PracticalDermatology

It was nice to hear from many of you that working the clock has become a good strategy…I know it definitely worked in Milwaukee, where “Bucks in 6” finally came true and brought us a trophy!

One of my favorite stories was about how a famous dermatologist met a celebrity who gave him his card and said, “Here’s my number, but don’t call me.” Seriously? How does that compute? This denial of access message reminded me in some ways of the demise of speaking on the phone and how the cyber world now controls us, where nothing is sacred or private…except in medicine, where the beloved patient portal is now the medium for how patients communicate with us once they leave the office. Similar to the Sex in the City episode where Carrie was dumped via Post-It Note, nobody wants to talk anymore.

Even before the pandemic and especially during it, the immediate access to food delivery, on-demand programming, and anything that could be bought online created a culture of impatience, disrespect, and eroded etiquette. We can all see it now as we go back to restaurants, to the grocery store, and into airplanes…everyone is first and everything should be available in an instant or people just lose their minds. Nowhere is that more evident than in the patient portal, where now a typed tantrum is almost as entertaining as a live one.

We use a portal for patients to discuss prescriptions, appointments, and therapies as well as to keep information, such as photos, secure as compared to email and texting, which is great when used correctly. This secure method for exchange when speaking on the phone isn’t an option brings a lot of benefits to patient care. Many portals allow for uploading lab results and medical records, which is even better, since the fax machine is now sitting outside next to the Pinto or Gremlin from college that doesn’t start anymore.

The problem arises when the expectations of patients having that much access to an office grows so out of control and they take horrible advantage of the courtesy shown by office staff, or as we are seeing more often, demonstrate how disrespectful they can be in print instead of in person. The customer service model tends to work against our clocks as well as against what is efficient. We often cannot keep up with the patient’s need for immediate replies, nor can we get biopsy or lab results overnight when we ship them out. For many, including us, the biggest issues are prescriptions that get sent out. Even though we tell the patients three times that they should use the samples and wait to get the trade size in the mail, the message never seems to stick. And, of course, giving patients prescriptions in hand so they can get substituted is still our fault, because pharmacists and PBMs should be trusted more than “providers.”

This is on top of the trend that health care systems are now firing physicians because patients are switching away from clinicians who don’t adapt to using portals to be readily available (patientengagementhit.com/news/what-are-the-top-pros-and-cons-of-adopting-patient-portals). I love articles like this where they try to make physicians look like the bad guys for not adapting to trends, while the patients who aren’t sharing in the medical decision making should be given refunds. Even better is now we can spend more time explaining why “lichenified” is not profanity and apologizing for using terms like “neurotic excoriations.” Here I used to think “salve” and “maculopapular” were four-letter words, now we have to really brush up on “Dermspeak” or risk making everything a cut and paste page from Dr. Google’s playbook.

I got a nice email from the Mount Rushmore of “Dialogues of Dermatology”: Dr. Warren Heymann shared with me the frustrations we all relate to with the, “lack of boundaries that has been created by this new system of patient communication.” As a purist and mentor I feel his pain as the connection made by talking face-to-face with patients erodes in favor of immediate turnaround. Do we need to start hiring dedicated portal navigators to replace receptionists? Do we need to have patients sign more waivers so they understand that we cannot beam up their prescriptions or be online at 2am to answer why we described eczema as “impetiginized” when they are clean? Or should all of us “providers” think about what kind of care we are “providing” when we have one more source of contact to answer to? We thought the curbside condyloma text was bad; now we have to be prepared to both give out our number and answer the call.

Special thanks to Jim Del Rosso, DO for the title inspiration and Warren Heymann, MD for the topic—two of my favorite dermatologists on earth.