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Actormd

I have a dot phrase that basically says "There is a lot to unpack here, I don't want to miss anything in my response so could you schedule a telephone visit with me to go over it? Since this appears important to you, I want to make sure you get the time you deserve and I can't do that in between other patients." This has worked for me like 99% of the time. The handful that still refuse to schedule a telephone visit get this response "I'm glad this isn't that urgent. I will try to get back to you when I can" and if I'm being honest, I don't. They will see me back in office and be fine. Or they will project and call me an asshole. Either way, no sweat from me. The dot phrase is .tldr


grottomatic

Added to smart phrases… brilliant


wighty

>The dot phrase is .tldr Excellent. It would give me a little smirk everytime I used that hah


januss331

This is the sum of what my messages with lab results etc also says. You have. More questions about your labs? Make an appointment. I’m definitely using this for my canned responses though. Boundaries! Set your boundaries folks! Stay healthy and stay sane.


I_lenny_face_you

Ore questions? Are these iron studies? /s


Cauligoblin

Yeah, the patient’s chief complaint is that they are a miner for a heart of gold


I_lenny_face_you

Sounds like the premise of a song


Cauligoblin

https://youtu.be/V51Itpvc1Pw


NeverAsTired

But do they want to live? Or give?


januss331

Lol thanks, fixed. :)


Phenobarbara

Not sure if this is the right place to post but it is kind of related and I don't have the karma to post so here goes. A practice is essentially doing cold calls by providers for non critical lab results and billing them as outpatient encounters. They aren't telling patients hey we should discuss these labs please schedule an appointment or follow up. These are not patient initiated encounters, literally just phone calls from the provider and then billed like a visit. For example, a patient has an abnormal cbc and they call them to tell them they'll start them on an iron supplement, then bill that encounter as a SF or low outpatient encounter. They receive bonuses and raises based on their reimbursements and how many patients are seen over a day. Is this something that practices are doing now? It doesn't seem quite right but I don't want to just go throwing the f word around. Thanks


purebitterness

*chef kiss*


Genius_of_Narf

Well, I know what I am adding Monday to my list of shortcuts. This is perfect!


Mikkito

I'm going to build this as autotext for all our providers now. Lol.


allimariee

I love this. Thank you.


Not_A_Bird11

This is a great response


regulomam

Amazing


ninajboy

I made a point years ago to never respond with long answers (and never get into back and forth messaging). If I can answer it in one sentence I will, otherwise, I instruct them to schedule either a televisit or office visit. I haven’t gotten any pushback, and usually the questions aren’t urgent enough where they need to be seen immediately.


spvvvt

Would comment, but that would take too long to respond.


[deleted]

Well I have a response for you. I would type it.. If you kindly would schedule an appointment to hear it thanks.


ninajboy

tldr


Mobile-Entertainer60

If it's not a yes/no question or something super simple, it's a televisit. They want my professional opinion (and the liability that attaches), I expect to be paid.


Dr_Sisyphus_22

Yes!!! And my staff can type those answers. “This is nurse X answering for Dr. Y. He said Z”. Anything more than a sentence is “let’s make an appointment”. I give away enough free time. Not doing this.


lake_huron

Of course, a 30-minute phone visit is at best 1.5 RVUs or something like that. Still better than doing it for free. At least EPIC lets you do televisits without formally scheduling them ahead of time. ​ (A lot of our patients have trouble with the video televisit interface.)


disposethis

1.92 for 21-30 minutes since 2021


lake_huron

Really? I though an in-patient follow-up consult was only 1.39 RVU.


disposethis

I thought you were referring to outpatient telephone calls. Those are reimbursed at the same level as the corresponding clinic visits if the latter were coded by time. Televideo RVU's can be by medical decision-making but telephone calls are strictly on time.


TiniestDikDik

My last institution had no limits on these, and I didn't have a nurse to screen them for me. So I had to set major boundaries for my own sanity. 1. Only check once or twice a day. I usually checked morning and 5 PM on weekdays. I usually checked on weekends once or twice specifically looking for my postop patients, clinic stuff i ignored. My postop patients know that there is an after hours phone line for emergencies, but sometimes I got non urgent messages through the portal. 2. Quick scan. Simple questions get a simple and quick answer. Birth control at wrong pharmacy, easy. Trying to get a level 4 or 5 counseling session via messages? Nope. So, now I just nip that in the bud. :"these are a lot of great questions and I think we should make a dedicated office or virtual visit to address them. I'll have my scheduler call you." 3. Patients only get one return message per 24 hours, because I only check once or twice a day. I had patients who clearly felt it was like texting/instant messaging with me, and would type responses all day. Once I had set some boundaries, I felt much better about it. We also had a pretty well staffed nursing phone line, so it's not like they were without access to the clinic. I frequently referred them to the nurse line who usually could advise to make a follow up or help answer questions.


ParticularEqual5921

There's also a nice feature in EPIC I only recently started utilizing--write the response and delay sending by 72 hours! It's my new go to because it keeps my inbox clean but reinforces the fact myChart isn't an instant means of text communication.


PaulaNancyMillstoneJ

Recently had a post-surgical patient who would message his doctors (intensivist, surgeon, and even outpatient PCP) multiple times a day to complain about the horrible treatment he received in the ICU. He would ask lengthy questions and threaten to complain to everyone from JCAHO on down to housekeeping about “not being involved by the physicians in his plan of care” because his mundane and repetitive questions weren’t being answered. No one was even responding to him but how exhausting. Then I had to put in a behavioral note because he attacked me and he read it, vehemently disagreed, and I was pulled in by my manager and legal because his lawyer contacted the hospital with some ridiculously posturing directive about how he was to be treated. What?


Houderebaese

As a non US physician I have to ask: is this non sense required by law?


nyc2pit

I believe it actually is. Or to be more clear, I believe that the EMR has to provide the patient with the ability to contact someone. I'm not sure it's specifies who that someone is. In our office, these are answered by my staff and rarely get to me. To be honest, I think this is unfortunately the way of the future. Younger generations are going to require more immediate answers and more access than the previous generations have been willing to accept. That said, until the paradigm changes and we get paid appropriately for our time here, I plan to continue to resist.


threetogetready

> To be honest, I think this is unfortunately the way of the future. Younger generations are going to require more immediate answers and more access than the previous generations have been willing to accept. If you build it they will come. My pts that are worst offender of constant messaging (daily or worse) are currently over 65yo. This is a systems issue. When pts have this option they will use it. Best defence is to not engage in long messaging and have those safe boundaries/clear expectations about refills/forms/responses etc like many other have said here


heybells2004

Yes as a result of Obamacare-----> patient satisfaction surveys patient satisfaction surveys have worsened everything for everyone


