don't have scheduled patient message answering time.

I have a patient panel of about 2500 patients. These add up very quickly. Contrary to popular belief, we don't have all of our patients' medical histories memorized. Any questions that come up require us to go back in and familiarize ourselves with their charts.

This phrase here "I messaged him all the time with questions, requests to change dosage, try new meds, etc." makes me cringe. You are being selfish with your doctor's time.

Roughly 5% of my patient panel uses 90% of my mental energy. It's not the sick and complicated patients that cause me stress. It's the entitled patients who feel their time is more important than my time that cause me stress.

mountainsoft said:
I try not to abuse the messaging service, maybe 3-4 times a year at most, usually far less. I just had an office visit 2-3 weeks ago, so I'm far from overdue for a checkup. Maybe I'm wrong, but I don't think I'm asking for anything major over messaging.

"Could I get a referral to a cardiologist" - Make an appointment

"Could I try a lower dose of my BP med" - Make an appointment

"Could I get blood tests for vitamin D, B12, Magnesium" - Make an appointment

The only time I haven't got the "make an appointment" response is when I'm giving THEM some kind of information (a BP reading or something).
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Sending 3 to 4 messages a year is a lot. If all of my patients did this, I'd have 7500 to 10,000 messages per year to deal with. Figuring 48 working weeks a year, five days a week, that's 50 messages per day. If each message took me 3 minutes (don't I wish it only took me 3 minutes per message), that's 2.5 hours per day just replying to messages. That's 12.5 hours per week.


And FWIW, I am very good about responding to patient messages on time, even if it is requesting to be seen for the problem. Those patients that abuse the messaging system get a 15 second triage at best. If they're not dying, I'm telling them to come in to be seen.
 
dirtbiker said:
What you think is a simple request is not a simple reply. A simple request to reduce a medication requires me to pull your chart up, go over your meds, and usually look at the last visit. Then, I need to know I have numbers I can trust. In other words, that your blood pressure and pulse were checked in my office with calibrated equipment, and I will always recheck myself. I also need to ask you questions to determine if the problem you believe is caused by your medication is actually caused by that, and not a myriad of other causes. This requires an in-person visit, both for the best care and for liability reasons. Imagine if your BP cuff is inaccurate, or you're using it incorrectly, and your BP is high, and that's why you're feeling dizzy. I reduce your medication, and then you have a stroke when your BP spikes. Bad outcome for you, and liability for me.
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This paragraph should be modified and pop up every time a patient clicks on the message link. It would help with many of the frustrations expressed in this thread by setting proper expectations.
 
This is why I pay for cash-only conceirge care. I just call or text my PCP's cell phone and whatever issue I have will be taken care of in <1 hour.

I am friends with another "normal" (not concierge) internal medicine doctor at a semi-rural practice that doesn't do online messaging. He gets a handful of calls at the practice a day that his staff can handle, and maybe 1-2 calls after hours/weekends on his personal cell - most patients that call him are usually apologetic and calling with a legitimate issue.

It's MUCH harder to be abusive IMO if you have to call vs. firing off a message behind a screen.
 
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My PCP uses MyChart and I find it very helpful. I seldom message her….less than once per year and always get a timely response. One request that I made at an in person appointment was to schedule the blood work that she always orders at my annual check up prior to the office visit. This works well for me. That way if there is any change it can be addressed at the appointment.
 
dirtbiker said:
Patient messages are literally the largest source of stress in my busy life, and I would imagine 9 out of 10 PCPs would express similar frustrations with patient messages. It is universally hated. Why? Because it is nearly always a losing proposition for us.
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I appreciate hearing a doctors side of the situation and completely understand. On the other hand, why offer a messaging option if it's problematic for the doctor and useless for the patient?

I have the same complaint with businesses who post email addresses, then never answer emails.

Don't promise services that can't be provided.

dirtbiker said:
By the way, these messages are answered in between patient visits, early in the morning before seeing my first patients, or staying late after work. We don't have scheduled patient message answering time.
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That is unfortunate. But I am not asking the doctor to provide free unpaid care. If a messaging option is provided, it should be an allocated slot of time, just like an in-person visit. I would never expect my doctor to answer messages on their own time with no reimbursement.

