Doctor-Patient Communication in Today's Digital Age
http://thedianerehmshow.org/shows/2012-01-24/doctor-patient-communication-todays-digital-age
Many Americans send email and text messages more often than they speak on the phone. Whether electronics offer the best way for doctors to communicate with their patients is in debate. Some doctors are concerned about privacy and liability issues and a loss of face-time with their patients. But doctors who favor emailing say it's a more efficient means of communication, helps build better relationships and encourages patients to take more control of their health. One recent study concluded that patients with diabetes or hypertension who communicate with their doctors via email have better outcomes. Diane and her guest discuss doctor-patient interactions in the digital age.
Guests
Dr. Joseph Kvedar
founder and director, the Center for Connected Health, Boston; associate professor, Harvard Medical School.
Dr. Sam Bierstock
founder and president, Champions in Healthcare.
Dr. Steven Schwartz
associate dean of clinical informatics and a family medicine physician, Georgetown University School of Medicine.
Deven McGraw
director, the Health Privacy Project, Center for Democracy & Technology.
Comments
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In a recent email to my book group, I paused to check the book's availability with a huge online book seller. To my amazement their website OPENED to the exact book and every other book written by the author I had just mentioned in the email to my group. My internet carrier told me that certain words in emails are electronically charged to alert merchants. How can we ever by sure that insurance companies are not doing the same to our doctor-patient online correspondence? What is the point of signing all those confidentiality forms if our emails are not private?
Thank you for bringing up this topic. I am continually frustrated by the lack of email communication with my doctor's office and hospital. For alleged privacy reasons (and fear now being discussed), they are incapable of sending any information, such as lab results, over email. This seems to be a waste of time and patients money in the US where medical bills are absurdly expensive.
My work as a computer programmer has given me the insight and experience to know that this is a very bad idea. Email is not secure, there are technologies, though not widely used, that can be used to make email more secure but, by and large IT IS NOT SECURE AND NO PRIVATE NON PUBLIC INFORMATION SHOULD EVER BE TRANSMITTED OVER IT.
Doctors using five senses? That is usual over seas. But when they wont listen if you have one, or at the emergency room, you see no eye-contactt, other than them eye'ing their blackberry, you have to consider where you are at. You have to get a translator than can cross the class barrier of insured vs. uninsured. This program assumes that a 'real doctor' is present when you are face to face with a medical professional.
I'm mildly amused when I hear doctors talk about having conversations with patients. I've had an acceptable long-term relationship with my family doctor; my wife has also had long-term relationships with her care providers, from general practitioners to specialists.
I simply can't recall ever being reached by any means by one of our doctors, except during office calls or hospital rounds. Whenever we call the doctor's office, we are invariably routed to a nurse who fields, screens and answers all calls, and becomes the intermediary for any conversation with the doctor.
It seems ridiculous not to open up real, direct, person-to-person email communication with our doctors, since it seems impossible to reach them in any other way.
I was undergoing infertility treatment for three years. When I got pregnant I was overjoyed. I went to an appointment and had bloodwork done. The next day I had a message on my answering machine, from a nurse, saying my pregnancy was "bad", to stop taking the medications and to call to make an appointment in a few months if I wanted to both trying again. I can't tell you how that affected me emotionally. If that is an example of efficient use I technology to commuicate with patients, I'm am 100% against it.
Thank you for taking on this topic. The care required for communication is indeed worth the effort! We have a household with both a 13 year old and an 85 year old, so medical arrangements, information, and medication management can amount to many hours each week. Our physicians and nurses are happily EMAIL savvy. If EVERY question required office time, I am afraid that things would have been utterly unmanageable for our household.
I have had to telephone the doctor's office only occasionally, when an email response was delayed. FAR less often than 10 years ago, when there was no email possibility. Back then, the response was more frequently delayed.
How does a physician get paid for this service? A lawyer can charge per minute, but insurance companies and medicare do not pay for a physician to communicate with a patient through email.
Our office has not had success in billing for email consults.
Catherine
Email for normal questions and reports would make it easier to communicate for doctor and patient at their convenience, rather than hanging on for long periods of time. This would not be very helpful in cases of urgent need for communication. I would like to be able to make appointments or ask simple questions without worrying about interrupting the doctor at critical times.
