David Baxter PhD
Late Founder
Physicians Are Talking About: Email Communications With Patients
by Nancy R. Terry
12/02/2008
Advances in communications technology have altered the way that people interact with one another, both globally and within the same household. It has also affected the way that physicians communicate with their patients. Recent postings on Medscape's Physician Connect (MPC), a physician-only discussion board, address the issues involved in email communications between physicians and their patients.
"How many times have you played phone tag with patients?" asks a doctor in family medicine. "Email gets the patient's concern and your reply across without having to rely on timing."
"I use it to communicate with family members of my patients in the ICU," offers a New York neurologist. "Dealing with patients by email can save headache if you have a difficult personality," says another MPC member.
Gerald W. Staton, Jr., MD, Professor of Medicine at Emory University School of Medicine, said in an interview with Medscape, "I communicate all the time by email with patients who want to communicate that way. They don't have any trouble getting my email address from the Emory Web site, and if they initiate the email, I respond." Dr. Staton admits that his institution has a problematic phone system, which makes emailing the easier form of communication. "I have had one or two patients who abused email communication, but most have been very appropriate. So, bottom line, I like communicating by email with patients."
Some MPC members see few advantages to emailing patients: "Communicating by email with patients sounds attractive, but is easily prone to abuse."
"Keeping up with your emails in a timely way is not any less demanding than keeping up with phone messages, which you will continue to get also," says one harried MPC community member. A New York department head at a major teaching institution agrees. "I get about 200 emails per day, and I'm not looking for more." However, he adds, "When patients live in other countries, it is often the only practical way to communicate."
Apart from the necessity of responding to an increased volume of emails, the harried MPC poster considers emailing patients to be a medicolegal minefield. "These emails are discoverable, even when they haven't been formerly incorporated into the medical record. They are also never truly confidential, because copies of them exist on every server that handles them." The New York department head points out that his institution discourages emails concerning patient care because emails are not confidential (for example, a patient's employer can access the physician's email) and, therefore, not HIPPA compliant.
One method to eliminate the problem of confidentiality, says one MPC physician, may be to use email services such as www.housedoc.us, which are encrypted and HIPPA compliant.
A critical care physician is concerned about the potential of emails to be used by litigious patients. "Every email you send is saved for posterity and can be manipulated for future lawsuits." Another member has even stronger reservations about emailing patients. "I am computer savvy, yet I do not use emails to communicate with patients -- no, no, no. Until people stop suing, no medical email communications for me!"
For some, the specter of malpractice lawsuits seems no more a threat with email than with other forms of communication. "It's actually no different than any communication," says an MPC physician. "We are now legally required to maintain a written record for each interaction, whether in or out of the office. Otherwise, you can't prove what was said if challenged."
Dr. Staton is not particularly concerned about email communications being used in malpractice lawsuits. "I just refuse to worry about the lawsuit issues. My word is my word, whether I speak it or write it; I figure I should stick by what I say."
To reduce the potential for patient abuse of email, one MPC contributor advises, "Make it clear that the medium is not for emergency use and you will charge for the service (no insurance). They'll think twice about using it."
Concierge Practice, Dating Patients, and Medical School Dropouts
Physicians are also talking about concierge practice as a way to overcome reduced reimbursement from third-party payors and to avoid third-party regulation and intervention. Typically, patients pay a monthly fee to have a doctor on call. A family medicine physician comments, "There are models of concierge medicine with monthly fees as low as $25, which still allow physicians to decompress their patient panel and improve income and practice satisfaction. This model can work in many settings, not just upper-income areas." Says another contributor, "In my traditional practice, I would have had to see more and more patients each year with the obvious consequences. I could never in my heart allow myself to practice assembly-line medicine! I make not much more money in my concierge practice (which has a much lower patient volume) than I did in my traditional practice, but I certainly feel much better by practicing medicine the way it should be!"
One fascinating discussion thread that has been active since July focuses on the problems of dating a patient. One MPC contributor points out that in some disciplines, such as psychiatry, dating patients is unethical and illegal and that "one could lose their license for such interaction." The contributor continues, "Look at the medical board sites from any state, and you will see inappropriate patient relationships as a cause of suspension." But physicians are human, and such relationships occur. Another contributor says, "My wife was first a patient, then an employee, then my wife. As soon as you and your patient feel a chemistry and you are both unmarried, then seeing them outside the office seems okay. You have to tell the person, 'I can be your doctor or your boyfriend, but not both.'"
