Because he or she is afraid — afraid of being overwhelmed by one more responsibility, of not being reimbursed for time spent answering emails, of patient privacy, of HIPAA, and of course, of legal liability if they set an expectation of replying to emails in a timely manner and — for technical or other reasons — don’t get to the one that results in a patient’s death or disability.
The Associated Press has the story, It’s no LOL: Few US doctors answer e-mails from patients, and it’s an ironic read:

[Most Americans] want the convenience of e-mail for non-urgent medical issues, but fewer than a third of U.S. doctors use e-mail to communicate with patients, according to recent physician surveys.

“People are able to file their taxes online, buy and sell household goods, and manage their financial accounts,” said Susannah Fox of the Pew Internet & American Life Project. “The health care industry seems to be lagging behind other industries.”

Isn’t it ironic that you can engage in the most sensitive of financial transactions, ranging from filing your taxes, managing your bills and bank accounts, and buying and sellings thousands of dollars worth of stock online. But you can’t email your doc, look at your own medical charts or lab results, or virtually manage anything having to do with your health care. Fidelity can tell me how much money I’ve saved for retirement in two clicks of a mouse. Yet my local doctor/hospital combination can’t give me access to my medical record, lab tests, or billing records.

Are doctors’ fears founded? Well, not via any rational reading of the research:

Most studies have shown patients don’t abuse e-mail. They generally don’t deluge doctors with rambling messages, and Internet exchanges may even help doctors’ productivity and cut down on office visits.

For example, a 2007 University of Pittsburgh study published in the journal Pediatrics followed 121 families who e-mailed their doctors. Researchers found 40 percent of e-mails were sent after business hours and only about 6 percent were urgent. Doctors received on average about one e-mail a day and responded 57 percent faster than by telephone.

The problem is that whenever new technology is introduced, there is a temporary lag before it is completely and wholly embraced. This lag is more pronounced with technology introduced into a specific field or industry. Automobile unions didn’t just one day embrace the use of robotic assemblers in car factories — in fact, they fought long and hard to prevent their use for years. The Web was introduced long before it gained sufficient momentum to host the likes of Facebook. Virtual worlds have existed online since the 1980s, but only now seem to be coming into their own.

Computers have made significant inroads into the health care field in the past decade, especially for doctors’ own use. They’ve already helped reduce prescription and medication errors, and have been invaluable in speeding up imaging and making technology like functional MRI possible.

But some things, like breaking down the doctor-patient communication barriers, are not just a function of technology and technology adoption. There are significant psychological and sociological factors at work here, and only time and a new generation of e-patient-friendly doctors is going to change them wholesale.

Until that time, you’ll just have to get used to your doctor not answering your email.

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