Fascinating. What e-mail is not using https or 128-bit encryption?
Years ago, I was able to call my doctor when I had a minor problem and after a quick call I was able to get a prescription called in.
Today, the doctors want to see me, which means I have to navigate their front office, make and appt., take time off work, sit in their office for hours if they are running late. Or, if all I need is a phone call back to ask a question about a previous visit, I am unable to get through to the doctor. Because of this, sometimes I choose not to go to the doctor for minor issues. Or I go to an urgent care and that becomes an issue of inconsistent records - if the problem worsens, the doc has no record of the initial visit.
In event of a serious problem, I would have enough sense not to email the doctor, but to make that appointment.
Encrypted emails are relatively secure. The doctor can require patients to use the encrypted process to protect them both.
HIPA rules have already destroyed any medical privacy. Insurance companies, other doctors, even employers (if they are self-insured) have access to medical records if patients sign a HIPA release.
All of the concerns presented occur in person as well. Insensitive doctors can bluntly tell patients they have cancer or they may leave a phone message that says they saw something on a mammogram and please schedule a follow up. The phone messages can be received by an employer, a spouse, a child.
Thank you for addressing this important issue.
Pam W.
I have neighbors with COPD, and diabetes from cortizone therapy. Took him awhile, now he understands using the scale, and inputing his medical info across lines. They have data base for doctor to work with. Chest paines always call 911. After release from hospital, he sees his local primary care doctor within two weeks, and gets clarification from her, and she has access to his data after release from hospital.
But if you are not home monitored patient, you have to worry about the quality of the programming software the hospital or doctor's practice uses. They may not pay for a professional service to upgrade it, and they may have bought it from a friend of a friend. So software has to be upgraded in a professional manner, by professionals in infomatics, not buying system from a 'fellow alumnus.'
I love providing accessI to care for my patients. But what about compensation for the physcians dor their time? In many ways it can increase the work load. Emails take time and may take away from other patients.
Initially I'd like to state that as a patient dealing with undiagnosed pain it is helpful to brainstorm in an online setting.
I am also a student of facial expression recognition. Studies have shown that an individual is capable of increasing their abilities of spotting emotions during conversations in just an hour of practicing with a F.A.C.E program (Facial Expression.Awareness.Compassion.Emotions.) It could be greatly helpful in the medical field where it is important to know whether or not your patient has been adhering to to the recommended lifestyle or regiment changes. Although, this would require more intensive awareness of ones patient... as well as actually listening.
I am about to change my primary care physician because, in my infrequent office visits, her eye contact remains primarily with her computer, not me.
Unlike previous, or "old time" doctors, with her, I always leave the office feeling worse than when I went in - feeling unseen, unheard, and in part, hopeless that the person I want and absolutely need to care about me, not just for me - doesn't; and doesn't even really know me, just her "map," the records that she's created of me according to her computer medical models. She even talks like a computer, spouting medical book facts, but with no heart, and little about me or how I might improve my situation.
Certainly email communication between doctor and patient may under select circumstances, and with security/privacy protocols followed, may help those communications. But with my recent experiences, such regular and growing emailing practice, only points us all away from the real human to human caring contact that is foundational to true healing.
Doctors using computers in the exam room need to look at the patient and not focus on the keyboard. I feel as if I'm not even there!
This registered nurse has direct experience with the potential abuses of new technologies by health care providers at the alter of less time and fewer visits = greater profits. In particular, in home health care there is a movement to the use of telemedicine (for example, equipment which reports blood pressure/pulse/respirations daily) to determine whether or not a visit by someone or a call to a physician is needed. Your physicians may want to discuss the dangers of this practice. Of course, in home health care, the fewer visits made by someone, the greater the home health care provider profits in our prospective payments, your health for my profit, system.
Bruce, RN
God, I hate that. Bruce, RN.
Kudos to Dr. Bierstock who articulates the critical importance of the face to face relationship between doctors and our patients. As a community child psychiatrist, I rely on a personal interface where words alone are insufficient.
