RE: Virtual Office Visits

March 17, 2006

I prefer to avoid

conflict too, but if it comes to that I simply say, in a calm, quiet,

respectful tone: “You should

choose a doctor whose services you value enough to pay for them. I will have your records ready to send

to whomever you choose. Good-bye.” No further conflict.

Annie

Re:

Virtual Office Visits

OK, see

here is my problem, I am the queen of avoiding conflict. I now have this

practice model so I can do everything myself (I do have one staff person) and I

really like to just answer the phone and take care of things right then. The

vast majority of the time these things are really easily taken care of by me in

a few minutes. Its just those pain in the rear (probably axis 2 people

according to my husband) who know how to push all my buttons and don't want to

come in. I still make them come in and I don't call their meds in, but I don't

like it, it makes me uncomfortable to have these arguments or near arguments

with these people I am really just trying to help. One lady actually said

to me " cha ching, cha ching, there goes the copay cash register " .

All because I wouldn't call in her antibiotic for otitis. I feel like I have

told my patients I'm starting this new practice because my relationship with

them means something and I want to provide a level of care that is less hassle

for them and more fulfilling for us both. Most of my patients hated the

whole " leave a message " with the nurse thing. Now I feel like I need

a person to run defense for some of these patients. I probably just need to get

a grip.

March 17, 2006

I've used VOV with RelayHealth (called WebVisits) but never pushed the

option and only a few patients tried it. I do think a doctor can

integrate VOV well into a practice if done carefully. seems to

have done that nicely.

But for me, I've chosen to not charge for the visits. Rather, I use it as

a triage method. When I get one, I understand it to mean the patient is

very worried about something. Most of the time I am able to reasure (ie-

known problem already being addressed, or new subtle related issue that is

not serious), book an appt ( " you are right, that's important, let's get

you in here to take care of that " ) or I get an appropriate test if the

problem is already being followed (example - yesterday, VOV from patient I

saw last week, belly pain has changed... that triggered next step of eval

that I'd planned and he's getting an ultrasound, then will follow up).

But I personally don't like to use the VOV for new issues or to really

" provide care " . I see it as another option for a patient to communicate

safely -- sometimes the anonimity of the web/email allows for additional

comments that need to be said, but may not once a person is face-to-face.

I believe VOV is a tool that can be used well or can cause problems, but

it's not a true replacement for an appt.

In the end, nothing can replace a relationship and face-to-face time for

patient and doctor.

Tim

> -

>

> Do NOT keep patients who are disrespectful to you. I totally agree

> with !!

> Take care of yourself first. The rest will follow.

>

> Pamela

> Pamela Wible, MD

> Family & Community Medicine, LLC

> 3575 st. #220

> Eugene, OR 97405

>

> roxywible@...

>

>> ,

>> Unless you're really desperate for patients, why would you want to

>> keep patients like this? What's worse, they're probably the ones who

>> will be most likely to sue you if something goes wrong. I've learned

>> that even with this open access, high touch practice model, there

>> are some patients who are not going to be happy. If it's either make

>> them happy, or make me happy, I think I'd rather make me happy and

>> select for patients who appreciate what we're giving them.

>>

>> Seto

>> South Pasadena, CA

>>

>>> OK, see here is my problem, I am the queen of avoiding conflict. I

>>> now have this practice model so I can do everything myself (I do

>>> have one staff person) and I really like to just answer the phone

>>> and take care of things right then. The vast majority of the time

>>> these things are really easily taken care of by me in a few

>>> minutes. Its just those pain in the rear (probably axis 2 people

>>> according to my husband) who know how to push all my buttons and

>>> don't want to come in. I still make them come in and I don't call

>>> their meds in, but I don't like it, it makes me uncomfortable to

>>> have these arguments or near arguments with these people I am

>>> really just trying to help. One lady actually said to me " cha

>>> ching, cha ching, there goes the copay cash register " . All

>>> because I wouldn't call in her antibiotic for otitis. I feel like I

>>> have told my patients I'm starting this new practice because my

>>> relationship with them means something and I want to provide a

>>> level of care that is less hassle for them and more fulfilling for

>>> us both. Most of my patients hated the whole " leave a message "

>>> with the nurse thing. Now I feel like I need a person to run

>>> defense for some of these patients. I probably just need to get a

>>> grip.

>>>

March 17, 2006