Bioethics Discussion Blog: E-Mail in Medical Practice: My View

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Monday, October 18, 2004

E-Mail in Medical Practice: My View

There is not enough time spent in face to face communication between patient and physician in the doctor-patient relationship. So many of the conflicts, errors and misunderstandings in medical practice are clearly related to deficiencies in communication. Even telephone communication may be inadequate in certain clinical situations. With the introduction of e-mail communication in medical practice, these obstructions to good medical care of the patient can only worsen unless attention is taken by both sides to avoid the wrong kind of e-mail communication.

My view is that the use of e-mail in medical practice should be very limited to simply the transmission of data between patient and physician where no discussion, explanation or detailing is necessary. In this context, the data the physician would send to the patient might include appointment dates or changes, laboratory values or results about which the patient would already be aware of the clinical significance, non-personal general health information and so forth. The data the patient would send to the physician might include appointment date requests or changes, specific self-monitoring information (such as blood sugars or weights)or non-urgent followup symptom reporting.

Issues of privacy of information also must be considered. It may be necessary to transmit this data only on secure server websites. Since consultations via e-mail should not be an e-mail activity, professional compensation specifically for appropriate use of e-mail would not be of significance.

Though, to some, my view of e-mail in medical practice might seem unduly constrained and conservative, I believe anything beyond the functions that I have written would be harmful to the profession. ..Maurice.

2 Comments:

At Saturday, January 28, 2006 7:38:00 PM, Anonymous Moof said...

Every month, my PCP emails me the standing order lab values which have been ordered by my nephrologist ... and I'm grateful to him, because otherwise, I wouldn't ever have an idea of how things are going.

And that's not the only way emails have been useful ...

On one occasion, I emailed my PCP about a problem I was experiencing with a physician he had sent me to. In the email, I had been able to be quite detailed, and had all of the relevant dates, etc. carefully researched and organized. The problem was quickly taken care of.

If the possibility of writing to my PCP had not existed - he would never have known about the problem, since I would simply not have said anything at all. I certainly would never have called and told him about it - and much less made an appoinment to see him about it.

You'll find that some patients who do not do well "nose to nose" may be able to be more forthcoming in writing. That this particular PCP accepts emails, and sends them, is the only reason I haven't gone elsewhere.

This patient's perspective is that not enough physicians use emails ... and the usage is too restricted. It won't work for everyone, but there are some people it will work better with than do the more commonly used forms of communication.

 
At Sunday, January 29, 2006 10:54:00 AM, Blogger Maurice Bernstein, M.D. said...

Moof, I am glad that you have found e-mail communication with your physician satisfactory but I still wouldn't change my opinion about the use of e-mail in medical practice. One of the issues that are important is the issue of confidentiality. As you can see from TV and newspaper stories, e-mail is absolutely not private or confidential and if e-mail is used as the form of communication, all parties should be clear about that fact. Would your doctor get the same understanding of what you were experiencing with the other physician if you had written a letter, put it in an envelope, written your doctors name and address on the envelope, sealed it and put it into a mail box? I think so and unless someone in his office opens and reads his mail, your communication would have remained confidential. Also, in both a letter or e-mail the sending party really can't transmit emotions except only in words or smiley faces, both not very exact ways of doing that. Even with a phone call to your doctor, only the vocal tenor can be heard but a very important clue to emotions, observing body language, is missing. As I said, I am pleased that you found e-mail a useful medium for you. Anything that helps to bridge the gap between patient and physician is valuable but just like the prescription of medication, it should be taken with caution. ..Maurice.

 

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