Today (7/21/2023) I read an article in Beckers regarding research that indicates charging patients for sending email to physicians has not decreased the physician email burden. According to this article, the burden of emails from patients on physicians through their practice portals has increased 50% after the pandemic. The article further states that those physicians who receive a lot of emails feel burned out and are thinking about leaving their profession.
This got me to wondering what that burden tells us and makes me wonder what (other than charging the patient) might help alleviate this burden.
I find myself wondering:
· Does this indicate a pent-up demand for physician attention that was unmet during the pre-portal time period? Clearly, in the absence of the ability to email the physician at any time, the time a physician had to spend interacting with a patient was constrained by the duration of an office visit, and, by my experience as a patient, others in the office had as much “face time” with the patient as did the physician. Furthermore, that time was scheduled at the physician’s availability and convenience. So, this new 24 x 7 conduit of availability has significantly changed the nature of the relationship between physician and patient.
· Why is the physician having to answer all the emails? Clearly others in the practice have the expertise and availability to review and, potentially, respond to the patient on the physician’s behalf. Other than my primary care physician, physicians whose offices I visit rarely see me anymore; I am usually seen by a Nurse Practitioner who seems quite capable. Are these care providers also being overburdened with emails or could they be handling some of the emails that the physicians feel obliged to handle?
· What proportion of these emails generates a patient bill? - According to this article, only 3% of the emails received generated a patient bill. What are the criteria for generating a patient bill? Are those criteria appropriate? Do they need to be adjusted?
· Is the portal email system setting the correct expectations for a response? – When I correspond by email with service organizations for products I own, I get an immediate response to inform me that they have received my email, that I should expect a response within a stated time period and reminding me that repeated email queries will only further delay their ability to respond. Are physicians’ office portals set up to respond in this way? I know that, when I call one of my physician’s offices, I get a reminder to call 911 if the matter is an emergency. Wouldn’t the same reminder be appropriate in such an auto-response?
· Would the proposed use of AI to compose suggested responses really help this problem? If the problem is the sheer number of emails that need to be answered, one wonders how much time that would really save. It probably depends largely on the ability of the AI to formulate the correct response. An article I read recently suggested that responses from a generative AI system seemed to be more empathetic than answers generated natively by the physician. Would more empathetic responses reduce the patient’s need for further communication?
· What if AI could be used to perform some level of email screening? - I note that both my personal and professional email accounts have spam filters that automatically limit what would otherwise be an overwhelming daily email load for me. I note that I am able to further screen what gets through in part by the name of the sender and in part by the subject of the email. Could not similar software detect that the same person is repeatedly emailing the physician auto-respond that their first email is still awaiting the physician’s response?
I am also reminded of my early naivete about technology relieving us of chores to have more free time. One of the clear burdens of technology has been the increased expectations for performance that is has created. As automation eased a number of our chores, our expectations for service from those who benefitted from that easing also rose.
Finally, I find myself wondering what this might tell us about how we structure our relationships with patients we follow once they leave the hospital (or for patients we may see in clinics or on home visits). If we successfully fulfill our role as primary care providers, will we have the same problems? If so, how will we handle them?
What do you think?
As always, the thoughts and opinions in this blog are my own, and do not necessarily reflect the thoughts and opinions of my employer or of ASHP.
Dennis A. Tribble, PharmD, FASHP
Ormond Beach, FL
datdoc@aol.com