An inboxologist relieves this clinician's stress, and his patients' too

When visiting a Starbucks near my office one morning last week, I was surprised to find myself the only customer in the store. All of the employees were scurrying around filling orders. Despite being first in line, it took a few minutes for someone to even notice I was there. It turns out they were filling online orders for people to stop by and pick up later. Waiting alone at the front counter, I felt like a much lower priority than their virtual customers.

Something similar is happening in primary care, and it is called the patient portal or inbox. This is the space in the electronic health record where all of our “online orders” go — prescription refill requests, patient messages, test results to review, and more. The patient portal has become patients’ preferred way to reach out to their medical practices, as it does not require that you stay in one place, or wait on hold for a reply. A steady stream of these messages throughout the day often compete with my attention to patients seeking care in-person in the exam room.

Patient portals emerged when health systems widely adopted electronic health records in the early 2000s. What started as an efficient alternative to telephoning the office has since grown to be a significant platform for delivering care. Many doctors feel managing their inboxes has become like a second, full-time practice that runs in parallel to real-time office care. The burgeoning popularity especially challenges underresourced primary care practices, since insurers generally do not pay for care delivered via patient portals.

I’ve been relieved to see one solution gaining ground: Inboxologists, or clinicians who help manage patient portal tasks for busy primary care clinicians, are a welcome addition to practices like ours that have deployed them. They are not just relieving clinician burden. Patients are also benefiting from them in a way you may not have considered.

When I am less inundated with patient portal tasks, I can be more focused on the patients in front of me. To achieve this goal, I have one important ask of patients — that you are willing to accept an occasional answer to your portal message from a clinician other than your regular doctor or clinician. Certain messages will always require your own primary care clinician to weigh in on and respond to. But many others — like questions about how to interpret test results — can be addressed by other members of the practice group.

Inboxologists are part of the care team of clinicians and staff who combine their skills to provide thorough and timely care. Collectively, care teams can perform far better than the sum of its individual members alone. What may seem like a tradeoff can actually be win-win for patients and providers.

I have yet to see inbox distraction reach the levels of frustration that I experienced in Starbucks, but it can create a challenge for me to remain fully present in the exam room. Every patient who comes to the office deserves to have their doctor’s attention focused as exclusively as possible on them. I think any innovation, like inboxology, that helps achieve that is worth a try.

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