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.
All of the discussion of technology, privacy, time constraints, liability and sociological trends is missing the real issue: doctors can’t afford to provide uncompensated services.
Insurance payments are tied to services provided in the office, face-to-face. Anything else is free. Why should a highly trained professional with big overhead expenses runnning a small business give away his/her expertise?
Those doctors who do it generally are going to be salaried employees of university hospitals (e.g. Beth Israel Deaconess in the article) who have no overhead and get paid regardless of how many patients they see, staff model HMOs (which have an incentive to reduce, not increase patient visits) and “boutique” providers who charge patients an annual fee to cover these uncompensated services.
> you’ll just have to get used to your doctor not answering your email.
Oh, posh. :) Some bloggers will stop at nothing to get me to curse, but it won’t work this time.
Fellow patients out there – THINK: you do have a choice. My primary, my oncologist, my orthopedist, my urologist – all reply to my emails. (They’re all at Beth Israel Deaconess Medical Center in Boston, but that’s not the only place that’s like that.)
Three of the four use PatientSite, the hospital’s secure email system (sort of like using email on your bank’s web site). But even without that, it’s really wonderful to get this form of support.
Your doctor may appreciate knowing there are precedents and well established guidelines:
Print, snip & save. :)
YOU DO HAVE EVERY RIGHT TO REQUEST THAT YOUR DOCTOR COMMUNICATE IN A WAY THAT WORKS FOR YOU. And if they decline, you have a right (if you wish) to find a doctor who will. Just ask. Some do, some don’t.
p.s. Please also be aware of the Patient-Centered Primary Care Collaborative, which, among other things, is working to let doctors *be* paid for time spent in communication, both by email and phone. PCPCC appears to be a very good group, fighting for changes to let doctors actually spend time taking care of you.
Really now. Shall the doctors also be tied down to computers? My spouse is constantly paged all hours of the day and night and answers calls promptly. There is NO reimbursement for these calls, unlike the fees attorneys charge for calls. If you wish for your doctor to be on her/his toes, then allow them to also take a bit of a rest. A phone call is enough, without having to be concerned with responding to emails. Further, whatever is promised about online “confidentiality,” most are aware of the frequent breaches. I would not want my family’s medical information hacked into, or printed out by a doctor’s office employee for whatever purpose. Yes, it DOES happen. Technology is good; however, NOT in every area of life.
I’m a family medicine resident who MUCH prefers email to phone for non-urgent issues. I even started a blog as another means of communicating with patients.
I harbor the suspicion that many doctors don’t want to use email because they type slowly! But I agree with the article – it’s only a matter of time ’till email is the norm.
I have two reasons why I prefer to communicate with patients via email rather than telephone:
1) It is more efficient. Both patients and I have complicated schedules and it is frustrating to play phone-tag.
2) It is a competitive market place and I feel that by providing better service (communication), I can compete better.
It certainly isn’t for everyone. But I feel it is the direction we are heading. Particularly with the convergence of the phone/text/email/PDA/beeper.
I’m compiling a list of articles on this topic (here’s the post that hooked me in anew).
I’m interested in medical journal articles (which I suspect will be the most influential among health professionals) as well as popular press accounts (like this AP story, which reach the rest of us). You can email me at sfox(at)pewinternet(dot)org.
It is very interesting to see that the MDs writing in support of email exchanges are clearly adopters of social networking technology, writing very active – and very interesting- blogs.
Inversely, the MDs against the use of email with patients do not seem to have understood that, in the world we are all developing together, medical knowledge is a network (one of the principle of participatory medicine).
Soon we will start real large scale implementations of PHR. When this happens only the doctors who have developed or transformed their practice to actively use email communication (or other forms of secure electronic communications) with their patients will be competitive!
No one has mentioned the other side of “E” mailing your doctor. By calling the office the doctor can take the phone if he-she is able to according to time constraints–get the problem solved, or ask that the patient come into the office, and pass the phone to the assistant to make an appointment. If a doctor gets an “E” mail from a patient who may have a crush on them, where does the “E” mail stop?
