Electronic Communication Between Physician and Patient

Lets go back to the topic of ethical issues in doctor-patient relationships and think about the increasing role of the use of e-mail in medical practice. The National Center for Ethics in Healthcare of the Veterans Health Administration in July 2004 issued a report by their ethics panel, which speaks to this role. The benefits and cautions are presented after consideration of the ethical issues involved and recommendations (pasted below) are made. The VA is developing a website called My HealtheVet to help support this new kind of communication.
For the full report go to National Center for Ethics Veterans Health Administration
and click on “Online Patient-Clinician Messaging”. Let me know how you feel about the use of e-mail and web posting as a means of communication between patient and doctor. ..Maurice.

Excerpts from VAH Report

Surveys repeatedly show that patients want to be able to communicate with their clinicians online. And online patient-clinician communication is widely held to have significant potential to enhance patient-clinician relationships, promote greater involvement by patients in their own care (including self-monitoring), and ultimately improve the outcomes of care. Concerns have been raised, however, about patient privacy, the effects of online communication on patient-clinician relationships, and the potential impact on clinicians’ workload and reimbursement.
This report by VHA’s National Ethics Committee (NEC) examines the nature of online communication and explores the ethical challenges of online communication between patients and clinicians. It offers the following recommendations to assure the ethical practice of online patient-clinician messaging within VHA:

(1) Clinicians and health care organizations should ensure that online communication takes place only when the confidentiality and security of personal health information can be reasonably assured. Once implemented nationally, My HealtheVet will provide the foundation for a secure environment required for responsible online communication between patients and clinicians.

(2) Clinicians should ensure that patients who do not interact electronically receive the same quality of care as their online peers. Online communication should not be allowed to exacerbate existing inequalities in health care by discriminating against those who have no or limited access to online communication.

(3) Clinicians should be aware of the potential effects of online messaging on the patient-clinician relationship and take steps to avoid “depersonalization.” Just how online interaction affects patient-clinician relationships is an empirical question that is still unsettled.

(4) Participation in online messaging should be voluntary for both patients and clinicians. As VHA gains more experience with this medium, requiring clinician participation may some day be justified. However, patient participation should remain voluntary.


(5) Clinicians should assure that patient participation in online communication is well informed. Clinicians should enter into an explicit agreement with patients, either orally or in writing, regarding the terms and conditions that will govern their online communication. However, there is no need to require patients to sign an informed consent form.

(6) Clinicians should limit their online communication with patients to appropriate uses. Online communication should not be used to initiate a patient-clinician relationship, to handle situations of an urgent nature, or to convey information that is highly sensitive. Messages should be carefully worded and organized to ensure effective communication, and should conform to organizational standards with regard to message handling.

(7) Health care organizations should recognize online interactions with patients as part of clinicians’ professional activities in institutionally appropriate ways.This may be accomplished, for example, by formally scheduling time for messaging, or by adopting the recently proposed AMA CPT code for online evaluation and management of patients to capture data regarding online patient communication, evaluation, and management as a professional clinical activity.