by Robert W. Parker, MD
E-mail seems to be here to stay and is a part of most our patients’ everyday lives.
Patients with e-mail access (58%) want to communicate with their physicians by e-mail(1) but only about 6% have ever used it for that purpose. Physicians, on the other hand, are less enthusiastic, citing that they are already overwhelmed with phone calls.
Exactly what are the concerns that physicians have about e-mail correspondence with patients? Does it reduce phone calls to the office? Just as the telephone has been both a curse and blessing to doctors, so it is with e-mail.
The advantages for physicians are many:
• E-mail is convenient and asynchronous.
• Physicians can reply when they have time.
• Laboratory and imaging results can be communicated quickly, and can be sent by office staff.
• Appointments may be requested and scheduled.
• Referrals can be accomplished by e-mail.
• Compared to phone conversations, e-mail offers a better record of the physician and patient interchange.
• Patients can be referred to educational web sites for more information on their condition.
• E-mail does satisfy patients and can reduce phone calls.
Most physicians are concerned that they will be overwhelmed by e-mail, but that usually is not the case because patients tend to be more succinct and thoughtful in their e-mail requests. However, the body language cues we pick up from personal interviews and the voice cues from phone conversations are lost in an e-mail. As a result, any issue more than a simple transfer of facts should be handled by personal calls or office visits. Emotionally charged issues also should be avoided in e-mail. Additionally, since e-mail is a type of permanent documentation just like a patient chart, take care to steer clear of comments that could be interpreted as inappropriate.
Our faculty practice group at UTHSCSA utilizes an e-mail authorization agreement which both the patient and the physician sign and enter their respective e-mail addresses. The disclaimer establishes that this is protected healthcare information although we cannot guarantee privacy or security of any electronic message. The agreement lists simple instructions for appropriate uses for e-mail messages and advises that very sensitive information should not be sent over the internet.
If you intend to use e-mail to communicate with patients, instruct them to put their full name, medical record number, and possibly their phone number in their e-mail. It also is helpful for the patient to use the category of the transaction in the subject line. Finally, you should configure an automatic reply to confirm receipt of messages and ask your patients to do the same.
Among the advantages for patients are:
• They have time to think about their questions and compose their thoughts.
• They have a written record of the response from their doctor.
• They find it much easier to reach their doctor by e-mail than by telephone.
• They can get test results, request refills, and make appointments.
Patients, who also are concerned about privacy, want a timely response and we should respond within two or three working days. It is a good idea to include an “escalation footer” on your own e-mail stating that if the issue is urgent the patient should call the office or come in.
In spite of these concerns there are many advantages of elec-tronic communications for healthcare providers and patients:
• In a survey of 178 physicians in university-affiliated ambulatory clinics that used e-mail, 55% believed that e-mail saved time compared with telephone calls.
• 3Some healthcare plans are beginning to reimburse for healthcare management by Internet.
• 4The American Medical Association has published guidelines for e-mail correspondence with patients.
Dr. Parker is associate professor in the department of family medicine at UTHSCSA.
1. Couchman GR, et al. International Journal of
Medical Informatics (2005) 74, 21—30
2. Gaster B, Knight CL, DeWitt DE, et al. Physicians’ use of and attitudes toward electronic mail for patient communication. J Gen Intern Med. 2003;18:385-389.
3. American Medical Association (YPS) guidelines for physician-patient electronic communications. 2002 Available at http:// www.ama-assn.org/ama/pub/category/2386.html. Accessed
August 24, 2004.
4. American College of Physicians. The Changing Face of Ambula-tory Medicine—Reimbursing Physicians for Computer-Based Care. Advocacy. 1996-2003. Available at: http://www.acponline.org/ hpp/e-consult.htm. Accessed July 8, 2004.
