Are we all just stupid?

I might be the only doctor ever to ask, Are we all just stupid? I ask this question despite the fact that I realize physicians are well educated and knowledgeable. And I ask this question despite the fact that my wife is a doctor, both my parents are doctors, and both my brothers and both my brothers-in-law are doctors. Yet in one area of our profession, medical practice is so pervasively backward and irrational that I must ask, Are we all just stupid?

I believe we are way behind the times with regard to the way we render professional services by telephone, fax, email, and telemedicine. The problem is not a lack of electronic devices; the technical innovations available to provide such services multiply daily. And the telephone was invented more than a century ago, for Pete's sake.

The problem is that we physicians routinely give away electronic medical services for free. We rarely stop to think that the advice we provide to patients electronically requires our time, effort, knowledge, and judgment and that it exposes us to stress and liability. RBRVS should have taught us that we ought to be paid more for our cognitive evaluation and management services. Why is it that we value and charge only for those services that we render inside the four walls of an exam room, a consultation room, or a hospital room? We need to join the e-commerce revolution. We need the will to start charging for all the services we render, regardless of where and how we do so.

Other professionals charge

Our professional brethren in fields such as law and accounting learned long ago that it is only common sense to charge for all services rendered, regardless of whether they meet face to face with a client. I sometimes wonder if lawyers and accountants think physicians are economically foolish in this regard. Is it any wonder that physicians are in financial distress--with clinic closures, reorganizations, and even bankruptcies becoming commonplace--when we give our professional services away?

I believe that charging for electronic services would not only reward physicians and our staffs for genuine work done, but that it is in the best interest of rational patient care. We would not be as inclined to make a patient come to the office for every service. We and our staffs could make ourselves more available to patients, when medically appropriate, by phone, fax, e-mail, and telemedicine without harming our practices economically. In fact, charging for these services would help us bear the costs (for hardware, software, modem lines, etc.) of becoming more electronically connected with our patients. Physicians might even "take call" more conscientiously if we were paid for electronic services.

Four-step program

To start the ball rolling, we can initiate such a change in our practice patterns in four steps:

Step 1. The next time you get an infuriating call from a patient--for example, an after-hours call from someone whose problem can be easily handled during office hours or from someone who insists on telephone or fax service when you recommend an office visit--send that patient a bill. Doing so would begin to communicate to patients that physicians can and should bill for electronic services. As we educate ourselves and our patients about this, we can make billing for electronic services more and more routine.

Step 2. Mail a letter to your local, state, and national medical associations and request that each of them issue a policy statement to its membership and to the public stating that it is proper, fair, and ethical to bill for services provided electronically. This would help get us over the psychological hump and past the old-fuddy-duddy resistance to charging for these services.

Step 3. Request that the leaders of our medical organizations insist that insurance companies delete from contracts all language that makes charges for electronically provided services contractually disallowable. Realistically, it is too much of a leap to think that third-party payers will agree to start reimbursing us for these services at the outset. But charging for these services should not be contractually forbidden. Striking this language would give us the discretion to bill patients directly if we so wish.

Step 4. Request that our medical organizations pursue a policy of incorporating payment for electronic services into all future third-party insurance contracts, including those with the government.

I hope you will do more than just nod and agree with me that there is an injustice here. I challenge all of us to help put a stop to it. I know we can. Because I know we're not just stupid.

From East Side Ear, Nose, and Throat, Redmond, wash.