Does your doctor respond to requests via secure messaging?

[TripleLindy]

Ridiculous thing to say. Equating an MD with a bank representative is way off base.

I never equated a physician to a bank representative. No need to go on the attack. My point was that charging a fee for messaging is going down the same path as banks charging fees to speak to a representative. If you don’t understand the difference, that’s on you.

The whole dialog started with calling time spent on messaging as unpaid time. It’s clearly a contentious point in the physician community.

Uncle!

 

[dirtbiker]

I never equated a physician to a bank representative. No need to go on the attack. My point was that charging a fee for messaging is going down the same path as banks charging fees to speak to a representative. If you don’t understand the difference, that’s on you.

The whole dialog started with calling time spent on messaging as unpaid time. It’s clearly a contentious point in the physician community.

Uncle!

Well, you actually did...

Yes, I understand that you charge - no need for the snark. But my opinion remains the same. If you charge for something like messaging, it’s the same thing as the bank charging a fee to speak with a representative, IMO.

 

[TripleLindy]

Well, you actually did...

Comparing the act of charging a fee isn’t even in the same universe as comparing a doc to a banking rep.

Apologies for any offense.

 

[Koolau]

If I have a question for my accountant or attorney, two other highly educated busy professionals, I don't expect to have a direct messaging service that I can pick their brain for free. Nor do most people. I don't understand why my profession is any different.

This being said, I don't dissuade most patients from sending me messages, and in many cases, I request them to message me. For example, lets say I start a new antidepressant for a low risk patient. I may ask them to call or message me in 4-6 weeks to let me know how they are doing, if there are any side effects, and if they would like a dose increase. I do this in lieu of an office visit, for patient convenience. It would be much easier for me to bring them back in 4-6 weeks for a quick and easy office visit. On the other hand, I have had discussions with some patients about proper messaging and what I am able to reasonable accomplish with a MyChart message.

The goal is good patient care, and some of the worst patient care possible is trying to do too much with a MyChart message. Often the best patient care is to ask the patient to come in to be seen.

Your doc would love an easy visit with a simple question. My patients aren't making my day longer with an easy visit. All of my slots fill up everyday regardless, and I voluntarily double book most days.

I wish I had the ability to have a "gate keeper" to manage my messages. I truly do. I don't even have a dedicated nurse. 1:1 (nurse to doctor) staffing is becoming less and less common in primary care. I'm an employed physician, so I can't control this.

I do see the patient's point of view. I'm also a patient myself, albeit I can answer most of my own medical questions, to be fair.

I renew my suggestion that you find a way to get out and retire as soon as possible. Apparently this is a real sticking point for you and I'm sorry it's taking joy away from a j*b you must otherwise love.



MyChart or similar isn't going away. I'm officially "encouraged" to use it by every doctor's office and on every official communication I receive from the health system that I use (Queens Medical in Hawaii). I find it quite helpful and my doctor(s) never criticize my use of it. I see it as win-win but obviously you do not. Blessings going forward toward FIRE.

 

[dirtbiker]

I renew my suggestion that you find a way to get out and retire as soon as possible. Apparently this is a real sticking point for you and I'm sorry it's taking joy away from a j*b you must otherwise love.



MyChart or similar isn't going away. I'm officially "encouraged" to use it by every doctor's office and on every official communication I receive from the health system that I use (Queens Medical in Hawaii). I find it quite helpful and my doctor(s) never criticize my use of it. I see it as win-win but obviously you do not. Blessings going forward toward FIRE.

I'm currently on my way to retiring as quickly as I can (well as quickly as I can for a comfortable retirement anyhow). At this point, I'm only a couple years away from a lean FIRE, but that's not my goal.

In all honesty, I'm probably making myself sound far more miserable than I am. The anonymity of the internet makes for a great place to voice complaints...

 

[Jerry1]

I'm currently on my way to retiring as quickly as I can (well as quickly as I can for a comfortable retirement anyhow). At this point, I'm only a couple years away from a lean FIRE, but that's not my goal.

