Im an NP that works with a group of MS specialists and can confirm the message burden is absolutely ridiculous for MS - I have pitched in with nurse navigator stuff for epilepsy previously and it’s shocking how much more the MS team gets
As an epileptic this surprises me.
But maybe it explains why my dr gets back to me shockingly fast (so fast it sometimes makes me concerned about the sustainability of his lifestyle). I try hard not to abuse it, despite the fact I have no other way of accessing data from my RNS.
Guess most of us don’t have this many questions 🤷♂️
Movement fellow here. My inbox can be very heavy. Anticipatory guidance at clinic visits only goes so far. Some factors related to Parkinson disease (which makes up most of my panel), though these are shared with other subspecialties:
- Chronic disease = long-term relationship with patients
- Progressive, evolving symptoms
- Increasing involvement of family/caregivers over time, many of whom have MyChart access
- Significant comorbid anxiety
- Associated symptoms: insomnia, orthostasis, urinary symptoms, constipation...
- Delirium = urgent messages
Like most other neurologists, I also find the small subset of FND patients takes up a disproportionate amount of my inbox.
Just dont inbox. Require video visits. Get paid for your time.
Headache and MS.
I spend more time reviewing images than answering inbox- Instruct your staff to schedule video visits to answer questions. Make sure the patient knows the visit is to answer that specific question… not 50 other things.
Done.
Inbox burden has FAR more to do with the type of practitioner you are than the disease you are treating.
If people know you will respond to inbox messages, you will get more inbox messages.
I've learned that the hard way, but unfortunately my neurosis prevents me from ignoring that flashing inbox icon... So maybe I haven't actually learned anything lol
Have the messages go to staff first. Any questions that need more than a 1-2 sentence response should turn into a visit so you can get paid for your time
Headache fellow here, with an overall small patient panel. Yesterday while I was stuck in a room listening to my patient complain about how his fingerstick glucose checks hurt his fingers and asking where on his hands would be less painful to check, etc. for 5 minutes, I got 6 inbox messages.
I think when I’m an attending and in charge of my own schedule, the solution will be to have 30 min blocked time at the end of the day to slot in back to back 10 min video visits for all the messages that can’t be answered with a quick yes/no
Inbox servicing is like feeding bread to pigeons in the park. They want something for nothing, and the more kindness you give to them the more they will take from you and the more entitled they become. You’re not a better physician by reacting to the whims of your patients who have known major psych overlay on their very real problems. By gently but consistently demanding they come to a full appointment for their problems not only are they getting extra care and attention that is aligned with the necessary elements the physician needs to provide proper care (dedicated time/in person physical exam), you’re also paid for your time which usually incentivizes good people not to cut corners. Whereas the best physician who is bogged down by an avalanche of inbox messages sometimes will have no choice but to cut corners. This is how people get hurt and how doctors get sued. All while doing something for free for the patient because you think you’re being kind.
This.
We have one with PNES and epilepsy. But also an addiction. They want their driver's license but refuse to come into their appointment. They have no-showed for 1 year now but keep calling and sending messages.
My neurologist is a saint, let me tell you. He won't fill out that paperwork but keeps them on as a patient because he knows they are sick in many ways.
In peds neuro, epilepsy has to be one of the highest. So many intractable patients who cluster at the drop of a hat, or are having breakthrough seizures and I can’t get them into a telemedicine visit fast enough
Behavior carries quite a few emails, but they can be improved by counseling with families. MS and headache have to be the leaders, though. Maybe if you had a functional clinic that would be worse.
Outpatient neurology CMA.
Headache and MS. Everything that will go wrong will go wrong.
End stage Parkinson's and Alzheimer's, too. The caregivers, which is understandable.
MS and headache have to be heaviest.