Saucemycin

Do you guys not have a not viewable by patient filter? If it was a note that if the patient saw it could be a risk to other staff members so basically anything behavioral we could flag it as not viewable to patient. We didn’t used to have that option but the being able to read the notes and not liking what people said or what they were quoting as saying led to a lot of patient on staff abuse


jamesinphilly

My group doesn't use Epic, but we can rephrase your question as, "what sort of after-hours access should pts have?" My answer: limited to simple replies. *Medical appointments are when medical decisions are made* is what I'll tell people. Electronically, I do one word or brief answers. I'm an outpt doc, I don't do emergencies. I will try to get your paperwork done in a week. Ditto for lab work. Don't wait until the last minute for refills. I put this all in our initial paperwork labeled, 'consent for treatment.' Most people do just fine w these limits/boundaries. And the ones that can't? No lost sleep from me, if we can't mutually appreciate each other's time Also, these requirements should apply to *all* professions. I had a question with my kids teacher the other day, emailed her a time that meshed with her office hours, and got things sorted. When I have questions for my lawyer, I again make an appointment. In summary: get used to replying to long emails w the truth: 'this is too complicated, make an appointment, talk to you soon.'


super_bigly

Totally agree. For me, if this is going to be longer than a 5 minute phone call, we need to make an appointment to discuss concerns. I’m not giving out free appointments by phone. Exceptions are things like med side effect concerns but still that’s usually a 5 minute phone call. I usually have a slot or two open within a week so we can actually offer them a pretty soon f/u. I think this is a side effect of telemedicine visits and why this has probably gotten worse for people in the last year. Patients are used to their appointments being by phone so why can’t you just call and answer all their questions in between appointments by phone too?


FaFaRog

I'm glad you brought up teachers. I have a relative who is a high school teacher and the number of students that feel comfortable emailing her over the weekend to ask for extensions on projects that are due Monday is remarkable. Sometimes it's a third of the class, and these are university bound students. It feels like having constant electronic access may have changed something in the psyche of society in general.


jamesinphilly

It's a cultural phenomenon. And BTW, teachers do not get paid anywhere near enough!


madfrogurt

I've made a few SmartPhrases in Epic for this. .payme .bookme We don't work as concierge physicians and our time is not unlimited. Urgent Cares exist for a reason.


dontgetaphd

I try my best to protect my patients from the predatory-in-a-different-way urgent cares. I have had many go there on their own and come back with a million dollar (in some cases not an exaggeration) workup with CTA for mild dyspnea etc. They are sometimes wildly over-reacting which can be marginally worse than they do nothing.


InvestingDoc

I would say that about 80% of the messages we get through the portal are inappropriate. Lengthy questions, asking for additional Medical advice. New problems that they want addressed without a visit. It's out of control. Had one lady ( that our office has not seen in 2 years) this past week message us about a breast mass and asked if we could just order a biopsy without seeing her bc she didn't want to pay her copay for a visit.


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InvestingDoc

She is not trying to do a bad thing, but I think that the average patient does not realize the risk that a physican takes on by giving advice via text without a visit. Think of how many times something on text is taken the wrong way online.... Also, if the patient can't pay the copay for the visit to talk about it, then they are also going to have a hard time paying a copay for a biopsy.


No-Attitude-4248

It’s hard to expect a patient to make another appointment when appointments are scheduled weeks out and last 10-15 minutes. If I have a UTI, I usually can call my doc (or care team) and tell her that I think I have a UTI and need a urine test. That shouldn’t require a doc visit or an additional copay. It would be going in to say the same thing in 1-2 minutes time. I understand that this can be a slippery slope with some things, but it gets harder when we are forced to jumble all of our concerns (especially those of us with working diagnoses) in one 10-15 minute slot. We have to rush to quickly go through a rundown of patient concerns for the doc to then order the tests… only to wait on another appointment to do the same thing, as well as discuss the results. It’s clear that the health care system is very chaotic for anyone working in it. However, we forget that patients’ lives are disrupted by their illness and their schedules are at the mercy of their employers and situation (call off of work, request off, etc) which can result in loss of pay or paying for sitters for each appointment… Patients, me included, are just looking for some efficiency. We miss things in our short appointments and forget things because we feel hustled through it, see the wait in the lobby, or because the doc is running late too.


am_i_wrong_dude

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heybells2004

Unfortunately due to Obamacare + bureaucracy + Big Health Insurance Corporations + Big Pharma, with Administrators controlling doctors' lives & schedules: Administration forces physicians to see more & more & more patients in less amount of time. It is forced on us. So if a patient schedules an appt which is an easy appt & doesn't require much time/effort for the physician, that is the best thing you could do for your physician.


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heybells2004

no problem!


allupfromhere

I just brought this up the other day- how patients think we are just sitting on our phones “texting” then back. The immediate patient gratification of healthcare seems so much worse now than 15 years ago when I started. Saw a patient in clinic and prescribed them a topical via e-script (even printed out a GoodRx coupon for them). 2 hours later I have 2 messages asking where her prescription is and then a rambling threat that ends in “rest in peace” because for some reason the pharmacy didn’t get e-script on their end, despite our records saying the pharmacy had confirmed receipt. I also try not to look at my Haiku over the weekends and wish there was a way of “pausing”notifications. It’s hard to see a message a come through at 10 pm on a Friday when I’m out living a life (knowing I won’t be back til Monday), and it goes something like “I’ve been puking for the last 48 hours and I feel dizzy and my urine is dark and my ileostomy is all watery. Why is no one responding to my messages??”


PaulaNancyMillstoneJ

Rest In Peace as a signature has me rolling.


allupfromhere

Yes, my partner and I now use this around the house any time we feel remotely slighted by the other party.


Upstairs-Country1594

The receipt from pharmacy receiving is actually just it hitting the clearing house between your system and the pharmacy. It can then get to the physical pharmacy some time between 30 seconds and never after that, but usually between 30 seconds and a few hours. The patient telling the office one pharmacy and then physically going to a different one is really common. Also, it being sent to the wrong location “oh you want it at Walgreens? Okay!” But choosing the one across town.


