There is already an established literature on doctor-patient email, but there is always room for one more journal article, right? Especially one which reveals (to me, for the first time) that the very first phone call was actually a call for emergency medical assistance. Alexander Graham Bell had just spilled battery acid on himself, hence his hurried, “Mr. Watson, come here, I want you.”
The very first email was not so urgent, which is probably as it should be since it’s much less immediate than a phone call.
This Archives of Surgery article’s contribution (again, I wish everyone could read the full text, not just the abstract) is to confirm that “in the setting of a prospective randomized controlled clinical trial, patients encouraged to use email access have significantly increased the level of preoperation interaction, without any reduction in measured satisfaction outcomes” (but no increase either, I might add).
In all, 26 of 100 patients initiated communication with their surgeon. Those who were given the surgeon’s email address were more likely to initiate contact compared to those who were given a standard contact information sheet.
Most of the emails focused on “general” questions (their example: “…if it’s possible to surgically cut out assorted lumps and bumps from the thyroid gland, is it in fact possible to reduce the size of the gland itself?”) but 4 messages contained requests for reassurance and 2 contained “social” questions (their example: “I would like to request if I can be scheduled for operation a little later in the day. As I have 2 young kids who go to school and child care, it will be difficult to organize care for them before 7am.”) The authors point out that many people “open up” when using email and may feel more free to raise issues that are difficult to raise in a face-to-face meeting.
That reminded me of an earlier article published in the Journal of Clinical Oncology (and beautifully summarized by Denise Grady in the New York Times) which found that empathy is a key component of care in cancer treatment. If doctors are not effectively communicating empathy in face-to-face meetings, can email (as well as coaching) help improve care?
I have so much I want to say about this but time is short. Quickie:
Maybe I’m different, but to me my doctor’s AVAILABILITY by email is a clear sign of empathy.
While breaking up my journal into chapters, I consciously created a very short chapter because I wanted to highlight (in the table of contents) a short but defining email from my oncologist, David McDermott at Beth Israel Deaconess in Boston. I’d written him between appointments with a real concern. He responded, I thanked him (knowing his busyness), and he replied “I am happy to field your questions.”
I’m sure it’s a judgment call. My primary, Danny Sands, knows me well enough that when the time came to let me know I had cancer, he knew it would work to discuss it by phone. (And he specifically noted his consideration before proceeding.) I’m certain he wouldn’t do that with many others. And THAT is a clear sign of empathy, too.
If it is used carefully, it sounds as though email could be very helpful. One caveat, though. It is easy for emotional issues to be misinterpreted on email. Empathy may be well expressed if the relationship is already established face to face, but it can be hard to build empathy on email.
I’d like to hear more about how surgeons organize their time, and how they fit email communication into their routine. And I’m wondering how asymmetry is a factor – i.e. the surgeon has a different understanding of the surgical process and a different level of concern. I suspect the potential for miscommunication and misunderstanding is nontrivial. Wondering if the communication would be better handled by a patient liaison than by the surgeon herself?
Thanks for those comments. I have another quote to share that goes to Jon’s point and then a personal story. From the NYT article:
…Cancer patients and oncologists have unique, intense relationships, she said, because the patients are fighting for their lives.
Even so, oncologists sometimes miss signs of distress, particularly if those signs are indirect, she said. For example, a patient may ask how big the tumors are, and the doctor may answer in millimeters — when the patient really wants to know: “Is the cancer getting worse? Am I dying?”…
When I asked a friend who was facing kidney removal if he felt he was getting all the information he needed from the surgeon, he replied, “I didn’t pick him for his communication skills, I picked him because of he’s the very best at this procedure!” This friend also took the route of Web-avoidance — his spouse was the e-caregiver, medical investigator, data gatherer, and listserve monitor.
Jon asked “if the communication would be better handled by a patient liaison than by the surgeon herself?” and Susannah’s friend added “I didn’t pick him for his communication skills, I picked him because of he’s the very best at this procedure!”
I think it depends on the type of surgery. When a family member had to have complex open-heart surgery we looked for a surgeon that was both evidently experienced with the particular procedure (an highly experimental procedure at the time) and was also able to communicate clearly and humanly with the patient and the caregivers. What would happen if, exactly like it happened with this particular surgery, serious unexpected complications happened? As long as everything goes according to plan you don’t need to communicate with the surgeon. That changes completely when the surgery fails and you need to learn what are the remaining possibilities and then communicate with the patient to reach an agreement.
What we didn’t expect were the 30+ visits the surgeon paid to the patient post surgeries to verify personally the patient state. And that is one aspect of the care that could not be transfered to anyone else, IMHO.
These visits were also clearly an integral part of the surgeon work as well as an important personal activity to validate the importance of his work. He deserved every bit of pleasure he could get, since he saved somebody’s life.
I don’t think a physician with poor communication skills or no sense of empathy will achieve that through the use of e-communication. But e-communication can further augment a patient-physician relationship that is already established and strong.
This site is sponsored by The Patient Services Department of The Renal Network, Inc. The Kidney P
The nice thing about email is that it gives you time to compose your thoughts and choose your words so that you can say exactly what you want to. There is a web site one can use http://www.housedoc.us, that provides for private and secure email communications between care givers and patients, that’s also HIPAA compliant, free, and easy to use.