“I assume you work in a concierge practice,” said the audience questioner, a physician at the American College of Physicians’ 2018 Internal Medicine conference in April. She said it to Dr. Danny Sands, my PCP. We give speeches together—shared keynotes—and we had just finished a teaching session in which we’d role-played two actual appointments in 2007 when I was dying. We’d done a before-and-after, first modeling the usual interaction, then talking about how it could be better, then repeating it the way he and I actually interact.
“Keep in touch,” he said at the end of each visit. And he meant it, because we do.
Dr. Sands is a pioneer, one who saw the future and has helped it become reality. In the 1990s, he co-created one of the first patient portals anywhere, PatientSite, at Beth Israel Deaconess Medical Center. In 1998, he co-authored the very first peer-reviewed journal article on how to do doctor-patient email (yes, twenty years ago!). So when I became his patient in 2002, it wasn’t long before I wrote him a note in the system: “This is so cool! I’m having a very good patient/customer experience.” And he showed that email in our presentation that day.
“I assume you work in a concierge practice,” said the physician in the audience. (A hallmark of concierge practices is that patients and clinicians are said to have unlimited time together.) But no, I go to a regular medical practice, still in that hospital. He's found ways to make it work, including ground rules for me. (More on that in a moment.)
The “keep in touch” approach can show up in surprising ways, and contrary to some fears, it doesn’t need to be a burden. In one incident I was overseas to give a speech on my own, and saw a worrisome rippling on my leg. Had the long flight given me a dreaded blood clot? As a first step, I emailed him. If he hadn’t responded soon, I might have taken further action. As it happens he was able respond, and we soon decided he needed to know more. So you know what we did? I fired up Skype and pointed my webcam at my leg. That certainly wasn’t diagnostic quality imaging, but it was enough: “Yep, find a clinic,” he said. So, far from home and uncertain, I had the confidence—from my own doctor—that action was needed.
More recently I began a new medicine, and we needed to get the dose right—a balance between effectiveness (symptom relief) and cost and side effects. It’s a long story, especially with today’s automated prescription companies, which can be great but can be torture if you have a case that doesn’t fit their scenarios, which mine didn’t. But over the course of a week we got the job done with no more clinic visits, no phone calls, instead with several secure emails in the patient portal. And of course practically speaking, the great thing about email is that each of us sends and receives at our own convenience.
To be sure, I’ve heard horror stories of people abusing the privilege, sending long long emails that take a long time to read and respond to. That’s not what we mean by “keep in touch.” In that 1998 article about email best practices, the rules were so simple they fit on the back of an appointment card. And two of them were, “Don’t use email in emergencies,” and, “Be concise.”
In today’s stressed healthcare world—especially in the US—it can seem increasingly inescapable that both patients and clinicians have limited time and options to have the kind of connection we'd all like to have. Indeed, the pressures can be real. But we shouldn’t limit ourselves to the practice methods that were taught decades ago—technology gives providers new ways to stay connected with their patients, to have the kind of relationship they always imagined when they went into medicine.
Keep in touch.
For more ideas on how to reach out to patients, read "4 Tips for Staying Connected Between Visits."