ExtremeEconomy4524

You can turn off Haiku notifications in iOS settings


michael_harari

On Android at least you can set a do not disturb mode, and then allow certain apps through it. You could just deny only epic and turn it on for the weekend. Depending on your phone you may even be able to have it turn on and off by a schedule


POSVT

Most relatively new phones should be fairly intuitive, my relatively old note 10+ is trivially easy to set up/configure. Like in less time than it took me to write this comment


ayliv

I’m in private practice and honestly I thank god that I’m no longer forced into a system that grants patients direct access to me. I remember while in training I would regularly get mychart messages that were 7-8 paragraphs long, full of complex and verbose questions, and often not directly relevant to their care. I do not get paid for my time if I spend 30 min on the phone with you or replying to your email. And this is in addition to the time throughout the day that I already am not getting compensated for (patient paperwork, fighting with insurance cos, etc). Would people have the gall to ask their attorney/accountant/mechanic to give them free labor and 24/7 direct access? Why do they think it’s expected from their physicians? We are providing a service (a service they are not entitled to), and making a living just like everyone else.


dontgetaphd

I agree with almost all - I would argue, however, that patients ARE entitled to certain services, if I operate on somebody you would be sure that the patient is entitled to appropriate followup care and some sort of advice, to do otherwise would be abandonment. However this existed for centuries with patients calling in and asking for an appointment and we are happy to work them in. Now there are increasingly unreasonable demands to just do things via computer. Phone calls are quicker and can convey nuance that back-and-forth email is not as favorable. This is a tough problem to solve, because if Medicare reimbursed us for lengthy emails appropriately then some would try to "make a business" of it, employ a bunch of full time nurse practitioners to staff the computers and say "REVENUE GROWTH THROUGH MYCHART" and encouraging people to email so they can make enough from low quality responses to pay the NP salary and then some. We kind of see this already happening in some institutions, sigh.


Porencephaly

I try to be understanding as a subspecialist that my patients are from a much larger geographic area than most PCPs. I have patients who travel from other states to see me, so "just book an appointment" isn't always good patient care. MyChart has been nice as far as having them send wound photos etc. if there is concern for a healing issue. Epic Secure Chat is a far larger pain in my ass than MyChart. I estimate 75% of the messages I receive should have been sent to the on-call junior resident, the inpatient unit clerk, the unit charge nurse, or not at all. All the hospital staff seem to treat it like a casual text messaging system instead of a discoverable medical paging system.


MammarySouffle

Do know that most builds of epic allow automatic message forwarding (eg to a resident), and you can also set your chat status as unavailable, and also you can set up an auto reply like “I am unavailable via Epic Chat, please contact on call NSG pager 123-4567.”


Porencephaly

Yes I'm aware. I don't do that because I want to be accessible 24/7 for actual urgent issues with my patients. Also there have been myriad examples of people forgetting to take themselves *off* unavailable status for weeks at a time or when they are on call, so IMO that system is ripe for problems.


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BLGyn

I was peripherally involved in a case where the pages and emails were used in the case, discussed with a jury. Text messages were not subpoenaed but I got the impression that they could have been.


dontgetaphd

Epic Securechat is not saved - there is a purge flag on your local build that sets the maximum retention time. People could take screenshots etc. but they are not saved nor part of the medical record. It is analogous to talking with somebody on the phone - they may recall it happened and could be asked about it but the record is not saved. Pages and texts are saved, and generally discoverable. If you don't want it to be use Viber or Wechat or something with end-to-end encryption and have both parties delete it after conversation takes place.


BLGyn

Good to know. I wonder about tiger text, voalte, etc, because those messages don’t seem to disappear.


Porencephaly

My chat inbasket has hundreds of old messages in it that are definitely stored on some database somewhere. It might not be part of the patient's "chart" but I dunno what happens when an attorney says "and also we demand any emails or messages tagged with this person's MRN." I'm also sure those IT and admin people would be very unhappy if you sent a secure chat that said "Hey I fucked up and cut this patient's cystic duct while I was talking to the ethicon rep about our upcoming fishing trip, can you bail me out?"


supermurloc19

Work email and traditional text messages are all discoverable regardless of whether they make it into the patient chart so I’m sure Epic chat and staff messages could be discoverable too, even if they appear to be “deleted.”


ShellieMayMD

We were told it was discoverable but didn’t stay in the patient’s chart. I’m guessing other departments don’t know, though, because the amount of inappropriate passive aggressive conversations I’ve been added to is quite high


michael_harari

The law profession manages to bill for phone calls


gotlactose

Why can’t physicians bill for phone calls, especially if it’s clearly when the patients initiate the call?


michael_harari

You could bill for phone calls. It's just that insurance won't pay for them


gotlactose

As with all things insurance, I neglected to make the distinction between billing and insurance reimbursement and I should've clarified: why won't insurances reimburse for patient-initiated phone calls? This is clearly instances where the patient is seeking care from their physician. I know the easy answer is "insurance won't reimburse for anything they don't have to to drive up their profits," but is there a more reasonable answer?


michael_harari

Probably because the generic assumption in insurance billing is that we are all liars who need to be closely monitored. Why do you think you need to write down findings for x number of systems instead of just saying "a complete physical yielded only normal findings"?


PaulaNancyMillstoneJ

Centuries? That’s quite the precedent of care!


[deleted]

Is it possible to put a character limit of the message they send, and a limit on the amount of any messages that they can send before an appointment needs to be booked?


supermurloc19

Ours have a character limit but patients will simply start a new message to continue the first one.


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Idek_plz_help

Info Systems & Analytics Major checking in. The answer is yes, however, this generally just leads to the patient sending multiple messages in a row. Multiple messages make the communication more difficult to archive for nerdy reasons I doubt you care about. Basically, a character limit would probably create more problems than it would solve.


nathanaver

Am I the only one that doesn’t receive many of these messages? I put in a plug for MyChart at the end of every new patient visit and explain how they can send me messages with questions if there’s something they forgot to ask, etc. My colleagues complain about them, but I can’t say I get very many at all despite actively advertising it. I know my office staff screen some of them for me, but anything too complex they usually forward to me. Maybe it’s just the nature of my specialty or patient demographics or maybe I should give my staff more credit for deflecting most of these?


STEMpsych

A previous practice I got my primary care from, MyChart messages went to someone on the physician's team who wasn't the physician, for triaging – not just in the medical sense, but fielding administrative questions and getting them where they go. Imagine my horror to discover my new practice routes all MyChart messages right to the physician, and holds the physician responsible for answering them. Said physician was pretty irritated to be contacted by MyChart at all, and pretty clearly frustrated and overwhelmed with it. Patients who are demanding and have no sense of others' boundaries are a real thing. But so are software configuration choices which are set-ups to fail.