In all honesty, I'm probably making myself sound far more miserable than I am. The anonymity of the internet makes for a great place to voice complaints...

I would get to the point of lean fire and then do something else. My primary doctor does not accept insurance. He’s a holistic doctor so his practice is different than a typical primary care system, but he is an md and is my first stop for all my health questions. I can assure you, that he is not stressed at all and intends to work until he can no longer. I imagine you’d get the same experience at a practice that uses a concierge model. The key is to get as far away from or even eliminate entirely the insurance payment model. As you know, it poisons the dr patient relationship. Combine that with corporate group practices and it’s easy to see why you don’t particularly like your current situation.

 

[pacergal]

As a patient, I certainly appreciate my providers quick response to messaging, which I use rarely. Most of the time, the response is from another provider covering the "in basket".

As an RN, when I worked, I was "attached" to my providers in basket and spent much of my time pulling things out that I could handle alone, or previewing requests and doing what I could for my doc.
As a manager, it was my job to help create schedules, which I knew were impossible for our docs. Managed care is managed by folks who have none to little experience with direct care and bottom line is numbers. It is ridiculous to expect every single visit to take 15 minutes (and part of that time is the assistant doing vital signs and prepping the patient), no matter if it's a quick recheck, a full physical, or a procedure. The thought was "you will have no shows to get caught up". !! Only at the end of my career were the docs finally given a mere 15 minutes twice a day for phone calls, etc.
I worked 10 hour shifts, my docs "worked" an 8 hour shift, but were always there after I left. And they did not get paid overtime.

 

[harllee]

I have been trying to use my chart to get an appointment with my dermatologist about a new concerning spot on my nose. I gave up and finally called ( on hold for a while) and got an appointment for Monday!

 

[dirtbiker]

I would get to the point of lean fire and then do something else. My primary doctor does not accept insurance. He’s a holistic doctor so his practice is different than a typical primary care system, but he is an md and is my first stop for all my health questions. I can assure you, that he is not stressed at all and intends to work until he can no longer. I imagine you’d get the same experience at a practice that uses a concierge model. The key is to get as far away from or even eliminate entirely the insurance payment model. As you know, it poisons the dr patient relationship. Combine that with corporate group practices and it’s easy to see why you don’t particularly like your current situation.

I couldn't imagine a more stressful job than as a concierge PCP. I'm currently moving in the opposite direction; into administration. It's not something that I ever thought I'd do, but it's trading one stress for another, but at least it's a different stress. lol.

The insurance aspect certainly can cause stress, but that's near the bottom of my work stressors TBH.

 

[Texas Proud]

Well.... just had mine respond. I needed a prescription refill and for some reason it was not listed on my medications. I asked that it be refilled and they responded with a refill order.

 

[badatmath]

Well I had a "physical" last week and the doctor didn't order CMP (showing glucose and all that jazz) so my question was "why not" and and "can I get one". 4 messages back form the medical assistant have not answered this. To be fair they did order a lot of blood tests and perhaps it was lost but this doesn't seem like I should have to wait 2 more months for a new appointment. They didn't say I did they just seem to be writing a script that doesn't go with the question. So I called and after an hour on hold they said they'd leave a message and someone would get back to me.

 

[Koolau]

^^^^^

It does seem strange that the doc wouldn't have ordered a CMP for your physical. Do you have a portal to contact the doctor (more or less) directly?

 

[GenXguy]

I use the messaging system to request refills of medication.

The only time I used it for anything else was to request a pharmacy change, which I had also called about, but then they called me, and when I brought up the message, they said they don't see the message. But then later, I got a message sent to me which included a forward of my original to an NP, that they had said they didn't see earlier.

 

[badatmath]

^^^^^

It does seem strange that the doc wouldn't have ordered a CMP for your physical. Do you have a portal to contact the doctor (more or less) directly?

