My nemesis “ mychart”

[scharnhorst]

How do you guys deal with mychart messages ?
how much are you willing to advise via these messages ?
it seems like patients want everything addressed through mychart now

thanks

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[VA Hopeful Dr]

Whatever you are comfortable with.

Personally, if it's related to a recent visit or labs I'll usually deal with it that way. If it's a new problem, that needs a visit.

 

[bronx43]

How do you guys deal with mychart messages ?
how much are you willing to advise via these messages ?
it seems like patients want everything addressed through mychart now

thanks

If it's a truly sick patient, then I do whatever is necessary for them remotely until their next appointment. In fact, I often contact them before they reach out themselves.

However, if it's a Karen or worried well that sends a page of questions expecting a lengthy instantaneous answer, then they need an appointment. Anything that can't be answered by the staff should be an appointment. If they get angry and switch docs, then so be it. You'll thank yourself in the long run.

 

[WhiteCoatWonder]

magically, all of our "direct" patient-to-physician electronic messages get routed through the fabulous RN team first, so that's helpful.

i'm pretty guarded and strictly clinical in my response to these messages. i literally write anything in the chart/message like its Exhibit A. one piece of advice i got a lonnng time ago was "make sure you're comfortable with everything you put in writing to be on the overhead projector one day in a courtroom" (lol but really, though)!

so, for these e-messages: if you have a yes or no question, we can answer it electronically. if you have a question that id be comfortable with a nurse answering in the hospital (eg was i prescribed 12.5 or 25? did you put in my referral for PT?), we can answer it electronically. if its about explanation of labs/diagnostics, new (nonspecific or concerning) symptoms, refills on your oxy from 15y ago or the gettysburg address, you're comin in.

 

[AMEHigh]

I try my best to be helpful through messaging if it is something that doesn’t take too much time/thought or truly doesn’t need an in-person visit. I actually even text a few of my patients with my work number.

Me and my partner have been having to go to various doctor’s appointments lately for mostly minor stuff but we’ve both struggled with getting through to the doctor for the most basic stuff. It can be rather frustrating. Obviously I know we’re busy but if one can’t get through on the phone without being on hold for 2 hours, then messaging it is.

So I do try to give my patients grace. But I have been "stern" when they take it "over the line" and just tell them what the boundaries are and it’s been fine the 2 or 3 times I’ve had to do that.

 

[FamilymedMD]

I work for myself in a non fee for service setting (DPC). I love addressing problems and questions by EMR portal, Signal (free secure texting) or phone for appropriate issues. It's much faster than seeing them in the office.
I don't miss the days of having to drag them into the office so I can get paid instead of working for free. Now it's frustrating when they insist on an office visit that I know could be handled by text or phone.

 

[deleted87716]

Meh. For every patient portal message I get that's more appropriately answered in that medium as opposed to going back and forth on the phone between me and my nurse, I get two that need to be appointments. *sigh*

 

[bronx43]

I work for myself in a non fee for service setting (DPC). I love addressing problems and questions by EMR portal, Signal (free secure texting) or phone for appropriate issues. It's much faster than seeing them in the office.
I don't miss the days of having to drag them into the office so I can get paid instead of working for free. Now it's frustrating when they insist on an office visit that I know could be handled by text or phone.

Just curious, what EMR do you use?

 

[FamilymedMD]

Elation. Some of the patients complain about trouble getting into the portal but I think you get some of that with any EMR (or group of patients).

 

[avatarftw]

Have you guys noticed a lot more EMR messages? I'm getting like 3x more messages or calls than my old job and I see about 25% less patients than previous position.

There's a lot of patients with new complaints that have not been addressed at a previous visit, neither with me nor any of my colleagues. And pts are expecting us to manage their new complaints. I've set up a smart phrase saying, "Please set up an appt to discuss your issue(s). My way of practicing medicine is to have all new complaints be addressed in a dedicated visit for the best care."

One of the other docs will order tests without seeing a patient and when the this doc was on call they said they would order tests for a new complaint.

However, they didn't and when I was on call I got asked to put in the lab orders that the other doc recommended. There is no official visit, just an EMR message from pt saying, "hey I am concerned for X disease" and the other doc says, "I recommend getting, X, Y, Z tests."

I don't think it's good medicine to order a workup for messages from mychart that are new complaints and while I"m more than willing to go the extra mile for patients, I think it's also good to be reimbursed for my work. I was going to let pt know my policy about new complaints needing a dedicated appt and defer to the other on call doc to order the tests that they recommended. What say you?

 

[BigSib]

How do you guys deal with mychart messages ?
how much are you willing to advise via these messages ?
it seems like patients want everything addressed through mychart now

thanks

I would prefer patients use the portal to knock down on phone calls and the easy stuff the staff can take care of like refills, hang nails, etc. You have to educate your population how to be 'good patients.' I give them a single page letter on their first visit describing how to best interact with us.

For the types that like to call nearly daily we force them send portal messages. They know it will take a few days to respond but at least they feel somewhat heard I guess. Hate to put it this way but they're not tying up the phones with sob stories.

Patients I know well we can triage appropriately or even manage some chronic stuff like diabetes or HTN. Try to only have a handful of those at a time.

 

[VA Hopeful Dr]

Have you guys noticed a lot more EMR messages? I'm getting like 3x more messages or calls than my old job and I see about 25% less patients than previous position.

There's a lot of patients with new complaints that have not been addressed at a previous visit, neither with me nor any of my colleagues. And pts are expecting us to manage their new complaints. I've set up a smart phrase saying, "Please set up an appt to discuss your issue(s). My way of practicing medicine is to have all new complaints be addressed in a dedicated visit for the best care."

One of the other docs will order tests without seeing a patient and when the this doc was on call they said they would order tests for a new complaint.