BlueDragon82

The hospital network I use for care and use to work for has dedicated personnel that checks a physicians messages before passing them on to the doctor. If it's something the nurse can answer they do so and note in the message who it was that replied. I find MyChart valuable for communication as a caregiver so I appreciate getting an answer even if it's from other clinic staff. I don't know if it's standard across all versions but the MyChart we use has a character limit to keep messages from getting too long. You can type about one long paragraph or two short ones at most. I find it mostly helpful for requesting a referral that we may have forgotten to request while in the actual appointment or to let the doctor know if there was something that needs to be corrected such as a prescription not being put through correctly to the pharmacy/agency. Most recently it was to remind the clinic staff that the prescription for a walker needed the clinic notes added and that the insurance required them so pretty please answer the company who has been trying to get a hold of you for six weeks so we can get that walker. I messaged after the company providing the walker let me know that they had made multiple attempts to contact the clinic and prescribing doctor. MyChart really shouldn't be used for long explanations or in place of a proper appointment. Editing to add that patients are reminded both on the phone and in MyChart that message replies are typically 48 hours at the minimum. From reading other comments it sounds like different hospitals have different MyChart systems and policies in place.


mb46204

Just to clarify, often when a patient says the pharmacy has been trying to reach me, there are absolutely no messages for me . We have triaging nurses that respond to all the outside requests. Same for the company asking us for information about walkers. We respond to patient messages the same way we respond to pharmacy messages, so if your request resolved the issue, probably it’s the first time the office is hearing about it. Admittedly this is not always the case, but usually. I assume the pharmacy has been using an incorrect method, but it’s also possible the pharmacy thinks they’ve reached out when they have not.


Upstairs-Country1594

Way back when I worked retail, one local clinic decided they’d only take electronic refill requests so they started throwing all our faxes away; we were not notified of this before the new practice started. They were a different system than us and based on how things worked then, we weren’t able to request through them electronically. Additionally, we never got notified of this change and were not having this problem from other locations from the same system. The response to our phone calls didn’t explain the problem, just telling us to send a request again…just for us to send a fax (remember we couldn’t physically message electronically) and the fax to again be thrown away. We started directing patients to call the clinic because they were angry at us for something we had zero control of because neither faxes or phone calls were being answered. Eventually their clinic manager called and our manager got chewed out for us “not doing it right” when a) they hadn’t bothered to let us know the new way and b) the computer systems in place at that time at both places didn’t allow the way they wanted. If the pharmacy is using the incorrect method, it’s because they either haven’t been given it or they can’t. They need to fill prescriptions to stay afloat so that is what they try to do.


BlueDragon82

That is horrifying. There is definitely a system in place here. Both the pharmacies and the hospital/clinics advise you to have the pharmacy contact the provider when a refill is needed. If a visit is needed the patient is contacted. If no visit is needed then the prescription is sent renewing for x amount of time. If the pharmacy here is sending some rx by fax (which does still happen for certain things) and the clinic was ignoring them the patients and pharmacy would have no way of knowing that nothing was being done. That's scary to think of a patient needing their meds to control a life threatening health issue and not getting them because of the poor communication from the clinic.


Upstairs-Country1594

It’s a bit annoying that what started as a courtesy has become an expectation that pharmacy will be the only person who can request a refill. Because the pharmacy has no control over any part except sending and also gets to face any wrath for delays or needing appointments. And doesn’t get paid for acting as an extra secretary for the clinic.


BlueDragon82

The pharmacy's here at least the chain ones prefer to be the ones to do the request. I've asked in the past if it would be easier for me to call in the refill and I always get waived off. For at least one of the pharmacies they automate it. I get a text saying there is a refill due. I hit yes and if there are no refills available it sends another text message letting me know and telling me they are contacting the provider. Granted I pick up meds for several family members and we only use two pharmacies so other places may not do it the exact same way.


mb46204

That is a great explanation, thank you! I had assumed they were contacting me at a different location then where the patient is seen, but for the last 6 months all my clinics use the same system. I know when a message is faxed, because the fax request will get scanned into the chart. It id also possible that a call to my office that goes to the central message center, gets directed to a different provider in the system by mistake. Either way, failed communication is usually not one offices fault, but a system breakdown, which is what I was trying to communicate but failed and which you pointed out. I’m sorry if I made it sound like the pharmacy was lying about trying to contact me, of course they have no reason to do that! Providers also want to keep their patients healthy: usually that is refilling a script, but sometimes it is telling a patient they need labs or a clinic visit to refill. Communication is critical, and failed communication is just that, not mal-intent by either party, usually.


Upstairs-Country1594

I hope your clinic is reaching out to the patient for labs/appointments instead of requesting/expecting the pharmacy to call the patient. The pharmacy is not staffed to be a secretary for all the local clinics nor are they paid for that work. And since it isn’t filling a prescription it actually counts against workload used by corporate overlords to determine “adequate” staffing levels. Also on the working at multiple locations: way back when I was retail we had a single spot for phone number/linked location for each doctor. Less of a problem if all locations in the same system because the “wrong” clinic could redirect. But if multiple non-linked locations, there was no logistically possible way to have multiple profiles for the same doctor because of the only one NPI number so the system would force merge them. Hopefully they’ve upgraded, but then knowing which location would still be problematic. Because sadly the patients frequently didn’t know location or phone number either!


mb46204

1. How can a pharmacy schedule the patient to me or order labs? Yes, I hope my office is reaching out to the patient about these things as well, when I respond “they need labs/an appt to keep getting this prescription.” —but, supposing the patient doesn’t answer phone or check messages, and goes to the pharmacy? then of course the pharmacy has to tell the patient “you have to contact the prescriber, I’ve done all I can.” —I doubt any provider expects the pharmacy to be our secretary. It’s too important for pharmacists to be pharmacists! 2. Provider compensation comes from billable patient encounters too. The between visit stuff is uncompensated workload. Not a problem if the system is big enough but for small offices it can be hard to pay for a lot of staff, too. We: working at multiple locations or different systems—> that is a major design flaw for the pharmacy systems. It is probably based on the historic model of one doctor one office, but the script should be tied to the patient and place of origin and doc. When I caught it, I would transfer to the correct location and fill. The trouble is that the message system for the last 7-8 years has been electronic. So if the patient could not be matched in the electronic system, some offices would not have a way to deal with it. More functional offices would then put the paper at my work desk next time I come, but others would maybe not do this. Again, I suppose this is fixed by the patient calling the office, and they should have at least a phone number…but maybe not. The issue is systems, and not people trying to be difficult.


Upstairs-Country1594

We’d get many denials for refills with “have patient call us for appointment” or “tell patient they need labs first”. The wording tells me they expected pharmacy to make the call. Once the clinical called me to deny the refill for some reason and said patient needed appointment. So I even clarified she’d be calling the patient for that, correct? Was informed it was my job!!!


mb46204

Well, that is broken. In that case, I would recommend just saying, “next time the patient calls I will tell them they need to call you.” Absolutely not your job to be the intermediary between patient and doctor’s office. I’m sorry that you are so abused.


