I recommend you all read The Good, the Bad, and the Really Important as it will reinforce why you are either doing DPC or need to do DPC. The author, Dr. Fred Pelzman, continues to struggle with the number of messages he receives as well as the triviality of most of them. It turns out that if you don’t have to pay in the FFS (fee for service) system when emailing your doctor then that is what you will do. I found his internally bargaining hilarious. Here are some examples:

As I’ve said in many ways, this is so very good, but it certainly comes with some challenges, and there may be ways we can make it better. 

I really do think that much of this contact does improve the care of our patients, their engagement in their health, and enhances our ability to provide care beyond the measly short 20 minutes we get to spend with them during the office visit. But it would be helpful if we could figure out a better way to screen these things, to ensure that most of the things that are of little clinical significance get filtered out — get screened, questioned and answered, or redirected before they come to us.

Then there was this from the comment section:

I am a practicing nurse who is just overwhelmed with the volume of portal messages. Ninety percent are unimportant and could be addressed at their next visit. This effectively takes my time away from the truly important work.  There need to be limits placed on the number of characters per message and the number of messages per month.

I knew that patient emails were going to break the FFS system when admins bought into patient portals. It is NOT perfect in DPC but because we have these things in our favor, it works.

• Patients are paying monthly, which includes emails and texting so they are not trying to get things for free.
• With only 600 patients the doctor can handle the questions.
• With more time with each patient during the visit, there are fewer questions emailed by patients.

Direct Primary Care fixes another issue, which is burning out doctors in the Matrix.

Dr. Pelzman will NEVER get it. I wrote about him in 2018 on my other blog. I guess some people just want to suffer.