Thursday, February 9, 2012

To email or not to email...

Using email to communicate with patients is controversial both inside and outside of medicine. Not only have recent articles in medical literature addressed this but the Wall Street Journal published a very recent Yes/No opinion discussion on it. There are multiple issues involved--security, HIPAA compliance (which can involve hefty fines if one is found non-compliant), ensuring that patients understand the parameters for email use, concerns about liability, and time constraints among the biggest that come to mind.

The AMA has published guidelines for physicians that want to use email in their practice. Most of them are common sense suggestions but some are burdensome and difficult to communicate during an already foreshortened visit thanks to the time constraints most doctors have in practice. For instance, I am supposed to "Request that patients put their name and patient identification number in the body of the message." My patients have no clue what their identification number is. I could request their date of birth but at this point they get my email address from my staff or from my business card and there are only five or six people who utilize it. I do print all communication out (since I don't yet have an Electronic Medical Record) and so far I have had no trouble identifying who I'm talking to...Another recommendation is "Instruct patients to put the category of transaction in the subject line of the message for filtering: prescription, appointment, medical advice, billing question." With only a very few people out of my population of 3000 are asking for this type of communication, it's ludicrous to create a strict policy with emails.

It is amusing that the development of these guidelines was prompted by request of the Young Physicians Section of the AMA in 2000 (and it hasn't been updated since 2002). It's amusing because "young" people these days hate email. They use social media, eschewing email as much as possible. That's a topic for another day but I understand that point of view. Email is cumbersome by contrast to Facebook messaging or texts even though it is more professional.  Also of interest is a separate publication by the AMA on the Ethical Use of Email with patients. Also very common sense kind of recommendations but I venture to guess most physicians have no idea this advice is on the AMA site.

So what's my feeling on using email? Well, as I mentioned above, I don't use it with very many people so at this point it is not a big issue. I find that the majority of individuals do not abuse the privilege and have short, to-the-point messages requesting refills or clarification of some minor medical question. The patients are in all ranges of ages, from early twenties to mid-seventies. If the question is too lengthy, I ask them to make an appointment. As mentioned above, I print out almost all emails and put them in their paper charts (what's wrong with that remark!) Emails do not take the place of phone calls because I reserve phone calls for more lengthy explanations of lab results or other tests where I need to be sure the patient understands what I am saying. Really bad news is only given in person, so that's not an issue. So far it's been a helpful supportive tool. It is possible that I'll change my mind as things evolve, or perhaps a social media site will take the place of email entirely. 

In the meantime, those patients who do utilize email to communicate with me really seem to appreciate the opportunity and don't abuse it. It seems like another good tool for bettering patient communication and that's a plus.

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