Earn your doctorate online

The New York Times Science Tuesday is always enjoyable. Today, Anahad O'Connor reports on doctor / patient emails:

Dr. David Ives, a general internist at Beth Israel Deaconess who receives about 30 e-mail messages a day from his patients, said, 'Most physicians are afraid they'll be overwhelmed, but it actually replaces telephone calls for me.'

About a quarter of practicing doctors, surveys show, have communicated with patients through e-mail. But many doctors feel that it means working for free, and some have begun charging for e-mail consultations. In some cases, patients pay a flat rate from $100 to several hundred dollars a year for such services, said Dr. Daniel Z. Sands, an assistant professor of medicine at the Harvard Medical School who also practices at Beth Israel Deaconess.

'I think it's reasonable to assume that if lawyers and accountants charge for time, then physicians should, too,' said Dr. Sands, a co-author of the new journal article.

Someday, when I write about the reimbursement schemes of law vs. medicine, and the pros and cons of concierge ("boutique") medicine, Dr. Sands' quote will be the centerpiece.

Until then, I'll just say that charging for email is probably more of a concern at Boston's Beth Israel than where I did my family medicine rotation (only about 50 miles away). At my site, doctors would give email addresses to the patients who were computer literate, on the web at home, and trustworthy enough not to abuse the arrangement -- a small, small subset of patients. A payment plan was not in the works, as far as I knew.

Furthermore, answering emails seems like an attractive job to delegate to med students (after the content is reviewed by the doctor, naturally). Students would have the opportunity to take their time with the diagnosis, consider the triage, look up potential treatments, check against the hospital formulary, etc. These are skills we have to learn anyway -- and it's a lot more stressful to do when the patient is in front of you, with a full waiting room to boot. Finally, if attending chart notes are any indication, the students would be more likely to write a longer, more thorough workup -- and one the patient could understand.