Primary-Care Doctors Offer Strategies for Managing Electronic Messages

By Anne Harding

December 31, 2019

NEW YORK (Reuters Health) - Several strategies developed by primary-care practitioners (PCPs) and physician groups for managing electronic messages may help doctors maintain communication with their patients while avoiding burnout, according to a new qualitative study.

"Patients really value electronic communication with their physician. It allows them to build a great relationship and access their physician's offices, but it does actually stress out our physicians, and we definitely need to develop strategies to deal with that so we can offer that convenient, high-quality care to patients without burning out our physicians," Dr. Sameer Asware of The Permanente Medical Group in Oakland, California, told Reuters Health by email.

Dr. Asware and his colleagues interviewed 24 physicians from eight medical centers belonging to The Permanente Medical Group, which includes over 9,000 doctors and is part of Kaiser Permanente Northern California, a health system serving 4 million members. Nine were primary-care chiefs and 15 were PCPs.

All study participants said they worked outside normal hours to manage their electronic messages. Several also felt anxious that an unlimited number of messages could accumulate in their inbox.

Physicians described several self-management strategies: taking action on an email right away rather than putting it away for later, aka "one-touch" system; using "smart phrases" to save keystrokes; "obsessively" clearing their inboxes; multitasking; having a medical assistant help respond to messages; and reminding patients not to email about urgent concerns.

At the group level, approaches included setting aside additional time for physicians to handle emails; having a medical assistant help respond to emails; covering a physician's inbox when he or she is on vacation; and having pharmacists manage refills for physicians.

The average physician gets about 20 patient emails a day, or 80 minutes of time at four minutes per email, Dr. Asware noted. "In Northern California, we manage approximately 22.3 million messages each year (inclusive of all specialties)," he added.

Dr. Asware and his colleagues are now working on pilot programs to help Permanente physicians with electronic message management, with the goal of developing a system-wide approach.

SOURCE: JAMA Network Open, online December 27, 2019.