EPtalk by Dr. Jayne 1/12/23

I volunteer with a couple of community organizations. Although I find the work gratifying, it can also be frustrating for those of us who are used to workplaces where time is seen as precious and communication is key.

One of my organizations keeps sending out “friendly reminder” emails telling recipients that “if you haven’t taken care of XYZ yet, please do so, but if you have already done it, disregard this message.” I’ve certainly seen this approach in business situations as well, so those who are guilty should be on notice. For those of us in fast-paced situations who tend to juggle way too many balls, it can be difficult to know if you did it or not – especially if the original request was some time ago. Sending the email only to the people who actually need to take action would be more useful and would avoid wasting other people’s time.

From Jimmy the Greek: “Re: telehealth. Check out this company that will set you up with a video chat with a doctor, and then sell you a bunch of prescription meds to keep on hand  ‘just in case.‘” Duration Health describes itself as “a mission-driven organization with a deep belief in patient autonomy.” Following a consultation, they prepare a customized kit from their list of 60 medications so that you can have the good stuff on hand in the event of trouble in the backcountry, natural disaster, or all civil unrest. They note that their formulary “contains the medications most prescribed at urgent cares for acute, non-emergent conditions, along with a select set of potentially life-saving medications for emergent scenarios where help is limited.” The list includes such favorites as antibiotics, antifungals, antimalarials, steroids, epinephrine, antihistamines, laxatives, altitude sickness treatments, emergency contraception, and anti-nerve gas agents. They focus their sales on those who anticipate traveling outside the US, into the backcountry, to an area at risk for natural disasters, or to a medically underserved area as defined by HRSA. Their OFFGRID promo will net you a hefty discount if you’re interested.

Here’s some good news for those of us who spend a lot of time at our desks. A recent study published in Nature Medicine shows that even short bursts of vigorous activity as part of daily life can help reduce the risk of death. Activities might include climbing stairs, brisk walks during a commute, and more. Participants wore wrist-based accelerometers that helped measure the amount of vigorous intermittent lifestyle physical activity (VILPA). More than 25,000 people aged 40 to 69 years participated in the study and wore the devices more than 16 hours a day for at least three days during a weeklong period. The “nonexerciser” group said they didn’t exercise during leisure time and they didn’t walk more than once weekly for recreation. The researchers compared mortality rates between those nonexercisers who did and did not have spurts of VILPA recorded by their devices. They also looked at data from another 62,000 research subjects who self-reported that they exercised regularly. The subjects’ health outcomes were tracked for approximately seven years.

The study found that even in nonexercisers, having engaged in bursts of vigorous activity was associated with a nearly 50% decrease in mortality from cardiovascular disease. Although the study can’t show causality, it’s hopefully interesting enough to help set a framework for additional investigations. The authors noted some limitations of the study. Only about 6% of people invited to participate actually accepted, so the subjects might not represent the general population. Additionally, some bursts of activity such as carrying something heavy like a shopping bag might not have been accurately captured by wrist-based devices.

It looks like every bit of movement during the day counts, so I’ll keep that in mind when I’m racing to the laundry room to rotate a load of towels in between conference calls or scurrying down the driveway to bring the recycle bin in before one of my neighbors calls the city inspector for leaving it out past dusk.

Of no surprise to anyone: MyChart message volumes decreased at UCSF Health after the organization began billing for them, even though the number of messages that actually generated charges were small. A research letter published in the Journal of the American Medical Association found that although charges occurred about 2% of the time, the overall number of messages declined from 59,648 to 57,925. The authors propose that the decline was likely due to “awareness of the possibility of being billed.” Interestingly, they found no significant changes in the numbers of scheduled visits or unscheduled telephone calls. They note that “future research should investigate overall costs under different payment models and the effect of billing for messaging on outcomes, health equity, and patient and clinician satisfaction.”

In speaking with my peers around the virtual water cooler, it doesn’t seem like patients understand the burdens that primary care physicians are facing including the deluge of messages that has happened since COVID appeared. Patients are unaware that a majority of primary care physicians are taking work home with them and continuing to manage phone messages, insurance preauthorizations, and visit notes well into the evenings. As I coach physicians on trying to make documentation more efficient, I keep hearing themes about not only lack of office staff, but lack of highly qualified staff, which pushes more work onto the physicians.

One physician I spoke with recently has had to perform all patient care tasks in his office, including patient intake (history updates, vital signs, etc.) because his medical assistant is on medical leave and the health system employer claims they can’t find anyone to serve as a temporary replacement. He’s thinking about resigning because he can’t get caught up and other physicians in the practice are unwilling to share their staffing capacity. I know that my former clinical employer still has a percentage of its locations closed because it can’t staff them, so I’m not surprised about any hiring crises I hear about.

Is your organization charging for messages, and how are patients receiving the change? Leave a comment or email me.

Email Dr. Jayne.