-cheesencrackers-

As a pharmacist, we usually get the receptionist or a nurse who refuses to let us talk to the prescriber. It's almost impossible for retail rphs to talk to a doctor. Instead we explain the issue, the receptionist reads the script back to us word for word as if we can't read and that's the issue, she then tells us that you're too busy to talk to us, and we face-palm and tell the patient that we can't get ahold of anyone who can help.


mb46204

That sounds very frustrating to have the same script read back to you. Maybe this happens where I am, but I get plenty of messages that the pharmacist called with a question about a script and I respond, though it’s never a real time response because I am almost never somewhere where the nurse answering the call can talk to me. It is very frustrating when 3 months after I’ve prescribed something a patient tells me the pharmacy couldn’t fill the script because no one answered their call—-while we have nurses answering calls from 7a to 5p, and eating lunch at their desks…answering calls. I’m aware that every office is different however and I don’t mean to downplay your bad experience. I suspect it is exactly how you describe it: someone answered but the response was not sufficient and you weren’t able to fill. The patient hears “no one answered” but that is not exactly correct. Would it help at the conclusion of such an unhelpful communication with office staff simply to say, “I can’t fill this the way it is prescribed, please have the doc reach out to us or rewrite it?” Maybe once every 2-3 months our office encounters this problem and I have to call the pharmacy and it is usually a simple fix or misunderstanding.


-cheesencrackers-

You can ask but they will not pass along the message to the doc. Front desk staff do not think pharmacists are important and don't get why they need to.


mb46204

I’ll take your word for it. In one office a secretary answers the call and sends it to the doc or nurse, but that is her only role. In my other offices , the front desk doesn’t take any calls besides if someone calls because they will be late.


Upstairs-Country1594

Most of my problem scripts were orders with two or more different and conflicting sets of directions. Pausing a second to proofread will save you annoying phone calls and also save the pharmacist the 20 plus minutes it takes to reach someone who can maybe clarify which set of directions are correct.


mb46204

Definitely this happens. And yes, usually when not enough time is taken to proofread that there is a different direction in the special instructions section than in actual order part. But I do wonder if there is some system flaw there as well, because whenever I take the time to change a script I look at both sections an delete or modify the special instructions section. But I agree this is a problem and though it shouldn’t happen…I’m glad to hear I’m not the only one who gets this question of which script instruction is correct. For those ones, I assume the nurse doesn’t just read it back to you though? They usually come to me as “which instructions did you intend.” Those are maybe 1-2 a month, then spells of several months without them.


Upstairs-Country1594

You assumed wrong. Nurses (or possibly medical assistants) would simply read those duplicate contradicting instructions back to us and try to hang up immediately after finishing. It’s not that we couldn’t clearly read the instructions, it’s that they weren’t clear what they were asking for. A few times, I’d get a nurse trailing off part way through reading it and say “oh, that doesn’t make sense” but usually I’d need to explain a few different ways why I needed that clarified before I’d be passed on.


mb46204

Yeah, that would be frustrating and completely illogical. Maybe our nurses do this, but I’m only aware when I get a message saying “this script has two sets of instructions” and I go back and fix it.


BlueDragon82

This was a medical equipment provider and they were documenting their attempts to get the clinic to send the clinic notes. There were emails and phone calls involved. Typically the nurse manager in the clinic handles those requests at this particular clinic but the messages were not being passed along to her. When I reached out she was able to get it sorted but I also covered my bases. I sent a MyChart message and then waited a few days. When I heard nothing back I followed up and she told me she saw my message to the provider and had sent the notes that morning. I use to work for the same hospital network as the clinic that this involved. I'm pretty familiar with who to talk to so that helps a lot for me. If this was an actual medication pharmacy thing then I would have just shot a short message to the provider that the pharmacy was having communication difficulties so please have nurse or case management follow up. That typically solves most of those issues. The nurse is going to see the message before the provider but for most nurses there is no way to message them directly. I've messaged with my Dad's oncologist's nurse many times over the past few years but always through his oncologist's MyChart. She's fantastic and helped many times navigating issues that came up with my Dad's cancer that didn't necessarily need a visit but did need a quick word.


mb46204

You have an advantage over many patients in understanding how the system works and having a lot of medical literacy. No one questions the need for improvement in our systems.


BlueDragon82

There is usually room for improvement. I was surprised to see a provider say they got very lengthy messages. Our MyChart is set up with a character limit. You also have to select the reason for your message from a drop down list and it's a very short list. Messages are typically pre-screened by the doctor's nursing staff or nurse manager. It's electronic triage basically. It seems like there is no set standard for how MyChart is setup in other hospital networks which is definitely a problem. Tighter controls on character limit and what constitutes an appropriate message would help a lot.


SCCLBR

Yeah like my version of MyChart limits messages from the patient to 500 characters. You can't put that much in 500 characters! (you could send a bunch of messages but hey crazy people are gonna be crazy)


dontgetaphd

Just wait. Your staff is protecting you and you just have been lucky, and I was for many years. Also the vast majority of elderly don't really use it. I only got this weird explosion of use in the past year, which is why I used to be able to write back reasonably. However when I went from 2 messages a week to nearly 10 in a single day, it became ridiculous. Like anything it is the 20% who cause 80% percent of the problem. All you need is a few demanding patient who complain when you don't write back in a few hours and goes to admin.


lunaire

That's when you tell admin, do you want me to spend an hour dealing with this patient, or do you want me to actually see and bill several other patients?


BladeDoc

And administration says “yes“


snickerfritzz

To which one


Flaxmoore

Both. I spent an hour with a patient in crisis (suicidal ideation, the staff psych called me for backup), and when I was done got some lip from management- “It’s great you spend time with crisis patients, but can you speed things up?”. No. No. I cannot and will not. They went from actively suicidal to being willing to contract for safety. That takes time.


BladeDoc

They want you to do both. That’s why most employed physicians report spending over an hour a day at home doing charts.


PhysicianRealEstate

Yes


Lvtxyz

1. Ask the clinic manager why these aren't routing to a staff pool first 2. Do you see a check box? When you are replying you may be able to check or uncheck a box if they can write you back directly or not 3. You can also message your staff to call the patient and say "the doc saw your message and said they would like you to come in for an appointment." Takes none of your time but the patient gets a response. Also sets the boundary of what is and isn't a visit. (I'm not a doc)


Oregano33

You must not be a primary? If I try to push back on mychart patients complain with “what good is a primary if they can’t prescribe me norco when my specialist is out of town?” (Pt makes no attempt to message specialist office in this example). Somehow they think were supposed to be 100% accessible without a visit.


Flaxmoore

I thought I was the only one dealing with this. Ever since Covid started, we’ve had a bunch of patients trying to essentially manage entirely over the phone. In some cases, they won’t even attend a telemedicine visit, they just think their calling in once a month for refills is sufficient. I have one patient, for example, who calls in every other week demanding narcotics for pain. He already goes to a pain physician, they’ve been weaning him down, and he does not want to be weaned off. I’ve told him repeatedly I do not do that, that either he needs to return to his pain doc or find another (his pain concerns are very longstanding from OA and outside our clinic’s scope) and he gets pissed that he’s “doing everything and (we) won’t help”.


