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February 7, 2023
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David Burda
Consumerism Innovation System Dynamics

Burda on Healthcare: When Healthcare Sends the Wrong Message

A recent story in the New York Times on hospitals and medical practices charging patients a fee when they respond to a patient’s question by email, text or secure portal message raised a lot of eyebrows. Why? It’s because for years, as a patient-engagement tactic, hospitals and medical practices have urged patients to communicate with them electronically. Now that patients are hooked, providers want to charge a fee for what used to be free. Think ATMs.

I raised my eyebrows at the NYT piece because it sounded awfully familiar. Why? Because Benefits Pro ran virtually the same story a month earlier in December. The NYT story actually led with the same Cleveland Clinic anecdote as the Benefits Pro story and mentioned the same big health systems as the Benefits Pro story. As a journalist, I have a thing about reporters ripping off someone else’s story and not giving them credit.

As a patient and as a consumer, I also have a thing about hospitals, doctors and health plans talking down to me. It’s not what they’re saying necessarily but how they’re saying it. I guess that sensitivity comes from hearing, “Watch your tone young man!” repeatedly during my formative years.

All of this leads me (and you) to a message I got on my patient portal from one of the several medical specialists I see on a regular basis for one of my several chronic medical conditions. I presume that the doctor sent the same message to all of their patients, and it’s not directly at me personally.

Below is a message almost exactly like the one I got — the only changes I made were made to take out any identifying information.   


Dear Patient,

The following is a reminder about when to use My(XX) to send messages to your care team.

Please choose only 1 method of contact. If you send a message, do not also call with the same request.

If you need a fast response, we answer messages within 2 business days. We do not read or answer messages outside of business hours, including weekends/holidays.

If you have an urgent need, call the office. Do not send a message. If we are not in the office when you call, ask the call center to send us a message and we will call you back in an appropriate timeframe.

You can send a message to:

  • Provide updates on your condition as requested by your care team
  • Provide pictures or videos if requested by your care team
  • Ask a non-urgent question, such as a clarifying question from a recent visit, or questions about referrals or upcoming appointments

Do not send a message:

  • If you have urgent symptoms, or an urgent worsening of your condition (call the office)
  • If you expect a response faster than 2 business days
  • That includes pictures or videos that were not requested by your care team
  • About an incident you or your proxy family member has experienced (please call the office)

Thank you for taking the time to review this information. We are caring for many patients, and correct use of this service’s messaging will help us better meet your and all of our patients’ needs.


The Medical Group
Hospital, Hospital and Hospital

Should you have any questions or technical concerns for messages please contact our support desk.


The specialist is telling me and all their patients that they will respond to my email when it’s convenient for them and don’t dare call and ask me the same stupid question if you haven’t heard back before I got around to emailing you back. And if you’re really hurting, email or call someone else.

I guarantee that if I looked up the mission, values or vision statements of my hospital-affiliated doctor, I would find the words “patient-centered,” “patient-centric,” patient-focused” or “patients first.”

I mean, I get what the doctor is saying. They don’t have time to answer the same routine question twice because they’re too busy taking care of other patients. But the reason patients are calling with the same routine questions is because the practice isn’t replying to emails when patients — their customers — need an answer. The practice is responding when it’s convenient for
the practice. Certainly not after business hours or on weekends
or holidays.

After business hours or on weekends or holidays are when most people have time to email their doctors and get answers to their routine questions. That’s because they’re typically not working or doing other things. Show me a small business that’s closed on Sundays, and I’ll show you a small business that will go out of business in less than two years. Be open when your customers need or want what you have or sell. It’s not that complicated.

The thing that really got me was the tone. Let me (the practice) tell you how to use your portal. Let me tell you when and how to contact me. Not only will I not answer your email after business hours or on weekends or holidays, I won’t even read them!    

If I talked to someone like that, they’d send me to bed without dinner. Or so I’m told.

Allow me to rewrite the doctor’s message with the customer in mind.


Dear Dave,

Thanks again for being our patient and visiting our practice to help you manage your medical issue. And thanks again for using your convenient portal to interact with us for all your non-urgent medical needs.

Regarding the message feature on your portal, we apologize for not being able to respond to your routine questions in less than 48 hours. If you need an answer to your question faster than that, please call us.

When you do call us, we’ll remember to delete the same email question on your portal to avoid bothering you with the same answer to your question.

Remember, you can always call us with an urgent medical question. And if you are having a medical emergency, it’s always best to visit our emergency department or call 911.

One more reminder, if you’re having technical problems with your portal, it’s best to call our IT support desk. That number is XXX-XXX-XXXX. We’re better at medicine than we are at computers!

Thanks again. Have a great day. And please let us know if you have any questions.


The Medical Group
Hospital, Hospital and Hospital


It’s not Shakespeare, but it gets across the point that the practice values my business as a patient. It’s not telling me they don’t really care if I’m their patient or not. And if you are, don’t bug us.

This pro-customer, pro-consumer, patient-centered, patient-centric, patient-focused and patients-first stuff isn’t that hard. I wonder why it’s so hard for hospitals, doctors and health plans?

It’s time to send the right message. One way or another.

Thanks for reading.

About the Author

David Burda

David Burda began covering healthcare in 1983 and hasn’t stopped since. Dave writes this monthly column “Burda on Healthcare,” contributes weekly blog posts, manages our weekly newsletter 4sight Friday, and hosts our weekly Roundup podcast. Dave believes that healthcare is a business like any other business, and customers — patients — are king. If you do what’s right for patients, good business results will follow.

Dave’s personnel experiences with the healthcare system both as a patient and family caregiver have shaped his point of view. It’s also been shaped by covering the industry for 40 years as a reporter and editor. He worked at Modern Healthcare for 25 years, the last 11 as editor.

Prior to Modern Healthcare, he did stints at the American Medical Record Association (now AHIMA) and the American Hospital Association. After Modern Healthcare, he wrote a monthly column for Twin Cities Business explaining healthcare trends to a business audience, and he developed and executed content marketing plans for leading healthcare corporations as the editorial director for healthcare strategies at MSP Communications.

When he’s not reading and writing about healthcare, Dave spends his time riding the trails of DuPage County, IL, on his bike, tending his vegetable garden and daydreaming about being a lobster fisherman in Maine. He lives in Wheaton, IL, with his lovely wife of 40 years and his three children, none of whom want to be journalists or lobster fishermen.

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