Editor's note: We work hard to write about issues that will help physicians run their practices in a manner that is both prosperous and efficient, while still delivering quality patient care. And we are delighted when our readers let us know what they are thinking. This month we are excerpting a blog by primary-care physician Jennifer Frank on her frustrations with "Dr. Google" and an article by associate editor Erica Sprey on crumbling patient boundaries. The articles has been edited for space and are followed by comments made by readers at PhysiciansPractice.com.
Warning — I am about to complain. I am about to say some things born of frustration. However, I strongly suspect that this will resonate with other physicians out there. I am used to patients coming in having obtained a pre-visit consultation from Dr. Google. More recently, this seems to have transformed from an in person comment of, "I think my symptoms might be from an ear infection" to a phone call dictation that goes like this, "I have an ear infection. My spouse looked in my ear with our home otoscope and it is red, so I'll need you to call in an antibiotic." In the past few weeks, I've had patients inform me that they need a CT scan ordered or request specific treatment based on a home test of some sort.
I respect my patients. They are experts of their own bodies. I enjoy partnering with patients and shared decision making. What I do not enjoy is having my medical education and clinical judgment bypassed by the patient's own medical summation. Patients are often right about what is going on and I listen carefully to what they think might be causing symptoms. However, even with medical knowledge and clinical experience, I cannot diagnose strep throat over the phone or determine what diagnostic test is the most appropriate for a particular symptom or even if the testing is necessary.
Natasha writes: Exactly, I cannot afford to keep my office running unless the patient turns up in the office to see me.
Rama says: I share the same frustrations! Yes people go to Dr. Google, self-diagnose, and say it is waste of time to come see us to get an antibiotic, as they know what worked for them in the past. Or [they want us to] send a referral to a specialist, as they are convinced only a specialist/procedure/costly diagnostic test will help solve their problem. Reimbursement systems have to change where they compensate for our time and expertise whether the advice, treatment, or recommendation is given over the phone or in-person.
What is your policy when patients ask for over-the-phone consults? Tell us what you think.