It may be argued that medical malpractice and increasing regulation have contributed to the decrease in physician compensation largely due to the need for physicians to carry large malpractice insurance policies and order additional tests to demonstrate they have provided appropriate care. My concern is are we not opening an Pandora's box of sorts that would lead to more lawsuits and regulation?
My primary care physician and his practice established a portal several years ago as part of a program that provides other services (e.g. same day appointments for urgent problems, free access to alternative health services, longer annual visits, fitness consults). The cost is $30 per month, which I can cover with my Flexible Medical Savings account (with pre-tax dollars). This has provided me with excellent primary care, and when my co-pays are taken into account, easily pays for itself over the course of a year.
I would like to hear about the patient's view on email communication with doctors. As a caregiver, I get lost trying to remember all my logins and addresses for doctor portals. I would like to have one way to reach ALL my doctors and a better way to make sure they all have the same information about me.
Does anyone else feel the same way?
I'd love to cover the cost of email contact with my flex pay account. How do you do that? Is there a specific code from the doctor that you need to get it approved? What kind of doctor do you see? Do they take insurance or are they direct pay?
I agree that sending a person to ANOTHER site just to communicate with one of several doctors is the convenience of the doctor not the patient. Again, email is secure today as a website.
Great topic! I love your show Diane!
Recently I had the experience of choosing a GYN doctor from the list of doctors provided by my health care plan. I am unemployed, so I carry my own health insurance. I tried to get a cost estimate before I made the appointment, but I was told it all depends on what happens in the appointment. I had a $40 co-pay before stepping into the exam room. During the appointment, I did not see the doctor, but her assistant. Two routine GYN tests were done, as well as discussing a problem issue I have. The assistant spent a lot of time pitching designer hormone therapy which is not covered by insurance and was unrelated to my problem issue. I said I could not afford designer hormones. The assistant eventually performed an exam and offered a course of action for my problem. Afterwards, I called the doctor's office back and was told they had charged my insurance company $450 for the visit. I have a sizable deductible, but I still have no idea what my final bill will be.
If I had known ahead of time that that doctor's office would charge so much just to discuss my problem issue, I would have cancelled the appointment and found another doctor. Now I will have to pay a big doctor bill and I am no closer to getting my issue resolved.
This is part of what is very wrong with our health care system. No cost disclosure to patients prior to making an appointment, then charging exorbitant fees for an office visit.
Thanks Diane for providing a forum for discussion of doctor-patient interactions.
An innovative patient healthcare provider portal with many unique features is Cyberdoctor (www. mycyberdoctor.com). This portal has taken care of several of the issues raised by the panel through its neat education platform. The interface is easy to use for patients and has appealed to physicians. Strongly recommend it.
Thank you Diane for discussing this important topic! The discussion as well as the comments posted are excellent and timely. I did check out the website for the Cyberdoctor (www.mycyberdoctor.com) and it does have many features that are not currently available. Wonder if doctors in Boston have acquired this new platform? Thanks again Diane for hosting such an informative show!
I am familiar with this interface www. Cyberdoctor.com
Very user friendly and innovative. Superb interface and functionality. The features make it easy for me to reach out to my provider and get responses.
What is the accepted "hourly rate" for a general care doctor's office?
For instance, a typical car mechanic (the whole shop) charges $75 an hour for most work. Services that cost more are expected to be disclosed to the customer.
If the doctor is to be my "consultant" on my health, why can't his or her rates be disclosed to the patients?
I enjoyed the show on doctor-patient communication. However, I was very surprised that given the focus on "communication" we heard almost exclusively from medicine and that no scholars or researchers were included from the field of Communication Studies. For example, right in your backyard, is Dr. Gary Kreps, Professor and Chair of Health Communication at George Mason University. Professor Kreps was at NIH, has published extensively on health communication, and is considered the father of health communication. GMU also offers a PhD Program in Health Communication (and it would have been great to hear from those students too). Too bad--a missed opportunity here to include those who are doing research on strategic health communication as well as medical provider-patient communication.
--Dr. Thomas Socha, Old Dominion University, Dept. of Communication & Theatre Arts, Graduate Program Director, MA in Lifespan and Digital Communication