Some lighthearted discussions posted on MPC focus on famous medical school dropouts (a pediatrician writes, "Captain Blood went to med school and later became a successful pirate") and whether tattoos, piercings, and long hair detract from a physician's professional image (one contributor says, "I guess if you live in San Fran or another large population center you can get away with piercings and tattoos, but I suspect that [one] will limit one's choice in the future with too much paint and hardware.").
by Nancy R. Terry
12/02/2008
Advances in communications technology have altered the way that people interact with one another, both globally and within the same household. It has also affected the way that physicians communicate with their patients. Recent postings on Medscape's Physician Connect (MPC), a physician-only discussion board, address the issues involved in email communications between physicians and their patients.
"How many times have you played phone tag with patients?" asks a doctor in family medicine. "Email gets the patient's concern and your reply across without having to rely on timing."
"I use it to communicate with family members of my patients in the ICU," offers a New York neurologist. "Dealing with patients by email can save headache if you have a difficult personality," says another MPC member.
Gerald W. Staton, Jr., MD, Professor of Medicine at Emory University School of Medicine, said in an interview with Medscape, "I communicate all the time by email with patients who want to communicate that way. They don't have any trouble getting my email address from the Emory Web site, and if they initiate the email, I respond." Dr. Staton admits that his institution has a problematic phone system, which makes emailing the easier form of communication. "I have had one or two patients who abused email communication, but most have been very appropriate. So, bottom line, I like communicating by email with patients."
Some MPC members see few advantages to emailing patients: "Communicating by email with patients sounds attractive, but is easily prone to abuse."
"Keeping up with your emails in a timely way is not any less demanding than keeping up with phone messages, which you will continue to get also," says one harried MPC community member. A New York department head at a major teaching institution agrees. "I get about 200 emails per day, and I'm not looking for more." However, he adds, "When patients live in other countries, it is often the only practical way to communicate."
Apart from the necessity of responding to an increased volume of emails, the harried MPC poster considers emailing patients to be a medicolegal minefield. "These emails are discoverable, even when they haven't been formerly incorporated into the medical record. They are also never truly confidential, because copies of them exist on every server that handles them." The New York department head points out that his institution discourages emails concerning patient care because emails are not confidential (for example, a patient's employer can access the physician's email) and, therefore, not HIPPA compliant.
One method to eliminate the problem of confidentiality, says one MPC physician, may be to use email services such as www.housedoc.us, which are encrypted and HIPPA compliant.
A critical care physician is concerned about the potential of emails to be used by litigious patients. "Every email you send is saved for posterity and can be manipulated for future lawsuits." Another member has even stronger reservations about emailing patients. "I am computer savvy, yet I do not use emails to communicate with patients -- no, no, no. Until people stop suing, no medical email communications for me!"
For some, the specter of malpractice lawsuits seems no more a threat with email than with other forms of communication. "It's actually no different than any communication," says an MPC physician. "We are now legally required to maintain a written record for each interaction, whether in or out of the office. Otherwise, you can't prove what was said if challenged."
Dr. Staton is not particularly concerned about email communications being used in malpractice lawsuits. "I just refuse to worry about the lawsuit issues. My word is my word, whether I speak it or write it; I figure I should stick by what I say."
To reduce the potential for patient abuse of email, one MPC contributor advises, "Make it clear that the medium is not for emergency use and you will charge for the service (no insurance). They'll think twice about using it."
Concierge Practice, Dating Patients, and Medical School Dropouts
Physicians are also talking about concierge practice as a way to overcome reduced reimbursement from third-party payors and to avoid third-party regulation and intervention. Typically, patients pay a monthly fee to have a doctor on call. A family medicine physician comments, "There are models of concierge medicine with monthly fees as low as $25, which still allow physicians to decompress their patient panel and improve income and practice satisfaction. This model can work in many settings, not just upper-income areas." Says another contributor, "In my traditional practice, I would have had to see more and more patients each year with the obvious consequences. I could never in my heart allow myself to practice assembly-line medicine! I make not much more money in my concierge practice (which has a much lower patient volume) than I did in my traditional practice, but I certainly feel much better by practicing medicine the way it should be!"
One fascinating discussion thread that has been active since July focuses on the problems of dating a patient. One MPC contributor points out that in some disciplines, such as psychiatry, dating patients is unethical and illegal and that "one could lose their license for such interaction." The contributor continues, "Look at the medical board sites from any state, and you will see inappropriate patient relationships as a cause of suspension." But physicians are human, and such relationships occur. Another contributor says, "My wife was first a patient, then an employee, then my wife. As soon as you and your patient feel a chemistry and you are both unmarried, then seeing them outside the office seems okay. You have to tell the person, 'I can be your doctor or your boyfriend, but not both.'"
Some lighthearted discussions posted on MPC focus on famous medical school dropouts (a pediatrician writes, "Captain Blood went to med school and later became a successful pirate") and whether tattoos, piercings, and long hair detract from a physician's professional image (one contributor says, "I guess if you live in San Fran or another large population center you can get away with piercings and tattoos, but I suspect that [one] will limit one's choice in the future with too much paint and hardware.").