You are kidding about the whole “crush” thing, right? You think a doctor’s refusal to use an efficient, easy to use and ordinary form of communication that would actually cut down on work for the entire staff because someone might have a crush is logical? Is there any common sense left on this planet?
One reason that physicians won’t send answers by e-mail is because they look upon everything as a risk for a lawsuit. Change the malpractice climate in our country and physicians will do a lot of things that will simplify communication and many others that will help to keep the cost of medical care down.
Hi, I’m a current senior high school student, and I’m doing a research on Universal Health Care. I would like to take just a few minutes out of your free time to ask you a couple of questions. Please reply as soon as possible to my e-mail below.
Thank-You,
Do you personally agree or disagree with consumer-direct health care reform?
Would consumer-direct insurance allow the people to buy insurance from other insurances?
80% of health costs contribute to preventable diseases, why doesn’t the government focus on preventing diseases instead of cures? (In your opinion)
Should health care be a basic right?
Is health care something the U.S. should be focused on?
Why do most doctors change their work field? Does med school factor into the shortage of doctors we have?
I think that the best way with a doctor is telephone not email. Even I do not understand people who contact their doctors via email.
Many physicians are answering emails, but using http://www.housedoc.us, a free on-line service. That’s mosty because HIPAA regulations prohibit them from using ordinary unencripted email. Also, the site lets them charge a small fee, so as not to abuse the service.
From Medscape Family Medicine
Physicians Are Talking About…
Physicians Are Talking About: Email Communications With Patients
Posted 12/02/2008
Nancy R. Terry
Author Information
Advances in communications technology have altered the way that people interact with one another, both globally and within the same household. It has also affected the way that physicians communicate with their patients. Recent postings on Medscape’s Physician Connect (MPC), a physician-only discussion board, address the issues involved in email communications between physicians and their patients.
“How many times have you played phone tag with patients?” asks a doctor in family medicine. “Email gets the patient’s concern and your reply across without having to rely on timing.”
“I use it to communicate with family members of my patients in the ICU,” offers a New York neurologist. “Dealing with patients by email can save headache if you have a difficult personality,” says another MPC member.
Gerald W. Staton, Jr., MD, Professor of Medicine at Emory University School of Medicine, said in an interview with Medscape, “I communicate all the time by email with patients who want to communicate that way. They don’t have any trouble getting my email address from the Emory Web site, and if they initiate the email, I respond.” Dr. Staton admits that his institution has a problematic phone system, which makes emailing the easier form of communication. “I have had one or two patients who abused email communication, but most have been very appropriate. So, bottom line, I like communicating by email with patients.”
Some MPC members see few advantages to emailing patients: “Communicating by email with patients sounds attractive, but is easily prone to abuse.”
“Keeping up with your emails in a timely way is not any less demanding than keeping up with phone messages, which you will continue to get also,” says one harried MPC community member. A New York department head at a major teaching institution agrees. “I get about 200 emails per day, and I’m not looking for more.” However, he adds, “When patients live in other countries, it is often the only practical way to communicate.”
Apart from the necessity of responding to an increased volume of emails, the harried MPC poster considers emailing patients to be a medicolegal minefield. “These emails are discoverable, even when they haven’t been formerly incorporated into the medical record. They are also never truly confidential, because copies of them exist on every server that handles them.” The New York department head points out that his institution discourages emails concerning patient care because emails are not confidential (for example, a patient’s employer can access the physician’s email) and, therefore, not HIPPA compliant.
One method to eliminate the problem of confidentiality, says one MPC physician, may be to use email services such as http://www.housedoc.us, which are encrypted and HIPPA compliant.
A critical care physician is concerned about the potential of emails to be used by litigious patients. “Every email you send is saved for posterity and can be manipulated for future lawsuits.” Another member has even stronger reservations about emailing patients. “I am computer savvy, yet I do not use emails to communicate with patients — no, no, no. Until people stop suing, no medical email communications for me!”
