So That’s Why Doctors Don’t Use E-Mail

I’ve known several doctors who refused to read e-mail from patients. They said it was simply a bad use of their time.

I also used to have a doctor who hated it whenever you came in and asked questions about some article you’d read in The Times about Lyme disease or some such. He’d get a pained look on his face — here we go again; patients pretending to be doctors — and then ignore the question.

But surely it’s in everyone’s best interest for patients to stay informed, right? For patients to do their own research, to ask lots of questions — especially of their own doctors — and so forth, right? Right?

Wrong. At least that’s what Hai Fang, Nolan H. Miller, John A. Rizzo, and Richard J. Zeckhauser write in a new working paper called “Demanding Customers: Consumerist Patients and Quality of Care.”

From the abstract:

Consumerism arises when patients acquire and use medical information from sources apart from their physicians, such as the Internet and direct-to-patient advertising.

Consumerism has been hailed as a means of improving quality. This need not be the result. Consumerist patients place additional demands on their doctors’ time, thus imposing a negative externality on other patients. … Data from a large national survey of physicians shows that high levels of consumerism are associated with lower perceived quality.


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  1. E Thomas says:

    Lower perceived quality? Whose scale? Doesn’t quality to some extent depend not only on perception of caregiver or patient, but on an objective (albeit undefined) scale?

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  2. Kevin says:

    Informed patients who ask questions are consumerists. Taking up a doctors time is huring other people. Challenging a doctor’s god-like authority lowers the quality of medical care. According to doctors. Shocking.

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  3. Justin Dearing says:

    What about an experts service where you emailed a doctor a question and paid for a response. As a software engineer, I can pay (I believe $250) to call Microsoft, and be guaranteed an answer on any question, or my (bosses) money back.

    Since most people just won’t pay out of pocket like this for health care, maybe they can pay their HMO a yearly fee for the ability to do this as many times as desired.

    I think part of this has to do with doctors not liking to be questioned. I’m sure they don’t like second opinions, except when they are giving the second opinion.

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  4. denis bider says:

    I agree with #1 and #2. On the face of it, this looks like a preposterous, self-serving paper.

    Quote: “Data from a large national survey of physicians shows that high levels of consumerism are associated with lower perceived quality.”

    But *of course* high levels of consumerism will be associated with lower perceived quality. The more you know, the more you see how careless the dang doctors are, and how poorly they do their work.

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  5. Scott W says:

    Like plumbers and computer programmers, there are all kinds of doctors: good ones, bad ones and everything in between. Some are in the profession because they care what they do and others are in it to pay for their new boat (and some of them just aren’t very bright people).

    So, where does that leave a patient/consumer? Just put up with the bad doctors and hope you don’t have to visit them with anything life-threatening? Sorry, I won’t be in that waiting room.

    I don’t ever recall learning that doctors have a monopoly on health-related knowledge-I’m going to learn whatever I can about my health and would be pleased to be corrected by my doctor, the same I’d expect from my cousin the carpenter when I tell him of my ideas to finish my basement (“Well, you can do it that way, but this is why some other way might work better…”).

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  6. Dave G says:

    I’m glad that people will reject this finding wholesale (or I hope they will), because there are tons of anecdotal examples on how dangerous this type of thinking can be.

    My brother went to complain of intense stomach pain to his physician and was sent home with the diagnosis of bad gas. After he talked to a friend about it the friend mentioned that it could be appendicitis like he once had, and suggested he go back. He did, was put through this same condescending treatment by the doctors, until he insisted it be checked out further, where he then found out that his appendix had just burst, which of course made the situation far worse than it need have been.

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  7. MBirchmeier says:

    I’ve talked to my cousin about this in the past who recently (3-5 years) became a physician.

    The problem with this is customers who are convinced they need because they saw the commercial, and think they’ve had the symptoms in the past. With many of these people if they don’t get the drug from the first doctor they’ll often go to another who will give them what they want.

    The problem isn’t with patients who have a diagnosed problem, asking why other options aren’t being considered. Such as a cancer patient looking for info on biopsy vs. chemo.

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  8. Chance says:

    “Data from a large national survey of physicians shows that high levels of consumerism are associated with lower perceived quality.”

    In other words, patients are calling doctors on their B.S. If a doctor doesn’t want to answer reasonable (and even the occasional unreasonable) questions, his or her lack of patience may rightly lead to a lack of patients.

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