Medical care has various tiers of service with differential quality levels. Each level is designed to meet a specific level of need. Physicians and patients do not always agree on what level of service is appropriate. Sometimes a patient feels that a higher level of service is necessary and other times the physician has a similar view. Consider the listing below of potential medical encounters.
- Physician and patient dialogue through the Electronic Medical Record (EMR) portal
- Physician and patient phone call to discuss a medical issue.
- Telemedicine visit with audiovisual capability.
- Traditional office visit with a physician or medical professional.
- Emergency Room (ER) Visit.
Each one of the above encounters has value, but clearly they are not equal experiences. The objective is to match the level of the encounter with the medical need. For example, if you are uncertain if your recently prescribed erythromycin should be taken with food, then an ER visit would seem a step or two too far. Conversely, if you have developed fever, vomiting and abdominal pain, and haven’t seen your doctor in a year, then leaving your physician a voice mail message seems like a misfire.
I have found that
patients tend to inappropriately use lower tier encounters when seeking medical advice. Over the years, thousands of patients have phoned
me or 'portaled' me with medical issues that clearly needed face-to-face visits. These patients often felt that their request for antibiotics or a CAT scan could be easily handled on a phone call. In general, I ask these patients to see me (or another physician) in the office for a fuller airing of the issues. After these visits, patients readily appreciate that this higher level of service was essential, particularly when my advice differs from their original request. These patients were utilizing a lower quality platform for convenience which would have been at the expense of quality.
As always, there are exceptions to everything. Medical
judgment is required on how intense the medical encounter level needs to be. Different physicians have different views and practices on this. Some doctors are more comfortable handling issues over than phone than others.
Phone medicine can be murky terrain for physicians. For instance,
if you call a doctor after hours who does not know you complaining of chest
pain, do you really expect him to simply refill your heartburn medicine? .
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