My last blog discussed non-verbal communication between face-to-face visits with healthcare providers highlighting the importance of time together, eye contact and touch. My fellow blogger, Dr. Quick, sent me an interesting link to a poll conducted by the University of Michigan’s Mott Children’s Hospital. In the C.S. Mott Children’s Hospital National Poll on Children’s Health (Email Consultation- Co-Pay or No Pay , October 21, 2013, Volume 19, Issue 4) ,the following information was noted:
- “6% of parents say they can currently get email advice from their children’s usual site of health care.”
- “77% of parents said they would be likely to seek email advice for their children’s minor illness if that service were available.”
- “49% of parents say the co-pay for an email consultation should be $0.00.”
Diabetes care and follow-up is mostly comprised of data interpretation, medication/diet adjustment, psychosocial support, and physical examination. Hence much of diabetes management lends itself to communication by technology which includes telephone, fax, telemedicine services, and email communiqués. Many staff members of healthcare teams, including diabetes, use all these technologies to communicate with patients. Typically, our nurse educators are the primary communicators of information between office visits and rely on these means to make medication adjustments based on blood glucose patterns.
Physicians often are in a conundrum when email serves as the vehicle for communication and express concerns about timeliness of response, security of information, and inability to retrieve medical records if not in the office. Other concerns of healthcare providers, based on the results of the poll, are that parents often do not “appreciate the unseen workload of email consultation, such as reviewing the child’s medical history and documenting the email exchange within the child’s medical record. They worry about the expectation that they are “on call” to answer emails at all hours of the day.” Of course financial concerns loom in the background as well, especially in view of the fact that there is often no reimbursement for email consultation. Lastly, and not insignificantly, the cost of implementation of secure email exchanges is substantial.
So, how do we handle communication in the era of rapid transfer of data and need for immediacy? I struggle with this issue on a daily basis especially in view of the need for time to analyze and provide treatment options based on the data provided in email. What about the patient/family’s hidden agendas, psychosocial concerns, and the need for eye contact and touch? Will that piece of patient get lost in data management? Clearly, the lack of the ability to provide follow-up appointments as frequently as possible would argue for intermittent email communication. However, the thought of 600 emails in a healthcare provider’s “in box” would be daunting! My biggest worry is that someone will email a message that needs an immediate emergency medical intervention and I am not available to see it- due to face-to-face clinical responsibilities. Lastly, it is well known that reimbursement for care and education that does not involve invasive procedures (such as diabetes care) is less remunerative than those specialties that require surgery and other diagnostic interventions.
According to the poll’s report, some healthcare practices do offer email consultation as “part of a package of online/electronic services that include family conferences, texting and web-chats” and charge a monthly or annual fee for this package of communication services. I am not directly aware any academic diabetes programs that offer these packages. And even if they did exist, I am not convinced that insurance companies, families, or healthcare providers would enthusiastically embrace reimbursement for diabetes related electronic communications in view of my comments above.
What are your thoughts? Would you be willing to be charged a fee for email consultation?
Published On: October 30, 2013