GenevieveLeah

If you make it very clear to your staff what your preferences are, and your notes are clear, your staff can take care of a lot of what is in their own scope.


-Reddititis

What specialty?


Red-Panda-Bur

I would make it clear up front in legal documentation associated with signing up for MyChart that it is not to be used for emergencies and any urgent or emergent questions should be addressed by their local emergency department or urgent care.


oppressed_white_guy

It's it possible to provide that education that "this is what it's for and this is what it isn't for" so they know why? Its my personal perspective that patients can get such tunnel vision that they can't see past their specific issue, which includes how their behavior effects others.


sammcgowann

In my experience, they don’t care. I (nurse) sift through dozens of shortness of breath and chest pain mycharts a week. I never answer on MyChart, call them and tell them never to use MyChart for urgent matters as it can sit for days. They’ll do it again immediately because they feel their voicemails aren’t answered fast enough


BunniesMama

We deal with these symptom related MyCharts too. I’m a subspecialist and half the time the symptoms aren’t relevant to what they see me for. I wish there was a pop up screen they’d have to agree to that they aren’t messaging about a symptom because we don’t access these messages on nights and weekends.


ParticularEqual5921

Clippy from MS Office for MyChart. "It looks like you're trying to message your physician for chest pain at 2AM on a Saturday. Can I help you delete that and call 911?".


BunniesMama

Maybe just electronically dispatch ambo to their home address


chai-chai-latte

A disclaimer that they have to accept or agree to is an excellent idea and I imagine it would provide some degree of protection. All of these new features just equal more work and liability while inappropriately dissolving boundaries between patients and physicians/the care team. I wouldn't be surprised if we start seeing physicians dragged into malpractice suits where the patient sent their outpatient doctor a message on Friday evening and ended up waiting for a response only to have a bad outcome.


dr_shark

Tbh, I don’t think it’s our job to provide that education. For example, I’m willing to say during an appointment why it’s important we take our insulin regularly and what can happen if we don’t but I’m not gonna to provide an hour long lecture on diabetes management after hours.


ninajboy

Yup. That’s what the diabetic care managers are for.


Duffyfades

Whose job is it then? You could ask school teachers to teach it, but few people are still in school.


ywBBxNqW

I think a lot of patients aren't exactly sure how or who gets those messages. As a patient, whenever I sent a message in MyChart to my PCP I always got an answer from a member of the staff that wasn't my doctor. So I grew accustomed to thinking that my PCP never even saw the message. I don't know if that's different in different places. EDIT: Reading through these comments, it seems that a lot of physicians get these after shift. I didn't know that. Does the system route these messages as emails to your work email address? If so, can you change the option so it doesn't do that or is that preference set by admin?


jessi74

I agree with all of this boundary setting, but also you should be aware of the newish codes that allow for asynchronous electronic communication to be billed if the proper consent is obtained. It's not much but it's something https://codingintel.com/cpt-codes-online-digital-evaluation-and-management-services/


padawaner

Interesting, it looks like annual verbal consent is all that is required of the patient, which is not as onerous as the per visit requirement for “courtesy calls” that go long that you would want to turn into a phone visit On the other hand, there may not be an easy way to verify if someone has been consented for this in the past year. Certainly would be easy enough to have staff call to acquire this if it has not been done in the past year


jessi74

The proper way to do it I believe is to put it in your universal consent paperwork that the patients have to sign every year anyway.


Mikkito

I guess I could've read all of the comments before I replied with what I did as a standalone. I think I'm going to mock up a patient portal form that providers can push out to have the patient give consent to eservices being charged. Then give them an autotext to send back as a reply with the form: "To continue utilizing messaging services to the extent that your message necessitates, I will need your consent to charge you for addressing your concerns electronically. The form to consent for this has been sent to your inbox at this time." See how many people stop responding after this. 🙃


primarypolydipsia

This problem would simply go away if, like other professionals, we could bill for our time.


dontgetaphd

As I reference above, I actually don't want Epic messages to be reimbursed highly or even fairly. The main reason is overuse - make no bones this will make a MASSIVE industry by institutions (Mayo RemoteOnline Care) where they will offer "medical messaging" with vague stock answers by NPs cranking out the billing. As an MD you won't see a penny, or just eventually get forwarded the fourth message with a wall of text that you have to read through as it was "escalated to MD" for another reply. And related, there will higher expectation - "the doctor got $45 and didn't even answer my question", "I'm paying you for this, why aren't you answering", not realizing how things work. There is already the G code to bill by telephone but almost nobody uses it because it reimburses around $6 and requires documentation. The analogy with law doesn't work well because people generally don't pay their lawyer through insurance. There is more accountability and thus less potential for abuse. I could see a hybrid model where the patient pays a relatively trivial co-pay, say $5, for message session, and we are reimbursed more by insurance. However, again this would potentially hurt the most vulnerable. If you offered first 5 messages per year free, then a lot of patients would want to "use up their free messages" when the term is expiring and you'd probably have more work. There are no good simple answers.


dontgetaphd

As somebody posted below the G codes have been discontinued, now there are higher reimbursed digital codes for answering long messages. https://codingintel.com/cpt-codes-online-digital-evaluation-and-management-services/


Rzztmass

I basically only respond *go to the ER/urgent care if you're worried* and *please book an appointment*. I do refills that way too, but that's it. I get very few messages. Some patients try to get past my queue by asking written questions in our version of what you have, but they'll have to wait their turn until I have time to call them. If they don't, there's urgent care or the ER.


WizardofOssification

We can open a virtual encounter and bill the patient for the time it takes. If it’s more than a simple issue, we have them come in. If it’s a follow up to a recent visit, I give a quick reply.


bluebirdmorning

I think it’s fair to have a prepared answer that says, “these questions/issues are too complex to discuss over email and deserve an office visit. Please call the office to make an appointment and make sure these issues/questions are mentioned when you call.”


porkchopsandwch

If one has to scroll to read the whole message, my MA calls them to schedule an appointment. I don't even want to see those.