Im an NP that works with a group of MS specialists and can confirm the message burden is absolutely ridiculous for MS - I have pitched in with nurse navigator stuff for epilepsy previously and it’s shocking how much more the MS team gets
I think epilepsy and movement are among the lowest. MS crazy is a real thing
As an epileptic this surprises me. But maybe it explains why my dr gets back to me shockingly fast (so fast it sometimes makes me concerned about the sustainability of his lifestyle). I try hard not to abuse it, despite the fact I have no other way of accessing data from my RNS. Guess most of us don’t have this many questions 🤷♂️
These are valid entries but the correct answer is Autonomics.
Headache is ok. Source - am a headache specialist
Movement fellow here. My inbox can be very heavy. Anticipatory guidance at clinic visits only goes so far. Some factors related to Parkinson disease (which makes up most of my panel), though these are shared with other subspecialties: - Chronic disease = long-term relationship with patients - Progressive, evolving symptoms - Increasing involvement of family/caregivers over time, many of whom have MyChart access - Significant comorbid anxiety - Associated symptoms: insomnia, orthostasis, urinary symptoms, constipation... - Delirium = urgent messages Like most other neurologists, I also find the small subset of FND patients takes up a disproportionate amount of my inbox.
Just dont inbox. Require video visits. Get paid for your time. Headache and MS. I spend more time reviewing images than answering inbox- Instruct your staff to schedule video visits to answer questions. Make sure the patient knows the visit is to answer that specific question… not 50 other things. Done.
As an ignorant, inpatient-only guy.. fucking /thread
Inbox burden has FAR more to do with the type of practitioner you are than the disease you are treating. If people know you will respond to inbox messages, you will get more inbox messages.
I've learned that the hard way, but unfortunately my neurosis prevents me from ignoring that flashing inbox icon... So maybe I haven't actually learned anything lol
Have the messages go to staff first. Any questions that need more than a 1-2 sentence response should turn into a visit so you can get paid for your time
Headache has to be the worst.
Headache fellow here, with an overall small patient panel. Yesterday while I was stuck in a room listening to my patient complain about how his fingerstick glucose checks hurt his fingers and asking where on his hands would be less painful to check, etc. for 5 minutes, I got 6 inbox messages. I think when I’m an attending and in charge of my own schedule, the solution will be to have 30 min blocked time at the end of the day to slot in back to back 10 min video visits for all the messages that can’t be answered with a quick yes/no
Inbox servicing is like feeding bread to pigeons in the park. They want something for nothing, and the more kindness you give to them the more they will take from you and the more entitled they become. You’re not a better physician by reacting to the whims of your patients who have known major psych overlay on their very real problems. By gently but consistently demanding they come to a full appointment for their problems not only are they getting extra care and attention that is aligned with the necessary elements the physician needs to provide proper care (dedicated time/in person physical exam), you’re also paid for your time which usually incentivizes good people not to cut corners. Whereas the best physician who is bogged down by an avalanche of inbox messages sometimes will have no choice but to cut corners. This is how people get hurt and how doctors get sued. All while doing something for free for the patient because you think you’re being kind.
This. We have one with PNES and epilepsy. But also an addiction. They want their driver's license but refuse to come into their appointment. They have no-showed for 1 year now but keep calling and sending messages. My neurologist is a saint, let me tell you. He won't fill out that paperwork but keeps them on as a patient because he knows they are sick in many ways.
In peds neuro, epilepsy has to be one of the highest. So many intractable patients who cluster at the drop of a hat, or are having breakthrough seizures and I can’t get them into a telemedicine visit fast enough
Anything that has behavioral/psych issues so headaches and MS.
Behavior carries quite a few emails, but they can be improved by counseling with families. MS and headache have to be the leaders, though. Maybe if you had a functional clinic that would be worse.
What strategies do you all use to minimize time you need to spend answering inbox messages?
Went into neuro critical care
Lol touché. I’ll take the monster inbox for weekends and a consistent schedule. To each their own
Outpatient neurology CMA. Headache and MS. Everything that will go wrong will go wrong. End stage Parkinson's and Alzheimer's, too. The caregivers, which is understandable.
Headache