Patient Manifesto: Communication and Accessibility

This is the second post in my Patient Manifesto series. In my first post I tried to outline some broad categories of things patients want and expect from their doctor. One comment addressed two points that I didn’t focus much on but that in hindsight should not have escaped me — communication and accessibility.

For communication, the issue that was brought up was how important it is for your doctor to communicate effectively with you. Many doctors do not speak English as a first language and thus language or even culture may be a barrier to good medical care. When it comes to women’s health this may be even more important as some cultures do not respect women’s rights as we do in the United States. Thus my follow up question is this:

Does it matter to you whether your doctor spoke English as a first language? How important is it to you that your doctor speaks good English even if you can still understand him/her?

The second issue is about accessibility. In my post, I stated that seeing a doctor within 2 or 3 weeks was probably adequate for me. However, as correctly pointed out in the comment, when there is an urgent matter, I would probably want to be seen within 24 hours. I didn’t really think about the phone accessibility issue as I know that most doctors are not very accessible by phone and they typically do not have the time to speak to patients on the phone. Most often patients are directed to a nurse to triage the situation and then pass messages along.

Interestingly, one health system that I am aware of allows patients to securely email doctors through an in-house messaging system that does not violate any privacy laws. So my question is this:

Do you want to be able to communicate and access your physician via email? If this were only available for a fee, would you still do it?

I ask this because I also know of another health system that allows this but charges patients if their problem is solved via email. In speaking to doctors that have used this system, some feel that it is difficult to keep up with emails as patients tend to prefer to email questions rather than come to the office for a office visit. This burdens the doctor with a lot of email. On the other hand, it saves time and money for the patient. However, the doctor faces a difficult task of determining which issues warrant an office visit and which don’t. One clear potential red flag is that doctors cannot diagnose disease without examining a patient. Given that email can be a legal communication, I don’t see doctors embracing it too much, unless they are only emailing back to tell the patient to come in for an office visit.

What do you think?