Do We REALLY Need Doctors To Do Consultations Via Email?

A few months ago I had some lively back-and-forth blog postings with a doctor who used email and instant messaging (IM) a lot in his practice; here, here and here.
Today my good friend Alec forwarded me another interesting news article (thanks Alec!) about the use of email by doctors; “It’s no LOL: Few US doctors answer e-mails from patients.”

This article points out that, unlike the doctor mentioned in my earlier blog postings I referenced, most doctors do not communicate via email.
The article reports that a recent Pew Internet & American Life Project survey determined less than 1/3 of physicians in the U.S. use email to communicate with patients.

“Doctors have their reasons for not hitting the reply button more often. Some worry it will increase their workload, and most physicians don’t get reimbursed for it by insurance companies. Others fear hackers could compromise patient privacy — even though doctors who do e-mail generally do it through password-protected Web sites.
There are also concerns that patients will send urgent messages that don’t get answered promptly. And any snafu raises the specter of legal liability.
Many patients would like to use e-mail for routine matters such as asking for a prescription refill, getting lab results or scheduling a visit. Doing so, they say, would help avoid phone tag or taking time off work to come in for a minor problem.”

These doctors have valid points and valid concerns. Have you ever visited a doctor’s office and just sat and observed? I did, back when writing my HIPAA book, I went to a doctor’s clinic, and also to a hospital, and the doctors I observed throughout each day were on the go…CONSTANTLY. When they were not treating patients they were writing on charts, filling out massive amounts of paperwork, or looking at lab reports. These folks were on the go all the time, and all the ones I watched ate lunch at their desk while filling out paperwork and looking at reports and lab analysis.
And over the years, whenever I am at the doctor’s office I also see this same constant going and working going on.
And now we expect them to add patient emails to all of this?
The report indicates that studies show there would be fewer office visits and phone calls. I don’t believe it. There may be fewer office visits and phone calls from *the patients who use email*, but there will always be more patients to fill those opened slots. Reach into a pool of water and scoop out a cupped handful of water…do you see a dent left behind? No…there will always be more to displace and erase the space where you took the water. The effect will be the same for patients.
This statement bothers me: “…even though doctors who do e-mail generally do it through password-protected Web sites.”
Folks, depending only upon a password on a website will not safeguard your protected health information (PHI). Unless it is encrypted, in transit and in storage, you PHI is vulnerable. Read my previously mentioned messages to learn how.
The study also goes on to state that, because patients have not yet abused the use of email *much*, that it is a good thing to use.
Well, if more and more patients use email, it will become quite a time consuming task for doctors to answer email. And, based upon how email is already abused (can you say “spam,” “phishing” and “malware”?) I can see this becoming a potentially largely abused option for physicians to give to patients for communications.
Considering how hardworking good doctors are, and how stressful their work is (this week’s Newsweek reports that studies show depression and suicide is higher for physicians than any other profession.), why expect physicians to also answer patient emails when they are away from their work? Give them a break and let them relax when away from the office! They need some decompression time.
Also, saying that doctors using email is not really a different activity from people filing their taxes online, or making online purchases is comparing apples to oranges. Medical consultations via email is not like filing your tax form once a year, or buying a book from an online store.

“Before e-mail can become as routine as a physical, doctors need to be trained to handle confidential patient messages in the digital age, some experts say. That would include learning to file e-mails in patients’ health records and instructing patients in the risks of electronic messaging.”

Indeed! Not only the doctors, but also the patients, need both training and ongoing awareness communications…EFFECTIVE training and awareness!
Now, after all this, I’m not saying that emails cannot be beneficial for healthcare purposes. Emails can be useful, but only if used in a secure, thoughtful manner, for the appropriate purposes, and not as a replacement for in-office visits where a doctor can actually SEE, HEAR, SMELL (yes, that can be important) and FEEL the patient and not just depend upon the written descripion that may appear in an email. It seems the best potential benefits of email would be for support purposes for the doctor, made by someone else in the doctor’s office, and not by the doctor him/herself.
Time will tell where the use of email for medical purposes leads.

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