By SUMATHI REDDY, Wall Street Journal, March 25, 2013
Patients love it. Physicians find it often saves them time and money. So why aren’t more doctors burning up the email lines with their patients?
The questions come at all hours, popping up on Dr. Mark Seigel’s personal email account: Can I dye my hair? Is it safe to drink red raspberry leaf tea? When will the nausea stop?
Dr. Seigel, an OB-GYN with offices in the Maryland suburbs of Washington, D.C., answers them all.
“There are some patients, who are kind of like frequent fliers,” he said. “I might get 20 emails from the same person. I know…they have fears and I’m mindful of that.”
Most doctors don’t agree with Dr. Seigel’s approach. As the rest of the world has raced ahead with instant communication, medicine still lags far behind. Just under one-third of doctors reported emailing with patients in 2012, up from 27% five years earlier, according to annual studies of more than 3,000 doctors conducted by Manhattan Research, a health-care market-research firm. Those texting rose from 12% in 2010 to 18% in 2012.
And just 5.5% of 30,000-plus Americans included in a National Health Interview Survey said they communicated with a health-care provider by email in 2011, up slightly from 4.6% in 2009.
Doctors who shun email cite concerns ranging from privacy and security issues to liability, inconvenience and the risk of miscommunication of important medical information. Some also say the time spent emailing with patients is time unpaid. Few doctors charge for the service.
Groups like the American Academy of Pediatrics’ Section on Telehealth Care are working on developing initial guidelines on how to deal with electronic communication, said Peter Dehnel, a Minneapolis-based pediatrician who is chairman of the group. Guidelines will address issues such as patient privacy and medical safety.
Those who do email say it is a convenient way to communicate with patients without the hassle of playing phone tag, and that it can keep patients from relying on Google searches that can sometimes lead to inaccurate information.
Patients generally love the access. Kira Bricker, currently pregnant with her second child, says she emails Dr. Seigel whenever she has a question. The first time was on Labor Day a few years ago when, at seven weeks pregnant, she had begun bleeding. Dr. Seigel responded in eight minutes.
“The ability to contact your doctor and receive a response in a timely manner provides peace of mind,” said the 38-year-old psychologist from Silver Spring, Md., “especially during a pregnancy when circumstances may change at a moment’s notice and you don’t know if there is a problem.”
Some doctors like Dr. Seigel hand out a business card with their email to every patient, but others say they only give it when asked. Most doctors also lay out ground rules. Dr. Seigel tells patients they can email him for any routine questions, but to call if it is an emergency.
The biggest benefit, he said, is the good will it generates: “It improves the reputation of my practice. I get very good ratings online.”
Jocelyn Bonneau of Manhattan generally asks her doctors up front if they give out an email address. The barriers to actually speaking with a doctor “can be frustrating,” said the 28-year-old financial analyst, who said she sometimes will “just give up and Google [my symptom] or just say, ‘I’ll get better,’ and that’s probably not the best way.” Being able to email with a doctor, like her endocrinologist Andrew Martorella, makes a world of difference, she said.
Dr. Martorella said his patients email him to get blood-test results, refill prescriptions or to say they’re running late. He estimates he gets up to 40 or 50 a day, which can take a few hours to respond to. Without email, he said he would probably need at least one extra person on staff to field patient phone calls: “I think it is definitely made a big change in terms of reducing costs, especially for solo practitioners.”
Dr. Martorella ends new-patient visits by asking if they’d like to communicate via email. If so, he asks them to sign a form agreeing to electronically communicate about health matters and giving him authority to discuss medical issues over email. The form, he said, ensures that he’s in compliance with the federal Health Insurance Portability and Accountability Act, commonly referred to as HIPAA, designed to protect the privacy of health information. HIPAA compliance is the main concern raised by doctors who don’t email.
The law requires that electronic communication related to an individual’s health is protected and secure, said Jane Thorpe, an associate professor of health policy at George Washington University. If someone communicates protected health information electronically through a phone or other mobile device, Ms. Thorpe said, “it needs to be in a secure system,” such as one that encrypts messages or through a secure portal. Personal email such as Gmail, she said, is “absolutely problematic.”
Andrew Adesman, chief of developmental pediatrics at Steven & Alexandra Cohen Children’s Medical Center of New York in New Hyde Park, N.Y., said he has access to encrypted email through the hospital, but avoids it in favor of a phone call or office visit, which he sees as a better forum for dealing with the volley of medical questions and clarifications. “Often times brevity has the potential to compromise clarity,” he said.
As part of the federal government’s stimulus act, physicians are being encouraged through financial incentives to use electronic medical records. One part of that effort includes the use of secure messaging to share health information with patients through, say, an online portal.
David Voran, a family practitioner in Platte City, Mo., used to email patients directly until his clinic system, Heartland Health, created a portal system about five years ago, which he said his office “aggressively” uses. The access it provides, he said, “is a huge comfort to a lot of my patients, especially those that travel a lot.”
Kansas City, Mo., pediatrician Natasha Burgert said her practice has a portal, but most parents prefer to email or text. She even texts with her adolescent patients. “It allows me to guide their health more directly” and avoid unnecessary office visits, she said. “It also gives me the advantage of directing their Internet searches.”
Some doctors, of course, do occasionally get bombarded by messages from problematic patients, or end up on an unwanted mass-email list. Debra Jaliman, a dermatologist in Manhattan, finds it particularly frustrating when patients email her on a weekend for a cosmetic prescription. She said the funniest email request she ever got was to call in a prescription to the pharmacy and arrange for a taxi to transport the meds to the Fire Island ferry. She said she wrote back: “I’ll call in the prescription, arrange your own ferry.”
She no longer sees the patient.
A version of this article appeared March 26, 2013, on page D1 in the U.S. edition of The Wall Street Journal, with the headline: When Email Is Part of the Doctor’s Treatment.
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