Ethics Forum: Thoughts on Managing Electronic Communication with Patients

Recent proposals in the U.S. to bill for electronic communication with our patients could be seen as a refreshing but contested attempt to battle burnout rates in the present era. A fee for electronic communications between patients and clinicians also acknowledges the value of the clinician’s time and expertise. But is this ethical?

Discussion

Burnout rates in medicine continue to skyrocket, and many clinicians are leaving our field.^1,2 Numerous experts have postulated causes for these rates of exhaustion, citing long hours, insurance company battles and the ever-encroaching electronic medical record. We don’t aim to solve these problems in our article, but we do acknowledge that the clinician’s electronic inbox does not promote job satisfaction, particularly given the growth in patient use since the beginning of the pandemic.³

In the present milieu, which undoubtedly will be considered an era of technological revolution, we have all, for better or worse, become much more reachable. Telephones have turned into cell phones. Cell phones have turned into computers. From our pockets, these devices continuously call out their siren songs for our attention. Emails, texts, tweets, Facebook—we can all be reached in innumerable ways.

For patients, electronic communication increases access to the healthcare system and can improve their care. This is particularly true for patients facing transportation challenges or burdensome work hours that can limit their ability to attend in-person appointments. Further, in recent years, shortages of clinicians in some specialties have resulted in several months’ wait times for clinic visits. Electronic messaging between patient and clinician can shorten these delays in care.

Adding fees to electronic messaging risks nullifying these advantages for patients with limited means.

A likely point of agreement: Not every inbox message’s urgency is equal. We all appreciate the modern ease with which patients can relay urgent matters to their healthcare clinicians, but given the simplicity of contacting one’s clinician with the stroke of one’s fingers, the reality is that the modern medical inbox is diluted with less critical and more irrelevant requests.

Triage

Ralph Waldo Emerson noted that Napoleon Bonaparte “directed [his diplomat] to leave all letters unopened for three weeks, and then observed with satisfaction how large a part of the correspondence had thus disposed of itself, and no longer required an answer.”⁴ While one would not advocate ignoring patients for three weeks at a time, we can appreciate the underlying parallel to our own communications.