For some, the specter of malpractice lawsuits seems no more a threat with email than with other forms of communication. “It’s actually no different than any communication,” says an MPC physician. “We are now legally required to maintain a written record for each interaction, whether in or out of the office. Otherwise, you can’t prove what was said if challenged.”
Dr. Staton is not particularly concerned about email communications being used in malpractice lawsuits. “I just refuse to worry about the lawsuit issues. My word is my word, whether I speak it or write it; I figure I should stick by what I say.”
To reduce the potential for patient abuse of email, one MPC contributor advises, “Make it clear that the medium is not for emergency use and you will charge for the service (no insurance). They’ll think twice about using it.”
I wanted to comment and thank the author, good stuff
The truth is ever since I came down with a woman’s disease “Hashimoto’s” I have come to realize how patients are under and mistreated by their doctors.
The Doctors’ unwillingness to use email is symtomatic of their crass and uncaring attitude. I can’t reach my doctor on Wednesdays and anytime after 3:30.
Plus I can’t shoot her an E-mail.
And they took an OATH?????
Despicable!!!!!!!
They have isolated themselves.
Doctors and patients are feel increasingly isolated and suspicious of each other. As you say, patients feel that doctors are crass and unfeeling, while doctors feel that patients expect them to provide their services for free, without caring that at the end of the day they have to pay their bills. Regarding emails, a doctor can spend the entire day responding to patients without being reimbursed a cent. This is largely driven by insurance provider, which is addition to spending less money, are able to erode physician authority so that there is no one to talk back. Sensitivity on both sides is required. For these reasons, we launched http://www.housedoc.us, which enables patients to communicate with their doctor by email. Routine communications are free, while doctors can be reimbursed for more elaborate consultations. That way everyone wins and can feel cared for and appreciated.
C’mon Dr. House Doc
I am not asking for a 1 hour consultation when I email.
Maybe my E-mail could be to order lab work or ask to change medication or share the latest research I have been looking at regarding my disease. But NO I have to call staff that never pick up plus have trouble speaking english as a language.
This communication stone wall I am facing is an outrage and only serves to limit quality healthcare.
Dr House…. Even Foreman on your TV show would agree with me.
Hi again. Its actually not that simple. You forget that the office handles hundreds of patients. When you call, first it takes the secretary about 5 minutes to take down and deliver the message, that is if she is not on hold waiting to talk to some insurance agent about approving an X-ray. Then someone has to go and retrieve the chart. The doctor then has to review the chart, and after that the phone tag starts, and finally the conversation. This is while there are other patients waiting to be seen or to talk to the doctor. The paperwork is also overwhelming. With hundreds of patients to manage, its to physicians’ credit that the system works at all. People don’t mind paying $5 for a sandwhich but would be infuriated if their doctor were to charge that. That’s all it would take for everyone to be friends again.
I didn’t forget that most offices handle hundreds of patients.
The operational business model of most doctor’s practice offices is horrendous. Appointments are never on time and hurried. Standard protocols are employed and no one is thinking outside the box.
I am sorry that the insurance companies have to some extent shaped this system and applaud your efforts to change it.
The fact remains that the use of Email would cut down on phone calls and workflow interuptions.
In closing, in ancient China, Doctor’s were only paid if their patients felt better!!!
As a patient who found this article while searching for my doctor’s email address to ask about changing my medication in response to some current bad press for the medication I am using, I would like to add that I feel I am much more articulate in writing, and feel I can get my question across to my doctor better if I am able to write. I don’t feel that my complete concern could be conveyed or resolved to my satisfaction in the form of a verbal message going through a receptionist, a nurse, the doctor, and filtered back to me. I also certainly don’t think that my present concern needs an office visit. I hope I find my doctor’s email address!
my doctor don’t email me as well so there is not need to worry about
At least u have a doctor, i havnt been to the doctor in 6 years, i also need like 10 shots, my parents wont take me, and im scared… Good luck.
that’s incredible.