Why is someone else answering emails to my doctor? | Expert Opinion

During a recent office visit, a patient posed a question that many others probably think, but don’t ask.

“Doctor, why is it that when I send you a message in the patient portal, it is usually a nurse who answers me?”

I took a moment to consider my reply.

“With the volume of messages that come in, we sometimes have to rely on other members of the care team to convey information. Why do you ask?”

“It’s just that you’re my personal physician,” she emphasized. “I should be able to hear from you when I need to.”

I expressed my trust in our nurses, and reassured her that I do see all of her messages. If an issue required more detailed explanation, I would reach out directly, I told her.

Hearing her concern stirred mixed emotions. The ability to develop long-term relationships with patients I’ve cared for over many years is among the most fulfilling parts of my job. But primary care has evolved.

The days of the solo practitioner managing every task are increasingly rare. These days, we need a well-trained, collaborative team to best meet our patients’ needs.

That model means more care — and more specialists involved in different aspects of a patient’s care, such as nutrition counseling, mental-health care, and medication management. I realized that, from my patient’s perspective, this team-based approach may sometimes seem as if I have simply become less involved in her care.

A collaborative care team allows doctors to combine their skills with primary-care colleagues, nurses, pharmacists, medical assistants, social workers, and other talented professionals in service of patients. It also helps restore work-life balance to a diversifying primary care clinician workforce that now almost equally includes women and men, many of whom are parents of young children.

Team-based care is most successful when our patients understand our goals of working collaboratively. That means explaining to them the special expertise of different members of the team, and the ways in which patients may interact with them or benefit from their skills and counsel.

Patients can also self-advocate and learn about the roles of care team members at your doctor’s office — it’s OK to speak up and ask questions about who that new person on your care team is and what that person’s role will be.

While wholesale reform of primary care delivery and financing are desperately needed in order to improve health equity and ensure access to care in all types of settings, the doctor-patient relationship remains the vital underpinning of clinical excellence.

That relationship is an expansive one, with numerous contributors playing roles both in the exam room and behind the scenes. Trust in care teams — everyone who is a part of them — is the reset we need.

Jeffrey Millstein is an internist and regional medical director for Penn Primary Care.