However, they didn't and when I was on call I got asked to put in the lab orders that the other doc recommended. There is no official visit, just an EMR message from pt saying, "hey I am concerned for X disease" and the other doc says, "I recommend getting, X, Y, Z tests."

I don't think it's good medicine to order a workup for messages from mychart that are new complaints and while I"m more than willing to go the extra mile for patients, I think it's also good to be reimbursed for my work. I was going to let pt know my policy about new complaints needing a dedicated appt and defer to the other on call doc to order the tests that they recommended. What say you?

New complaints, unless exceptionally simple, need an appointment.

 

[Sleepingdoc]

Patients like to talk and engage in conversation, unfortunately we are not there to just chat like a friend, you have ton of charts to do. Do what you are comfortable with otherwise they need a visit. if its simple question about medication dosage or how often it needs to be taken, sure its fine to text but that should be handled by nurses taking the call. Labs that need explanation need an appointment or needs to be done over the phone, not text. it can be misinterpreted by the user and can be used against you in a court. Go figure.

 

[cabinbuilder]

UGH, had a lady yesterday in urgent care who got a red flag value on her Urine Microalbumin that her PCP drew. She comes to urgent care telling me that the mychart lab is saying that she still has UTI. She had already had 4 UA's this past week and wanted to know why that value wasn't "fixed". Additionally, the urine culture grew Klebsiella and she wanted to know why her urine culture didn't say "E. Coli" like it was supposed to? Sigh.........30 minutes later finally got to the bottom of it and changed her antibiotic since she was having a reaction it the one given 4 days before.

 

[VenusinFurs]

Have you guys noticed a lot more EMR messages? I'm getting like 3x more messages or calls than my old job and I see about 25% less patients than previous position.

There's a lot of patients with new complaints that have not been addressed at a previous visit, neither with me nor any of my colleagues. And pts are expecting us to manage their new complaints. I've set up a smart phrase saying, "Please set up an appt to discuss your issue(s). My way of practicing medicine is to have all new complaints be addressed in a dedicated visit for the best care."

One of the other docs will order tests without seeing a patient and when the this doc was on call they said they would order tests for a new complaint.

However, they didn't and when I was on call I got asked to put in the lab orders that the other doc recommended. There is no official visit, just an EMR message from pt saying, "hey I am concerned for X disease" and the other doc says, "I recommend getting, X, Y, Z tests."

I don't think it's good medicine to order a workup for messages from mychart that are new complaints and while I"m more than willing to go the extra mile for patients, I think it's also good to be reimbursed for my work. I was going to let pt know my policy about new complaints needing a dedicated appt and defer to the other on call doc to order the tests that they recommended. What say you?

I think it’s appropriate to say you personally require pts to be seen prior to ordering tests and etc. I’d suggest reserving judgment on whether others are practicing bad medicine by ordering labs without a visit. Particularly when we are deprived of a super important resource: time. When ERs are practically spitting on patients for showing up with chest pain and I’m booking out at least two months and my organization only has people leaving and no one joining, you can bet your bottom dollar I end up ordering some diagnostics on patients between visits. Not anything major, but I absolutely will allow people to drop off UAs or a repeat tsh reflex on a patient who was subclinical 6 months ago and calls to report weight gain and fatigue. Not ideal, but not ideal medicine is better than neglecting concerns when there’s no one else to address them and I simply don’t have any way to see that patient in a timely manner.

 

[VA Hopeful Dr]

I think it’s appropriate to say you personally require pts to be seen prior to ordering tests and etc. I’d suggest reserving judgment on whether others are practicing bad medicine by ordering labs without a visit. Particularly when we are deprived of a super important resource: time. When ERs are practically spitting on patients for showing up with chest pain and I’m booking out at least two months and my organization only has people leaving and no one joining, you can bet your bottom dollar I end up ordering some diagnostics on patients between visits. Not anything major, but I absolutely will allow people to drop off UAs or a repeat tsh reflex on a patient who was subclinical 6 months ago and calls to report weight gain and fatigue. Not ideal, but not ideal medicine is better than neglecting concerns when there’s no one else to address them and I simply don’t have any way to see that patient in a timely manner.

Agreed. I also try not to do that but I'm fortunate to have set things up such that, barring if I'm just back from a week off, it never takes my patients more than 1 week to get in to see me (average is 2 days).

But I definitely will if it comes to it. Definitely in the examples you cite. I'll also give out paxlovid with reports of positive home tests after the nurse confirms no breathing issues. Its definitely not ideal but sometimes you just have to do the best you can.

 

[FrustratedFamDoc]

I think it’s appropriate to say you personally require pts to be seen prior to ordering tests and etc. I’d suggest reserving judgment on whether others are practicing bad medicine by ordering labs without a visit. Particularly when we are deprived of a super important resource: time. When ERs are practically spitting on patients for showing up with chest pain and I’m booking out at least two months and my organization only has people leaving and no one joining, you can bet your bottom dollar I end up ordering some diagnostics on patients between visits. Not anything major, but I absolutely will allow people to drop off UAs or a repeat tsh reflex on a patient who was subclinical 6 months ago and calls to report weight gain and fatigue. Not ideal, but not ideal medicine is better than neglecting concerns when there’s no one else to address them and I simply don’t have any way to see that patient in a timely manner.

Very well said.

I'm way over capacity on my census and still taking new patients. Lots of new patients. Local long time docs are retiring and their huge panels of patients need to go somewhere. Our methodology of patient care requires some degree of distance practice. To me, phone call is still king. Portal replies will frequently have a back and forth.

"hey Ms. Smith, it's Dr V. What's up? How can I help?" Boom, issue done. No replies. Next patient.

99% of chest or abdominal pain is going to see me in person. Ditto visual changes & vertigo.