EPtalk by Dr. Jayne 6/19/25

As a consultant working with care delivery organizations, I see many of them using “access” as some kind of a performance mantra. Whether it’s access to book a visit with a physician in an office or access to the emergency department, there is constant pressure to make sure patients are formally scheduled for some kind of revenue-generating service with the organization.

I was recently part of a discussion with other physicians who were talking about how access is being conflated with value. One example was the push for patients to book a visit with a provider, without giving full consideration to whether the provider had the correct experience and knowledge to actually treat the patient. It doesn’t matter if you get the patient in quickly, but to the wrong office since you’re ultimately going to have to book a second appointment elsewhere to meet their needs.

Another example was the boom in patient portal messages. Patients can reach their physicians quickly, but that’s not helpful when it causes providers to be burned out and creates risk that patients won’t receive the correct treatments because someone is trying to read between the lines of a series of message exchanges to create a diagnosis and treatment plan rather than having a direct conversation with a patient (either in person or via virtual care).

Another physician mentioned secure texting, which creates a staff access problem “where it’s easy to just fling messages out there rather than thinking through what you’re really asking. It seems like people formulated their questions better when they knew they had to make a phone call.” There may have been cocktails involved in this discussion, leading one of my colleagues to ponder the fact that that “patients have access to their notes, but they’re useless when the notes suck.”

We often look at ways to use technology to create more access, but these comments remind us that there might be “good” kinds of access along with those that are less desirable. I’m hoping that someone might read this and think it through the next time they’re in a meeting pushing for increased access. It’s not just about getting bodies through the door, messages to the provider, or notes to the patient. We need to get to a point where greater access is providing greater value and driving patient outcomes. Otherwise, it’s just a buzzword.

From Navy Fan: “Re: remote work. I’ve enjoyed being a remote worker for 15 years now and I hate seeing people mess it up for the rest of us. Did you see the story about Sentara Health, where remote workers accessed patient information using false identities?” I hadn’t seen it before a reader highlighted it, which reminds me how much we appreciate our readers when they bring us a good story. Apparently, the system hired remote workers to manage lab requisitions, but eventually discovered that they were not based in the US and may have been misrepresenting their identities. The situation impacted patients who had lab tests performed between January and April of this year. The bad actors had access to plenty of protected health information, including names, dates of birth, and Social Security numbers. A manager became concerned in early April when they noticed that the workers attending virtual department meetings did not match the photos that were submitted during hiring. Sentara Health is offering free credit monitoring and identity protection services.

I wanted to add my two cents to some of Mr. H’s comments earlier this week about virtual care prescribing of ADHD medications. He mentioned a study done at Massachusetts General Hospital that showed that at least with their virtual care model, there was not an increased risk of addiction in patients receiving stimulant medications. Mr. H noted that the findings don’t necessarily apply to freestanding telehealth companies that have been accused of cranking out prescriptions, especially those that are investor-backed startups where clinicians are paid on a per-visit basis.

Although I haven’t treated ADHD via telehealth, I’ve worked for several different freestanding telehealth companies and the pressure to prescribe is real. Large percentages of providers working for some of the big firms are 1099 contractors and some of them are trying to complete visits every three or four minutes, which means they’re not doing a detailed visit with the patient. Some of the companies are focused on patient satisfaction metrics, which means that if you don’t give the patients exactly what they request, you’re going to receive scrutiny due to your perceived poor performance. Some in-person organizations are hype- focused on the same metrics and place similar pressure on their physicians, but the risk is much lower with in-person care because you can do an actual examination and can leverage your care team to ensure you have a more comprehensive history from the patient.

Bad news for those of us that like a good nap: a recent research article showed that certain kinds of daytime napping are tied to an increased risk of death in middle- to older-aged adults. The study looked at 86,000 non-shift workers. Those who took longer naps, had high variability in the duration of their naps, and who took more naps around noon or early afternoon were those most impacted. One of the takeaways from the study is that physicians should be asking not only about sleep habits, but specifically about daytime napping. Given all the other data-driven recommendations, I don’t see this one being added to the formal recommendation set anytime soon.

My best time for napping is around 3 or 4 p.m. when my energy is fading and I just need a break. Conference calls during those times are the worst, but sometimes they’re unavoidable for me since I work in all of the US time zones. Based on the data, I should be able to mitigate my risk somewhat by taking consistent short naps in the late afternoon. That seems like a much more enjoyable option than some of the other things I can do to reduce my risk of all-cause mortality, especially since I’m already doing most of them.

What’s your favorite time and place for a nap? Do you like a hammock on the beach, or are you one of the folks I spotted catching a few winks on a park bench after leaving the local winery? Leave a comment or email me.

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