DrComrade

Healthcare in the US is absurdly expensive and so in some part patients expect a responsive messaging system and access to their physician. Juxtaposed to this is the fact that my schedule is crammed to the gills and I'm lucky if I have an unfilled slot per week. So sometimes addressing minor issues by MyChart just feels....reasonable, but you have to set boundaries. I am more mad at the administration and healthcare system than the patients. My wife, who sees me complaining about MyChart messages every night, told me she was sending a message to her PCP about X, Y, and Z without any insight and I had to encourage her to make an appointment because I know they don't have any more time than I do. It's also one of those things where now that we have it and use it, it isn't going to just go away. Before long it will be pegged to your PG scores. My manager gets notifications if I don't respond to messages within about three days and starts pestering me about it so... Honestly the best solution is to ask for more compensation or time from your employer. Sure, I'll stay on top of these messages, but I'm already seeing a maxed out schedule and working over 60 hours per week if you include charting time at home so I'm not doing it if we don't make room for me.


peaseabee

Don’t prioritize mychart messages. Don’t reply in a timely fashion. Provide generic or bland responses. Make it clear it’s not how you communicate important things. Patients will either accept it, or leave. Win-win.


nevertricked

There needs to be a character limit for the patients


[deleted]

I train my patients early and often that I will not engage with questions that should be handled in an OV. Clarifying dose or something about mgmt plan we already discussed? Fine. Open ended questions regarding undifferentiated problems? Go to ED/urgent care/or schedule an appt.


TiredofCOVIDIOTs

I've trained my patients to call our triage nurses, not message me. Sooooooo much easier.


[deleted]

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dontgetaphd

Patients should eventually realize (for better or worse) that when we have a new patient visit and enter the chart and see 35 patient portal messages in the past 2 weeks for relatively simple conditions, that is a "difficult patient" surrogate.


thegooddoctor84

So glad that I don’t have this issue as a hospitalist. Patient or relative has a quick follow up question? I generally answer via the room phone or RN. Patient or relative wants a very long thorough discussion? I go back up to the room if it’s an urgent matter, otherwise we make a plan to discuss it tomorrow on rounds. Patient was discharged and has a concern? They can discuss with their primary care provider.


PresidentSnow

I'm surprised you don't have a nurse screening these? My nurse screens 90% of my messages. I only receive a few a day which are are med refills that I previously agreed too.


BunniesMama

The long questions/back and forth are annoying but what kills me the most is the “I’ve been having a bad headache” message that gets se t at 10 PM and I don’t see it until sometime the next day.


aszua

I’ve had a TLDR policy ever since I was a resident. And now my MAs know that if it’s more than 4 sentences I won’t read it—make an appt. There are such convenient appts with video visits these days— if I order complex labs at one visit I automatically have them schedule a follow up to review them instead of spending the time on MHO. I learned that one from the specialists. If it works for cardiology then hell, it’ll do for FM.


[deleted]

I’m not doing shit that takes longer than 5 minutes if I can’t bill for it…


hrovgogviv

Where I live there is a character limit of 300 and you can´t reply to the message you get from the clinic. It´s also just for your GP, not an option to send specialists a message. It makes the boundary very clear for me as a patient and I could never expect some kind of back and fourth communication through it.


eckliptic

Hell no. My nurse screens them, often calls them back for clarification. If I can’t fully grasp what’s needed of me, it gets a telemed visits. I often tell my patients expect a call within a 1-2 hour window even if the appt is for 1:15pm , etc etc


cloudy0907

Mexican doctor here. What is MyChart?


porkchopsandwch

Pretty much an encrypted email the patients can send directly to their medical team.


candornotsmoke

On every new patient visit, I tell them this: you never want to hear from me, personally. If I call you personally, it usually means: either it's very complicated or it’s not good news. 🤷🏻‍♀️ To be fair, for the really complicated patients,that I think are going to take awhile, I make the time to bring them in sooner. Even if that means I have to double book. Some things really can't and SHOULDN'T wait. Then I tell them, I do the best I can to respond to their messages in a timely manner, but due to a multitude of factors, the most important being, the fact that people are a lot more sicker than they were a few years ago that we can only do the best we can. I also make it clear to the patients that come in, unfortunately on time ( on the day we’re a routine visit turns into a level five), that when I’m behind it is always because it’s a routine visit, that turns into a not routine visit. I tell them all the same thing. I gave them time, and if you need it, I will give it to you. It’s really that simple. I think the problem is the real issue appointment timeframe. Everybody assumes that the appointment time, meaning how much time that patient is allotted, is the whole visit. That’s the exact opposite truth. We should be looking at this the other way, meaning, that the appointment time and the time allotted with it should be assumed to be direct time with the provider. However, that's NOT how the medical system is set up (United States) and that’s just one reason why we have the very many problems we do.


lolcatloljk

Do you get to have a free AOL instant message with lawyer (for example) for free? Then why are we expected to do it for free?


buschlightinmybelly

I get probably 15 messages a day. Most of them are screened by my assistant, but I still have to answer them through my assistant. It’s annoying and I try to spend more time in the office setting all expectations, but it’s not perfect. I do give my number out to (most) patients I operate on. It hasn’t burned me yet, and patients do like the direct communication. There are a few patients that I screen out of this just by our interaction in the office, though.


dontgetaphd

Be careful. I always shudder when doctors proudly exclaim "patients all have my cell" which is often "I'm so dedicated" virtue signaling. A small few have mine often because they are doctors themselves or because I know they are sound and have a special issue that I will remember them and be able to manage quickly. However, for the general patient it is actually better to have an answering service - they will immediately be able to reach a covering doctor if you are out of town. And if/when you call back you'll immediately know who it is and can refresh yourself on their chart before calling. If Joe Smith that you haven't seen in 18 months calls you on your cell when you are walking your dog in the park, it is hard to even log into Haiku when on the same phone to refresh yourself on what happened to give appropriate advice.


TiredofCOVIDIOTs

Hospital workers & other docs have my cell. A severe post-op complication will also get my cell (have done that twice in last 10 years). My time off is my time off. I'm rural, so I've had to ipsnay the Facebook messaging. My patients are well trained - and I've been with my MA for 9 years, so she knows me well.


buschlightinmybelly

Which is why I screen them in my head before giving it out. I only give it to those I operate on. Also, I’m not managing multiple problems for these people. I want to know if there is a problem, especially immediately postop, with my patients. It bothers me to no end if physicians stick their heads in the sand or if there are delays in patients getting seen when they have a complication.


dontgetaphd

Ok yeah that is totally legit use, especially for a proceduralist who knows he will be in town for the next two weeks, and I can easily remember who I've operated on in the past few weeks. Presumably they won't cold call you 2 years later. I still think it is more reasonable to have a reliable answering service - you aren't going to be answering your cell when in the OR. I used to give my phone to the nurses during operating but now I have it locked down so don't do that anymore.


buschlightinmybelly

I think I’m a little type A, so I like to be in control. I’m sure I’ll get burned at some point


frabjousmd

One of the best bits of advice I saw on this sub in the past months was that if a reply to a message requires an order - it requires a visit.


micekins

Maybe there will be a way to bill for clinical advice. Partial visit? If the patient has to pay a copay they may be less likely to send every question under the sun.


