No LOL: Doctors don't answer e-mails

[Guest guest]

No LOL: Doctors don't answer e-mailsStory Highlights

http://www.cnn.com/2008/HEALTH/04/22/doctor.email.ap/index.html

LOS ANGELES, California (AP) -- 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 nah 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.

Many patients would like to use e-mail for routine matters such as

asking for a prescription refill, getting lab results or scheduling a

visit. Doing so, they say, would help avoid phone tag or taking time

off work to come in for a minor problem.

Still, a survey conducted early last year by Manhattan Research found

that only 31 percent of doctors e-mailed their patients in the first

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. 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 four 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 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.

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 percent less likely to

schedule an office visit. Patients also made 14 percent 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.