It's no LOL: Fewer than 1/3 of U.S. doctors answer
e-mails from patients; privacy is a concern
www.9-1-1.gov/communications
Tuesday, April 22, 2008         1:43 PM

WASHINGTON, D.C.  --  Suzanne Kreuziger is a registered nurse who uses
e-mail 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."

Kreuziger's experience is shared by most Americans:  They 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."

Doctors have their reasons for not hitting the reply button more
often.

Some worry it will increase their workload, and most physicians don't
get reimbursed for it by insurance companies.

Others fear hackers could compromise patient privacy - even though
doctors who do e-mail generally do it through password-protected Web
sites.

There are also concerns that patients will send urgent messages that
don't get answered promptly. And any snafu raises the specter of
legal liability.

Asurvey conducted early last year by Manhattan Research found that
only 31% doctors e-mailed their patients in the 1st quarter of 2007.

Two major health insurers, Cigna Corp. and Aetna Inc., this year
expanded pilot programs that compensate doctors who use a secure
Internet site to make virtual house calls with patients. That
includes the ability to send encrypted e-mail, a move some hope
will increase the number of doctors who go digital.

Dr. Daniel Z. Sands, an assistant clinical professor at Harvard
Medical School, is among the early adopters who doesn't get paid
for e-visits.

He sees communicating with patients online as no different from
phoning them, a practice that also is not billable.

Since 2000, Sands has answered patient questions by logging onto a
password-protected Web site of the Harvard-affiliated Beth Israel
Deaconess Medical Center. He also sets his Treo to retrieve new
messages every 4 hours. He mostly gets e-mails from patients seeking
advice for new symptoms or updates from chronic disease sufferers.

Although Sands has had mostly positive experiences, one patient
bombarded him with e-mails. She became "pushy" and her messages
were sometimes threatening.

"We sort of had this fight back and forth through electronic
communication, which is absolutely the wrong thing to do. I should
have picked up the phone and called her. Any message that takes
more than two volleys back and forth should not be done by e-mail,"
Sands said.

The American Medical Association says e-mail should not replace
face-to-face time with patients. The group's etiquette guidelines
recommend talking to patients about the technology's limitations.

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% of e-mails were sent after business hours and
only about 6% were urgent. Doctors received on average one e-mail a
day and responded 57% faster than by telephone.

A separate study by health care giant Kaiser Permanente published in
the American Journal of Managed Care last year found patients who
used its secure Web system were 7 to 10% less likely to schedule an
office visit. Patients also made 14% fewer phone calls than those who
did not use the online services.

Before e-mail can become as routine as a physical, doctors need to be
trained to handle confidential patient messages in the digital age,
some experts say. That would include learning to file e-mails in
patients' health records and instructing patients in the risks of
electronic messaging.

Kreuziger, the nurse who can't e-mail her doctor, works in a large
practice that also doesn't offer e-mail services. She often has to
phone patients to check on their blood-sugar levels or track them
down about an abnormal lab test _ a chore for a person who prefers
e-mail over the phone.

"I hate a ringing phone. It's an interruption," she said in an
interview.

Kreuziger and her colleagues recently asked patients about their
Internet needs. Of the 76 patients who responded to the
questionnaire, most said they would like e-mail access to
their doctors.

It's not the first time the medical field has been slow to embrace
technology. When the first telephones became widely available in
the late 1800s, doctors were concerned about being swamped with
calls.

Dr. Tom Delbanco, a primary care doctor at Beth Israel who e-mails
patients, believes it is just a matter of time before the technology
becomes a routine part of patient care.

"Medicine is very conservative. It changes slowly," he said.

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On the Net:

American Medical Association: http://www.ama-assn.org

___ Blue Wave/QWK v2.12