Out of curiosity, do you have dedicated time slots for phone or video calls, and receive payment for those times? If so, why is messaging handled differently?

dirtbiker said:
It's not the sick and complicated patients that cause me stress. It's the entitled patients who feel their time is more important than my time that cause me stress.

Sending 3 to 4 messages a year is a lot.
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3-4 was a worse case estimate. I doubt I even send one message a year, unless there's a follow-up message.

I'm not trying to waste anyone's time, and I'm certainly not "entitled". Trust me, I don't want to contact a doctor in the first place. On the other hand, my time isn't any less valuable just because the doctor has other patients. I may just be a number, but I'm not seeking healthcare to benefit the doctor.

Overall, it seems best to not use the messaging option at all. We already stopped using the "e-check in" options as we found them useless. The office didn't receive notification we were there even after clicking "we're here", so we have to check-in upon arrival anyway. Another pointless option. Even the staff told us it wasn't reliable.

I don't use video or telephone calls either, so I'll just add messaging to that list and stick with in-person visits. Of course, that does mean I won't seek care for minor things that seem more trouble than they are worth (such as making an office visit just to request blood tests). Difficult healthcare translates to no healthcare.
 
Aerides said:
Most blood test places have retail (cheap) rates for many things. You can probably get the ones you want for $50 each, at most.
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This is very useful advice. I've satisfied my own curiosity for many years by simply getting my own labs done.
requestatest.com and walkinlab.com are reliable, reasonably priced, and professional. There are others, but I haven't used them. You simply go to a local blood extraction center (Quest or Labcorp, usually) and get it done at your convenience.
 
Our primary care is very good with communications.

Last year I woke up with intense pain at 3:00AM and went to the ER.

They were kind enough to give me a document: "Pain Without a Cause" they went over it, especially the part that said if you wanted to commit suicide because of pain to call 911. That was the extent of the treatment I received at the emergency department.

When I crawled through the front door wondering what I was supposed to do, our PCP sent a message saying she was notified I was at the ER and would like to come in at 8? Yes I do! Walked out with orders for an MRI and a script for Oxy.
 
My question is - why can't doctors charge for messages? Our daughter once had a bad skin reaction to an antibiotic and I sent in a picture with a short explanation. Pediatrician said it was normal hives but prescribed a new antibiotic. Got a bill for $50 a few weeks later.

I think most people wouldn't even flinch at $25/message and if a doctor is getting 10 a day that need replies, that's almost $60k in extra gravy.
 
TripleLindy said:
This paragraph should be modified and pop up every time a patient clicks on the message link. It would help with many of the frustrations expressed in this thread by setting proper expectations.
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Nonsense. People should know better than to have such expectations of professionals in their craft. That goes for doctors, lawyers, pilots, construction contractors, your friends who are software engineers, bankers, etc. Nobody went to college for free, nobody became an expert in their craft without years of hard work. I'm a software engineer so all of my friends used to ask me to fix their home computers (almost always viruses) for free. I would just ask when they are going to come to my house to paint it for free, so that I could be sure to have the paint ready.

The expectation should be simple: everything on this planet has a value and that includes time and advice.
 
I think most of the my chart messages I send to my doctors are responded to by a physicians assistant or nurse practitioner
 
threeonesix said:
Nonsense. People should know better than to have such expectations of professionals in their craft. That goes for doctors, lawyers, pilots, construction contractors, your friends who are software engineers, bankers, etc. Nobody went to college for free, nobody became an expert in their craft without years of hard work. I'm a software engineer so all of my friends used to ask me to fix their home computers (almost always viruses) for free. I would just ask when they are going to come to my house to paint it for free, so that I could be sure to have the paint ready.

The expectation should be simple: everything on this planet has a value and that includes time and advice.
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Clearly people are not aware that many seemingly simple tasks require much more effort/time than thought. It’s not a matter of people asking for something for free - it’s that they don’t understand that something as simple as a medication dosage adjustment may not be able to be done without seeing the patient first.

Comparing that to asking for free labor? Nonsense. :)
 
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