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Comment by ejb999 | Hacker News Reader

They don't want to solve your problem over a messaging system - and prefer you to come in - the MD can't bill anyone for answering you questions over the phone or even via messaging - which is why they push for an appointment.

Not sure what line of work you are in, but are you willing to answer endless emails and or voice mails from customers, all for free? I know I am not - and while you personally may only ask one question a year, a typical MD may have a panel size of 1000 to 3000 patients (at least the ones I know); multiply one question per patient by 2000 patients, and all of a sudden you find out you worked for free for most of the year.

Maybe if insurance companies had a billing model that allowed the MDs for charge for this type of 'support', that made them some money it would be workable - but I can't blame them for not wanting to give out free care this way.

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> Not sure what line of work you are in, but are you willing to answer endless emails and or voice mails from customers, all for free?

It's common practice to answer emails and take calls from customers and not charge them for it in many industries. If you have 3000 patients, and you spend 3 minutes/patient/year on these interactions, then you spend ~30 minutes a day answering emails or leaving voice mails which is pretty standard.

No way a typical question takes 3 minutes to answer; just by time you read the message, pull up the chart, read the chart, make the call, talk with the patient and then document the outcome of the call back into the chart, you are in it for 15 minutes at least … not to mention the context-switching time you need as you move from one task to the next.

And I disagree that it is ‘common’ in other industries - ever try to get on the phone with an Amazon or Google or Facebook senior level developer to solve a technical problem -without being on a paid support plan? Sure, you might get some low level clerical person or entry level tech support, but you aren’t getting to those senior folks for free.

The estimation wasn't 3 minutes a call, but that each patient would take an average of 3 minutes of time in this communication channel. I imagine most patients wouldn't want to email their doctor every year, and that those that ask too many questions would be directed to appointments. I can think of a handful of times in my life that emailing a doctor/nurse would have been the most efficient use of time. Mostly the questions would revolve around "I'm having these symptoms, should I come in for a visit or should I stay at home."

I've (acting in the role of senior developer) directly addressed support tickets that were generated by user support emails and have even directly communicated with users in phone calls as standard level support. Not at Amazon, Google, or Facebook but in Fortune 500 companies and in B2C.

If you aren't talking to your users, how do you maintain empathy?

Doctors do entire appointments in 10-15 minutes. I think they can rip through messages sub 3 minutes.

sounds like you should go to medical school and prove the industry wrong then.

DO you actually have any reason to believe doctors spend more than 2 minutes on each message? I know a few doctors quite well and I've seen them go through the messages. They do not spend much time on each one at all.

This is a problem they're working on solving, I think. The hospital group I've been using in the Portland area recently announced that patient-initiated messages that take more than a few minutes, and require e.g. digging through a chart, are billable to insurance: https://www.legacyhealth.org/messages

MyHealth is just what this hospital system calls their patient-facing Epic portal.

If they don't want to have a way to ask a question, they shouldn't have one. The assistant who answers questions has literally never provided value. She is just wasting her time, and mine. I would actually prefer if they didn't pretend you could get useful info through the "ask a non-emergency medical question" option.

And as tssva said, these questions are often follow-ups on topics discussed at an appointment, so it's not untethered from revenue.

They are willing to answer some questions, I.e. the ones a nurse or medical assistant can answer; it’s the medical questions that only a provider can answer that they need to be able to bill for.

IME they are roughly as useful as Google, but with much greater latency. They are also wrong not-infrequently, either because they misunderstood the question, or because they gave an incorrect response.

When I have sent a message to my provider it has been because I had a follow up question because the direction given during a visit was unclear once it came time to implement it or there was an issue with a prescription (for instance a particular drug ended up not on my formulary and an alternative needed to be prescribed). The last time I sent a message is because the doctor said he was prescribing a medication and it appeared in my post visit summary but the prescription never was submitted. Even in these cases it can be like pulling teeth to get a response.

"Maybe if insurance companies had a billing model that allowed the MDs for charge for this type of 'support', that made them some money it would be workable - but I can't blame them for not wanting to give out free care this way."

Most primary care physicians today work for a base salary plus incentives. The base salary is the compensation for dealing with this kind of support.

I listen to a veterinarian frequently complain about people trying to skip the exam fee via various methods -- and the owner probably doesn't even know that what they're doing is a problem.

A free diagnosis over the phone is a lost exam fee. A health certificate over the phone -- exam fee. A vaccine appointment that turns into a sick pet and the owner just has some question -- exam fee. Trying to skip an exam before boarding: exam fee.

> the MD can't bill anyone for answering you questions over the phone or even via messaging

My patient portal clearly states that the Corporation can bill for questions sent as messages.

The Corporation by the way is a religiously-affiliated non-profit whose CEO earns tens of millions a year. In the past couple of years they have stopped doing vaccinations and blood draws. We go to the drugstore for those now.

So, why stay with them? The alternatives are even worse.

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