HOW CAN I GET IN TOUCH WITH MY DOCTOR?

Do you e-mail your doctor with questions or concerns? If not, you should.

Getting in touch with your doctor can be a nightmare, however it doesn’t have to be. With the near nationwide adoption of the electronic health record over the past ten years, most healthcare providers can now e-mail their patients. But many are keeping this a secret.

Amidst high levels of stress and burnout potential, healthcare providers, be they physicians, nurse practitioners, or physician’s assistants, simply fear an onslaught of messages that will make their hectic days even longer. But if managed correctly by everyone (that is, by you the patient, the provider, and the overseeing healthcare organization), e-mailing can be a valuable tool to help you stay healthy.

Hey Dr. M.,

I started that new blood pressure medicine - lisinopril 5mg a day. You told me to check in with you after a week, so attached are my daily BP numbers. What should I do - go up on the medicine? I feel great, no problems with it.

Thanks,

Paul L.

Dear Dr. Monteiro,

Unfortunately I’m still having those stomach pains after I eat, and the medicine you prescribed isn’t helping. What should I do?

- Mary S.

Hi Doc,

Got your message about my lab results. But why does it say my LDL cholesterol is high?

Thanks,

Mike D.

One significant barrier to e-mail communications is how your provider is paid. You can’t change this, but you can address it. Traditionally, healthcare providers are paid on a fee for service model. That means a primary care provider makes money only when seeing you in the office. Time spent outside the visit is not additionally compensated, thereby incentivizing in-office appointments over e-mail or telephone communications. Salary based providers are in contrast paid a flat salary regardless of patient volumes. This can support an e-mail friendly culture.

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I often shared with my patients that I was paid on a salary. That way they knew when I asked them to come in, it was for their health, not my wallet. It can be awkward for you to bring up this topic with your provider, but you could do your research. Some healthcare organizations, including reputable names like the Mayo Clinic, Cleveland Clinic, or Kaiser group, are publicly known salary based systems. Smaller, self-employed providers tend to still rely on service fees. This does not mean, of course, that a fee-for-service provider will not e-mail you, but a salary payment structure can help align incentives.

Written communications also may reduce medical errors, in contrast to notoriously error-ridden telephone calls, because information such as medication doses or treatment recommendations can be clearly conveyed. E-mails become an important part of your official medical record and are often reviewed by providers as would an in-office visit note. This means you should remember that all providers, plus ancillary staff such as medical assistants or nurses, who have access to your chart can read your e-mails. If you send a caustic message about your seemingly incompetent specialist to your primary care doctor, as I have seen far too often, don’t be surprised when your next specialist visit is a bit awkward.

Written by Jill A. Monteiro, MD, MBA

Published May 2020

Let’s start with what you can do. Firstly, log into your online medical chart. E-mailing between patient and provider is done within your electronic health record, not with your personal or work e-mail addresses. If you don’t know how to access your chart, contact your provider’s office. Most clinics now offer this service, and if they don’t, you can encourage them to do so. Secondly, find the e-mail feature. Typically you choose your provider’s name from a drop-down menu and then type and send your message. When your provider has responded, you will receive a notification e-mail advising you to log into your chart to read your private message.

Of course, you need to use this service wisely. You probably already know what you should and should not e-mail your provider about. I say this with confidence because I rarely received an inappropriate message from my patients. True, once I did open my e-mail to read, “I am having terrible chest pains,” and then noted the send date was two days earlier. Fortunately, a frantic phone call revealed that to be chronic indigestion, easily fixed with an antacid. But really, you know not to send urgent matters via e-mail, or forward a cute cat video from YouTube, or expect a complicated consultation over the internet. Use your good judgment and respect when the provider says, you need to come in to discuss this.

Providers need to trust that most people will use an e-mail service responsibly. They need to set aside time to fully respond to your e-mails and they must communicate what their response times are. I told everyone they should hear from me within 2 business days and that Wednesdays were my catch-up days. That meant my patient would not expect to get a medication refill on Saturday morning by e-mailing me on Friday.