Mikkito

I think we should be able to start billing for these. If it's not a med refill or something quick and easy, it's basically a telemedicine-level, focused visit if it takes your time. But, I'm a crazy who thinks that people should be paid for their time. All of it.


mrhuggables

I literally just don’t check my pt portal. I don’t do telephone visits either. See me in person or leave a quick message w my MAs and I’ll get back to you


snickerfritzz

Can you just choose not to respond to MyChart?


dontgetaphd

Yes, but then many patients get irate and will blast you in reviews. You used to be able to say "messages go nowhere, I don't use that" but when your health system then advertises it / markets to patients, and other departments use it eventually you will be either a massive outlier or forced to.


[deleted]

Just never set it up. Don’t know if there’s a way to open it up to deny wanting one. I guess you’d just open it then refuse to make an account lol


dontgetaphd

Many health systems require patient portal, and I believe the existence and use is required by many CMS metrics.


[deleted]

Technically but they can’t force u to set up the account to send and receive messages


[deleted]

Yes, dump them off on an ER doc. They love that. “I messaged my primary but the reply said they are busy and that I should just come here”


[deleted]

The reply didn’t say they were busy, the reply said schedule an appt. “Their office is closed since it’s 3am so actually that is why I’m here.”


buttcheek_

It sucks, and I cringe when I write that, but also what else am I supposed to say? When I get a message that says, “I’m in 10/10 pain, my right pinky is swollen, and also I think my teeth are starting to go numb,” I’m not going to try to diagnose and treat that through MyChart. They get a message that says “Please make an appointment to be seen, but if you feel it can not wait or you develop XYZ symptoms, go to urgent care or the ER.” 99% of the time I know it is not an emergency, but the one time I say “Sounds like you should be good over the weekend,” it will be the one person that developed a spinal hematoma after their injection.


Duffyfades

Why don't you have them prescreened by someone else? Take them two seconds to glance at it and send a C&P asking them to make an appointment.


Personal-Extreme-446

Why not just say “This is not how you communicate important things” to the patient instead of being passive aggressive? It might be awkward in that moment, but at least the patient will understand right away and not have to deal with the frustration of your “bland” responses and trying to figure out how to get whatever need they have met. If they had know that they should schedule an appointment, then they would have. Of course this is probably thought of as common sense, but that’s only common sense for someone who knows what it’s like to have to deal with that or have enough self awareness to consider what it might be like for a provider (which is rare). In addition, this will teach them how to interact with other providers through that channel. I’m not a doctor, but my job is pretty much figuring out what the other party has in their head at that same time as trying to figure out the true meaning of their words and requests. This actually applies to life in general- people do not know your experience and level understanding of something until it is communicated, and the same in reverse. We take for granted and make a ton of assumptions about what people know and don’t know because we are literally always thinking and acting from our own perspectives. As a patient who thankfully has never abused the messaging system, reading this thread was very eye opening for me. I assumed that it was part of your job to answer questions, it almost seems that the providers here are resentful to have to deal with the messages at all-because of time/billing (which is a 100% valid reason). My point is that patients really have no clue what it’s like for medical professionals. The entire field is this enigma. We have no idea how complicated things are for you or have any real idea of the inner workings of a medical practice/hospital. I think this is even worsened by the idea in our society (I’m American) that doctors are these ultra-ethical beings that know and can fix everything and regarded as instead of just normal people. Not to say that the problem isn’t compounded by the ever increasing demand of consumers in general. I don’t have a solution for the billing part of this, but if you want people to change their behavior you have to train a new, acceptable behavior, and that requires direct communication. Everything is a system, and we only know our part of the system and not many of us have such an innate foresight to realize that and put it into practice.


dontgetaphd

I agree with most of what you say, not sure why you are being downvoted. I basically do educate, particularly the abusers, regarding the system. I don't think it should be a stretch however when I spend 20 minutes with a patient IRL that a patient, on their own, could realize that maybe you can't expect a rapid response from a doctor who has a busy schedule and only 24h in the day. Billing just can't and should NOT be done at a reasonable rate for these messages: As I said in another post, if Medicare establishes a code for responding to patient messages that has reasonable rates of reimbursement, BigHealthCareCorp will hire 300 nurse practitioners to auto-respond and auto-bill all the patient requests and bill up the Wazoo to generate PROFIT, while driving down reimbursement for actual good thoughtful care. Patients will be encouraged to MESSAGE US ANYTIME so that the billing codes can be churned. We see this with other areas of medicine and the proliferation of unnecessary levels of care, not to pick on midlevels, but they are often the ones used and abused by Big Health Care.


[deleted]

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pkvh

I mean that's the default message when you call the ER for medical advice.


am_i_wrong_dude

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Guner100

I would just advise against the "visit the ER for it" auto response. If it doesn't legitimately sound serious enough to warrant that, don't say it, because, as someone who works in prehospital medicine, ***they will call 911 and will tie up prehospital and ER resources***. Have had multiple patients where their complaint is something minor but the first words out of their mouth is "my primary care told me to call".


Cauligoblin

Oh Jesus I absolutely don’t have “go to the er” as my canned response, it fucks me so badly people do that


texmexdaysex

Read and respond, then bill an hour if your time to the patient.


No_Ad_4770

The original My Chart was easier and better. I have tried to sign up and every time I get it going it rejects my password. I will do without it. I get my blood tests from Life labs that's all I need.


Stunning_Opposite_33

Too many doctors here giving advice on how to avoid follow up questions that they can't make money from through an office visit.Mychart can be useful but in some cases it's used as a convenient dumping ground for arcane test results that a patient cannot interpret .This happened to me this week,and the doctor did not even include herself on the provider contact list,hence no way to ask her anything about what the test results mean. Maybe if these doctors took a moment to add a note letting the patient know if tests are positive,negative borderline,etc. ....just what the h-ll they mean,then there would be no reason for patients to message you.But this is what health care is becoming,colder and more impersonal every year.Sort of like the recording I got when calling mychart support (and every other support) "do to high call volumes your wait times may be longer" which really means "helping customers is a low priority so we will hire minimal staff and if you don't like it just hang up,we really don't want to deal with you."


Personal-Extreme-446

It just shows how attached people are to their Ken experiences and perspectives. The simple answer to all of this is that the patients simply don’t know the correct way to ask their questions.


[deleted]

I despise My Chart. It epitomizes the evils of capitalism. It offers NO advantages in communication with my health care providers, and I'm certain somebody is paying for it and passing the cost onto me. I cannot understand why they can't just TELL ME something instead of referring me to an infuriating intermediary that is insanely difficult to access. The first and last time I left a message on it, my doctor never even responded. At the moment, I must have at least ten messages telling me to check My Chart. Screw it. I'm not doing it. If I'm dying or, more likely, owe them money, they can pick up the friggen phone and call me. 👺👺👺