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Should your Dr. use email?

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Contributed by: Delmar Knudson on 4/23/2008

I enclose the first paragraph from a niece of mine, and then my reply.

It's no LOL: Few US doctors answer e-mails from patients
http://www.charter.net/news/news_reader.php?storyid=14573253&feedid=14&storyid=14573253&feedid=14

2008-04-22 21:28:38
By ALICIA CHANG AP Science Writer

LOS ANGELES (AP) - Suzanne Kreuziger is a registered nurse who uses email almost exclusively to communicate with friends. But when it comes to reaching her doctor, there's a frustrating firewall.
The barrier is her doctor's own reluctance to talk to patients through e-mail.
'It makes sense to me to have the words laid out, to be able to re-read, to go back to it at a convenient time,' the 34-year-old Milwaukee woman recently wrote on a social networking site. 'If I were able to ask my physician questions this way, it would make my own health care much easier.' Sincerely, K......

Hi K.....

I have asked my several doctors if we could use email. So, far only the dermatologist does. I suspect that is because she would be less likely to be sued over the non-emergent calls, than other doctors. Many doctors (like myself) are always concerned that if the patient doesn't come to see us, and doesn't adequately describe his symptoms that we will be reassuring and suggest some home remedy, etc.; when the patient is going to be dead within the hour, and the relatives will sue us and our practice for every penny they can get.

But, I think much of this could be overcome, if the AMA, DO and other organizations would get together and write some common sense suggested rules and suggestions, including etiquette, privacy issues, etc. that would be the "standard of practice" on emails.An educational program on this for both care providers and patients should then be done.

Doctors who know their patient well enough, would still need to be careful in differentiating between the patient who "always cries wolf" (and, unfortunately, may be in dire need this one time), from the patient who minimizes his ailment, the patient who maximizes his ailment, and the very occasional patient who wants to know if she has what her great aunt had during the depression and would it be helpful if she took vitamin B12 and selenium and echinacea and does her rash relate to her asthma or perhaps should she wrap her chest with cow manure poultices (what one of my patients did), and should she see an orthopedist, and an internist, and a neurologist, and since her headaches seem to come after drinking coffee or cocoa or diet pepsi or dr pepper ... well, you get the idea.

But, I think the last patient is fairly rare; and could be handled. Also, the calls need to be recorded and, at least, temporarily entered into the record some way; and for long calls that require the physician to look up a bunch of lab tests and other things, and require a long, time-consuming answer, there should be some provision for reimbursement from the insurance companies, govt. etc. for these calls. Some HMO's and insurance companies are doing this.

I have often wished my Dr. would just send me an email on my latest PSA or other lab test, and not call me when I am simultaneously reading the newspaper, peeing, minding the ham and eggs on the stove, and (well, some of this is theoretical, but you get the idea).

I will have to dredge up my notes on the article; but there is one newly minted doctor who is doing an "exclusive internet practice": that is, he first goes to the home of the patient and examines him, takes lab tests if necessary, refers him to laboratories, x-ray and specialists; and then thereafter, if it seems appropriate, he counsels him and gives him prescriptions etc. via email; occasionally phoning him, or visiting him on another house call when deemed necessary. I am not sure how this new, untested practice will fare in the long run.

One reason he sees them first is that it is necessary to get some idea of what the patient looks and feels like in person, and what state of mind they are in. Also, in most states the doctor can be sued and/or lose his license if he prescribes over the phone to someone he has never seen (even if it's only "take two aspirin, and call me in the morning").

For my own part, both as a presumed member of the intelligent populace, and an MD myself, I would like to take care of some of my own minor problems, scheduling and rescheduling, etc. by eMail to and from my personal Physician. Sometimes, of course, a phone call or a visit is far more appropriate.

Even though emails can be lost or inadvertently deleted, or presumably the confidential information hacked into, I believe these problems could be overcome.

If they were to try it, many patients and doctors would find that eMail has a definite place among the other doctor-patient communications.

Delmar H. Knudson, M.D.

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Submitted By: Barbara Neff

posted on 5/8/2008 @ 6:53:03 PM

Rated Blog Entry

Greast points, Doc. I think email could be a wonderful communication tool between doctor and patient provided the patient is aware of basic ground rules, which might be printed at the top of each email generated by the doctor or his staff. I am thinking admin things such as appointments and test results could be communicated via email or questions following a visit, but not a diagnosis or a treatment plan. I think it could work. I can also see the pitfalls.

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Delmar Knudson

Denver , CO

Delmar Knudson has posted 173 blog entries and 18 comments since joining on 4/7/2006. Delmar Knudson 's average blog rating is 4.92.

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