Greetings. I write briefly to inform you I am aware of your Google Review placed nearly a week ago. I’m not upset, but I must say that I am rather surprised by some of the statements. It is germane to the situation when a patient expresses displeasure about his or her experience with our office that we all collectively learn from the experience to improve patient experience in the future. I write this letter to you in that spirit.

Briefly, I was never confused about your residing in two states. You shared that with me several times during our visits and that was well understood. I also never recall confusing you or your wife with any other patient. Before any medication is prescribed, we call or message the patient in MyChart. Most medications are prescribed while reviewing laboratory data and results to prescribe the necessary treatment immediately. Most prescription requests come directly from patients and their pharmacies, and we do our ultimate best to ascertain the need for those medications from both sources. You are indeed correct that wait times may be as long as 30 to 40 minutes, and that is never intentional. Like other organizations nowadays, doctors’ offices are short-staffed, and we also never believe that stellar patient care should be rushed. Some patient visits are quick, and others are longer depending on the individual patient’s needs and medical conditions, so I take no issue with noting that patients may have longer wait times. We apologize if this was not articulated to you as well as it should’ve been. Yet still, we work as hard as we can to be as efficient as possible with pre-charting and preparing intensively for future office visits to ensure that longer wait times are limited as much as possible.

I think the ball was dropped on our behalf with less than effective communication with one or both of you in several circumstances, and for that, I do sincerely apologize. To respond quickly to patients’ calls, questions, or messages throughout the day while tending to the needs of patients in the office, we often ask medical assistants and nursing staff to respond to patients because physicians cannot respond that quickly most of the time. We do not have nurse practitioners in our office. They are LPNs and MAs.

Also, it is easier for us to often message via the MyChart patient portal in our office, and most patients appreciate that and have no issue with it. Others express that they would prefer telephone communication, and we do our best to accommodate within legal and confidentiality bounds. The last time I remember having to communicate with you, it regarded an acute illness you had, and I was told what you were experiencing by nurses and medical assistants. Given your symptoms, I recommended that a physician see you in the state in which you were at the time because what I was told and what was described to me required an in-person evaluation, and you were not here to see me. Not every condition a patient has or experiences can be handled just over the phone or virtually, and we do our very best to educate all patients about that. It is never any physician’s goal to begrudge you the care you need but try to guide you to the appropriate type of setting based on your symptoms. Some things can be handled in the office, some virtually, and some require other forms of care, such as in an emergency department or urgent care facility.

I never flippantly stated that you “need to see a physician in the state where you live.” Those were not my words. Simply prescribing medication over the phone or in response to a patient request is never the answer for any doctor, because we are trained to interview and physically examine the patient, and that is often what we prefer. It is not about money or providing an inconvenience to the patient, but it is about gathering the best assessment of the patient’s condition and what the patient needs at the time. That’s what I remember.

I also operate in a space that provides high-quality, evidence-based health care to my patients with a deep level of compassion. That sometimes means following guidelines and my training as a physician in a way that a patient may not understand or agree with. I will never apologize for that because we are always operating in the patient’s very best interest.

The last thing I wanted to share is that I am a primary care physician. We do like to see patients in the office periodically to examine them and provide them with the preventive and chronic disease care they deserve. We have all had to acclimate to doing things virtually, but it is the physician’s prerogative if they have a level of comfort with that and how often we can do it. Some doctors prefer not to perform care virtually at all. I don’t mind doing it, but it would be preferred over in-office evaluation in certain situations. I understand you reside in two states, but I do not have licenses that permit me to practice in multiple states, and many physicians don’t.

Licenses are very state-specific, and we have certain rules and regulations to follow. Early during the pandemic, much of those regulations were relaxed to permit physicians to see patients virtually and to travel to other states to provide care, but now they have been reinstituted so we are not doing virtual visits as much. I have several patients who travel for work and who reside in other states as well, and they are aware and I was hoping you were, that given certain medical conditions they have and if I am to be their primary care physician, we do request an in-office evaluation from time to time.

I apologize that your perception of your experience with us has been sub-optimal. To do our very best to care for all patients, it is certainly evident we may not please all. It was always my goal to help you in whatever way possible and never to harm, and I thought our patient-physician relationships with you and your wife were good. We understand if we have lost your trust and assurance in our care delivery and respect your decision to ascertain health care for primary care elsewhere for you and your wife. If you have chosen to do so, please let us know, and we will note such in your charts appropriately. It was my pleasure and privilege to serve as your primary care physician during the period you allowed me to do so, and I wish you both nothing but the very best in your quest to ascertain the care you desire. Godspeed.

Earl Stewart, Jr. is an internal medicine physician in Atlanta, Georgia, a 2023 Doximity Digital Health Fellow, and a 2023 Climate and Health Equity Fellow (CHEF) with the Medical Society Consortium on Climate and Health. He can be reached on E.S.J., M.D., LinkedIn, Twitter @EarlStewartJr, and Doximity.

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