Is Your Practice and Patient Experience Living in the 21st Century?

old fashioned communicationsEmpowered patients expect physicians to use email. Patient Experience thought leader and Pediatric Rheumatologist Dr. Paul Rosen challenges fellow doctors to bring their communications into the 21st century to improve patient access to care, quality of service, boost patient satisfaction, enhance productivity and stand out above the competition.

All too often, it seems like 21st century medicine is stuck with outdated technology and attitudes about doctor-patient communications. Most contemporary consumers—the healthcare customers we call patients—are empowered and connected by the Internet, email and near-immediate, go-anywhere mobile communications.

But contrast that reality with this experience with my pediatrician’s office.

My wife came home from my son’s check-up and had forgotten the discharge instructions. Was he supposed to get a hearing test or a hearing test and a visit with an ENT specialist? She assigned me the task of finding out.

At work, I had a few minutes break early in the morning, but then realized the pediatrician office phone lines opened later in the day. I had to defer calling until I had another break later. I called at 1:30 PM and heard the voicemail recording that the office was closed for lunch until 2:00 PM.

I waited for another break in my work schedule and called after 2:00 PM. I related my question to the nurse. She said that she would convey my question to the doctor and call me back in 20 minutes. That was fine, but I was going to be tied up in a meeting at that time. Then, I asked the question: “Does the office use email?”

Pause. Silence. Then the reply, “No, we don’t use email, but I can call you back and leave a voice message.” I said that would be fine, but I was really thinking:

“This is not fine. I don’t want a voicemail. I don’t want to have to navigate my work schedule to submit my question. I don’t want to use the phone. I want to email or text my question into the office when it is convenient for me. I don’t need an immediate response. I am fine to hear back from the doctor by email at a time convenient for him.

“I don’t want synchronous communication for a simple follow-up question. I want dysynchronous communication for simple issues.”

In 2003, the American Medical Association released their guidelines for physicians interacting with their patients via email. At the time, physician concerns around patient-physician email included: increased time required to answer patient questions, impersonal form of communication, fear of inappropriate use by patients for emergencies, increased liability, discomfort with sending private health information over the Internet, and loss of revenue.

I wrote an article in The Journal of Pediatrics in 2007 describing the value of email communication to patients and physicians. The research findings in our study debunked the myths of using email with patients.

The practice of pediatrics could be transformed, I wrote, if we adopted this means of communication that had emerged 15 years prior. At the time, just 30 percent of pediatricians were using email with their patients.

The parent survey information showed that families wanted to be able to communicate by email with their doctors. They felt that email enhanced communication, improved access to care, and improved quality of care.

The idea resonated with the media, but unfortunately, did not make much impact in doctors’ offices. Five years later, surveys showed just 40 percent of physicians were using email with their patients.

Consumerism in healthcare has upgraded patient expectations. As further evidence of the communications chasm, another study found that “more than 60 percent of patients want to communicate with their doctor via email or other Internet technology. This despite the fact that 70 percent of surveyed physicians said they had basic electronic medical records capability within their organizations.” [Optum Institute and Harris Interactive, MedCity News, 2012]

This resistance to adopt technology begs the question: “Which century is your practice operating in?” Here is a quick checklist:

  • Do you use a fax machine?
  • Do your patients have to use the telephone to schedule an appointment?
  • Do your patients have to book their appointments during business hours?
  • Do your patients have to get their medical questions answered in a face-to-face encounter?

If you answered yes to these questions, it may be time to upgrade your patient communication and access platform. Competition to attract patients is becoming more intense. Communicating the message that you practice state of the art medicine will not resonate with patients if they are not able to interact with your office using modern communication tools.

In fact, many feel that communicating by email is already out of date. Patients are ready to take the next leap forward in communicating with their doctors.A January 2015 Harris Poll reported that two-thirds of patients are open to online visits with their doctors.

Current technology solutions are available that enable the doctor’s office to provide an automated portal of entry for patients. Software can enable 24/7 appointment scheduling, secure email and text, and video encounters.

These technologies connect physicians with their patients on the patients’ terms. As doctors and healthcare providers, we need to embrace them or become obsolete. In an industry based on effective communication, we should not be the laggards in using the technology available to connect with, and better serve our patients.

Paul Rosen, MD

For related reading, see our previous article and view Dr. Rosen’s thought provoking presentation at a local TEDx event in Wilmington, DE, titled: The next revolution in health care? Empathy.


Dr Paul RosenPediatric Rheumatologist Paul Rosen, MD is Clinical Director of Service and Operational Excellence at Nemours. He received a Masters of Public Health degree from Harvard University and a Masters of Medical Management degree from Carnegie Mellon University. Dr. Rosen’s interests include patient-physician communication, family-centered care, and the patient experience. He teaches medical students about improving the patient experience, and he serves as the faculty mentor for the physician executive leadership program for medical students at Sidney Kimmel Medical College at Thomas Jefferson University.

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