Doctor, should I have the surgery?Even mere radiologists get asked this question -- usually while they are performing face-to-face procedures on their patients (or face-to-butt, in the case of a barium enema). I usually give the stock reply that I'm a diagnostician, and treatment concerns are way out of my area of expertise.
When patients started e-mailing questions like this to me in the '90's, they were enough of a novelty that I answered them all. Currently, when each day brings me 50 - 100 nonspam e-mails, that's out of the question, and I cope by ignoring most of them. My reasons include:
- not enough time
- out of my area of expertise
- I've never met the patient
- rarely any way to verify they are who they say they are or have what they say they have
- potential legal exposure
- yadda yadda...
Since Real Doctors™ spend more face time with patients, they probably also get a boatload more patient e-mail than I do. I suspect that they handle these messages similar to the way I do it, and that any residual guilt I feel over unanswered messages is that much worse for them.
Real Doctors™ may find some solace in a recent Freakonomics post by Stephen Dubner: "So That’s Why Doctors Don’t Use E-Mail":
But surely it’s in everyone’s best interest for patients to stay informed, right? For patients to do their own research, to ask lots of questions — especially of their own doctors — and so forth, right? Right?He answers his own rhetorical questions with this quote from a new working paper from the National Bureau of Economic Research, titled: Demanding Customers: Consumerist Patients and Quality of Care. From the abstract:
Consumerism arises when patients acquire and use medical information from sources apart from their physicians, such as the Internet and direct-to-patient advertising.In other words, if the squeaky wheel gets the grease, the other wheels resent it.
Consumerism has been hailed as a means of improving quality. This need not be the result. Consumerist patients place additional demands on their doctors’ time, thus imposing a negative externality on other patients. … Data from a large national survey of physicians shows that high levels of consumerism are associated with lower perceived quality.
And we can't have that.