I used the portal but the doctor doesn't see them only the staff it seems. I did NOT get a call back after the hour long hold and the supposed "high priority" message that was left. . . but it was some what late in the day by then. I was just expecting them to say "we sent a lab order come by anytime". . .

 

[big-papa]

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?

It's always been clear with the clinic that my doc is a part of, that messaging is only there for administrative items like requesting a refill of a med you're already taking, requesting and getting an official referral and for me to receive notes from my latest visit and labwork. On the patient's side, any health related questions or changes in meds all require a doc visit. Though many of these visits can also be done via teleconference now.

Cheers.

 

[badatmath]

Well after 4 portal messages and 2 calls I was told to schedule another appointment which I can't get for 6 weeks. . . . ridiculous they won't discuss labs from last week. The most I can get is CMP is up to the doctor and not automatically a part of a physical. Well it is has been part of every physical I've had there . . . and I did have other questions about the test results which I thought were quite simple but apparently not.

 

[target2019]

I've been fortunate with my health group for a long time.

My oncologist initiates text messages. Yesterday he confirmed an appointment rescheduled for next week.

 

[Amethyst]

Well, today I got a prompt (1 business day), polite response, via the patient portal, from my latest doctor (not his assistant) about a blood test. He was very nice in person, too, and a huge contrast with the chilly jack wagon who preceded him. Wonder how long it'll be until he goes concierge.

 

[target2019]

On my healthcare message system I know my oncologist moves back and forth between two offices. He relies on others to read messages and bring them to his attention in various ways.

 

[Koolau]

On my healthcare message system I know my oncologist moves back and forth between two offices. He relies on others to read messages and bring them to his attention in various ways.

Yeah, I think it's standard for the assistants to review all the messages and be something of a "gate keeper."

 

[Amethyst]

Yeah, I think it's standard for the assistants to review all the messages and be something of a "gate keeper."

That has been my typical experience. Unfortunately, the assistants' translation, of what the doctor probably actually said in response to my message, has been less than stellar. I don't think they are hired for their communication skills.

 

[Koolau]

That has been my typical experience. Unfortunately, the assistants' translation, of what the doctor probably actually said in response to my message, has been less than stellar. I don't think they are hired for their communication skills.

Interesting observation.

Even though English is often the 2nd language for many of our health care professionals, I've not seen any significant issues with the go-betweens making sense of my requests and subsequent Doctor's answers.

 

[pb4uski]

The hospital system that I use has a very good portal for scheduling, transmiting test results, etc and I use it regularly as does my PCP and the rest of her team. Just last Wednesday I went in for blood work in the morning. Later that day I received two emails notifying me of my test results and when I logged in there was a short comment on the results from my PCP. We'll discuss them face-to-face at my appointment this week. It works very well.

The medical practice that I used as my PCP when we lived in Florida did a similiar thing.

 

[Koolau]

The hospital system that I use has a very good portal for scheduling, transmiting test results, etc and I use it regularly as does my PCP and the rest of her team. Just last Wednesday I went in for blood work in the morning. Later that day I received two emails notifying me of my test results and when I logged in there was a short comment on the results from my PCP. We'll discuss them face-to-face at my appointment this week. It works very well.

The medical practice that I used as my PCP when we lived in Florida did a similiar thing.

Yeah, it amazes me how quickly my results show up in the portal. Generally (and this depends on the doctor and her/his staff) I get answers to questions in 48 hours or less.

 

[elvis76]

Yeah that “make an appointment” loop is everywhere now, it’s basically policy and billing, not your doc being lazy. Anything that touches meds or labs = visit so they can document and get paid, otherwise they risk liability for free advice. Still annoying as hell. What worked for me was asking straight up “what can you handle over messaging?” and using nurse lines for simple stuff, and for labs just request a standing order during a visit so you can reuse it later without another appointment. If they won’t budge at all, yeah, switch, some clinics are way more flexible than others.