Sunday, September 28, 2008

E-mailing Your Doctor

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:
  1. not enough time
  2. out of my area of expertise
  3. I've never met the patient
  4. rarely any way to verify they are who they say they are or have what they say they have
  5. potential legal exposure
  6. yadda yadda...
I do make a few exceptions. I answer e-mail from the rare patients who are actually in my care. I'm happy to help guide friends and family through the medical wilderness. In special cases, I also respond to others. With the resources of a humongous university medical center, I can sometimes answer a question they still have after months of digging on their own.

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.

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.
In other words, if the squeaky wheel gets the grease, the other wheels resent it.

And we can't have that.

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